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Tong X, He H, Ning Z, Shen R, Du C, Zeng X, Wang Q, He ZX, Xu D, Zhao X. Characterization of kidneys in patients with systemic sclerosis by multi-parametric magnetic resonance quantitative imaging. Magn Reson Imaging 2024; 109:203-210. [PMID: 38513788 DOI: 10.1016/j.mri.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/09/2024] [Accepted: 03/18/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To determine the usefulness of multiparametric magnetic resonance (MR) quantitative imaging in characterizing the kidneys in systemic sclerosis (SSc) patients. MATERIAL AND METHODS Forty-six SSc patients (47.9 ± 12.8 years, 40 females) and 22 age- and sex- matched healthy volunteers (46.1 ± 13.8 years, 20 females) were recruited and underwent renal MR imaging by acquiring blood oxygen level dependent and saturated multi-delay renal arterial spin labeling (SAMURAI) sequences. The T2* value, T1 value, renal blood flow (RBF), arterial bolus arrival time (aBAT), and tissue bolus arrival time (tBAT) of renal cortex were measured and compared among diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc (lcSSc) groups and healthy controls using One-way ANOVA and analyzed by logistic regression. RESULTS Compared to healthy volunteers, SSc patients with normal estimated glomerular filtration rate (n = 40) had significantly lower T2* value (P = 0.026) in the left renal cortex, longer T1 value (right: P = 0.015; left: P = 0.023), lower RBF (right: P < 0.001; left: P < 0.001), and shorter tBAT (right: P < 0.001; left: P = 0.005) in both right and left renal cortex after adjusting for demographics. The dcSSc patients (n = 23) had significantly lower RBF in both right (226.7 ± 65.2 mL/100 g/min vs. 278.2 ± 73.5 mL/100 g/min, P = 0.022) and left (194.5 ± 71.5 mL/100 g/min vs. 252.7 ± 84.4 mL/100 g/min, P = 0.020) renal cortex compared to the lcSSc patients (n = 23) after adjusting for demographics, but the significance of the difference was attenuated after further adjusting for modified Rodnan skin score and digital ulcers. CONCLUSION Multi-parametric MR quantitative imaging, particularly multi-delay ASL perfusion imaging, is a useful technique for characterizing the kidneys and classification of SSc patients.
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Affiliation(s)
- Xinyu Tong
- Department of Nuclear Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Huilin He
- 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 (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Zihan Ning
- Center for Biomedical Imaging Research, School of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Rui Shen
- Center for Biomedical Imaging Research, School of Biomedical Engineering, Tsinghua University, Beijing, China
| | - Chenlin Du
- Center for Biomedical Imaging Research, School of Biomedical Engineering, Tsinghua University, 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 (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, 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 (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China
| | - Zuo-Xiang He
- Department of Nuclear Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| | - Dong Xu
- 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 (NCRC-DID), Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China.
| | - Xihai Zhao
- Center for Biomedical Imaging Research, School of Biomedical Engineering, Tsinghua University, Beijing, China.
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Allanore Y, Khanna D, Smith V, Aringer M, Hoffmann-Vold AM, Kuwana M, Merkel PA, Stock C, Sambevski S, Denton CP. Effects of nintedanib in patients with limited cutaneous systemic sclerosis and interstitial lung disease. Rheumatology (Oxford) 2024; 63:639-647. [PMID: 37294870 PMCID: PMC10907814 DOI: 10.1093/rheumatology/kead280] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/26/2023] [Accepted: 06/06/2023] [Indexed: 06/11/2023] Open
Abstract
OBJECTIVES To investigate the course of interstitial lung disease (ILD) and the effects of nintedanib in patients with limited cutaneous systemic sclerosis (lcSSc). METHODS In the SENSCIS trial, patients with SSc-ILD were randomized to receive nintedanib or placebo. Patients who completed the SENSCIS trial were eligible to enter SENSCIS-ON, in which all patients received open-label nintedanib. RESULTS Among 277 patients with lcSSc treated in the SENSCIS trial, the rate (s.e.) of decline in forced vital capacity (FVC; ml/year) over 52 weeks was -74.5 (19.2) in the placebo group and -49.1 (19.8) in the nintedanib group (difference: 25.3 [95% CI -28.9, 79.6]). Among 249 patients with data at week 52, mean (s.e.) change in FVC at week 52 was -86.4 (21.1) ml in the placebo group and -39.1 (22.2) ml in the nintedanib group. Among 183 patients with lcSSc who participated in SENSCIS-ON and had data at week 52, mean (s.e.) change in FVC from baseline to week 52 of SENSCIS-ON was -41.5 (24.0) ml in patients who took placebo in the SENSCIS trial and initiated nintedanib in SENSCIS-ON and -45.1 (19.1) ml in patients who took nintedanib in the SENSCIS trial and continued it in SENSCIS-ON. CONCLUSION Patients with lcSSc may develop progressive fibrosing ILD. By targeting pulmonary fibrosis, nintedanib slows decline in lung function in patients with lcSSc and ILD. TRIAL REGISTRATION ClinicalTrials.gov (https://clinicaltrials.gov), NCT02597933 and NCT03313180.
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Affiliation(s)
- Yannick Allanore
- Department of Rheumatology, Paris Cité University, APHP, Cochin Hospital, Paris, France
| | - Dinesh Khanna
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Vanessa Smith
- Department of Rheumatology and Internal Medicine, Ghent University Hospital and Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Martin Aringer
- Division of Rheumatology, Department of Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus, Dresden, Dresden, TU, Germany
| | | | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Christian Stock
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Steven Sambevski
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Christopher P Denton
- Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, University College London, London, UK
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Philip SS, Janardana R, Shenoy P, Kavadichanda C, Bairwa D, Sircar G, Ghosh P, Wakhlu A, Selvam S, Khanna D, Shobha V. Exploratory clinical subgroup clustering in systemic sclerosis: Results from the Indian Progressive Systemic Sclerosis Registry. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2024; 9:29-37. [PMID: 38333526 PMCID: PMC10848923 DOI: 10.1177/23971983231215470] [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: 08/14/2023] [Accepted: 11/01/2023] [Indexed: 02/10/2024]
Abstract
Objective To conduct an exploratory cluster analysis of systemic sclerosis patients from the baseline data of the Indian systemic sclerosis registry. Methods Patients satisfying American College of Rheumatology-European League Against Rheumatism classification criteria for systemic sclerosis were included. The clusters formed using clinical and immunological parameters were compared. Results Of the 564 systemic sclerosis registry participants, 404 patients were included. We derived four clusters of which three were anti-topoisomerase I predominant and one was anti-centromere antibody 2 dominant. Cluster 1 (n-82 (20.3%)) had diffuse cutaneous systemic sclerosis patients with the most severe skin disease, anti-topoisomerase I positivity, males, younger age of onset and high prevalence of musculoskeletal, vasculopathic and gastrointestinal features. Cluster 2 (n-141 (34.9%)) was also diffuse cutaneous systemic sclerosis and anti-topoisomerase I predominant but with less severe skin phenotype than cluster 1 and a lesser prevalence of musculoskeletal, vasculopathic and gastrointestinal features. Cluster 3 (n-119 (29.5%)) had limited cutaneous systemic sclerosis patients with anti-topoisomerase I positivity along with other antibodies. The proximal muscle weakness was higher and digital pitting scars were lower, while other organ involvement was similar between clusters 2 and 3. Cluster 4 (n-62 (15.30%)) was the least severe group with limited cutaneous systemic sclerosis and anti-centromere antibody predominance. Age of onset was higher with low musculoskeletal disease and a higher presence of upper gastrointestinal features. The prevalence of interstitial lung disease was similar in the three anti-topoisomerase I predominant clusters. Conclusion With exploratory cluster analysis, we confirmed the possibility of subclassification of systemic sclerosis along a spectrum based on clinical and immunological characteristics. We also corroborated the presence of anti-topoisomerase I in limited cutaneous systemic sclerosis and the association of interstitial lung disease with anti-topoisomerase I.
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Affiliation(s)
- Shery Susan Philip
- Department of Clinical Immunology and Rheumatology, St. John’s Medical College Hospital, Bengaluru, India
| | - Ramya Janardana
- Department of Clinical Immunology and Rheumatology, St. John’s Medical College Hospital, Bengaluru, India
| | - Padmanabha Shenoy
- Centre for Arthritis and Rheumatism Excellence (CARE), Cochin, India
| | - Chengappa Kavadichanda
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Devender Bairwa
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Geetabali Sircar
- Department of Rheumatology and Clinical Immunology, Institute of Post-Graduate Medical Education & Research and S. S. K. M. Hospital, Kolkata, India
| | - Parasar Ghosh
- Department of Rheumatology and Clinical Immunology, Institute of Post-Graduate Medical Education & Research and S. S. K. M. Hospital, Kolkata, India
| | - Anupam Wakhlu
- Clinical Immunology and Rheumatology, Apollomedics Super Speciality Hospitals, Lucknow, India
| | - Sumithra Selvam
- Division of Epidemiology and Biostatistics, St. John’s Research Institute, Bengaluru, India
| | - Dinesh Khanna
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Vineeta Shobha
- Department of Clinical Immunology and Rheumatology, St. John’s Medical College Hospital, Bengaluru, India
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Lepri G, Airò P, Distler O, Andréasson K, Braun-Moscovici Y, Hachulla E, Balbir-Gurman A, De Langhe E, Rednic S, Ingegnoli F, Rosato E, Groseanu L, Ionescu R, Bellando-Randone S, Garzanova L, Beretta L, Bellocchi C, Moiseev S, Novikov P, Szabo I, Krasowska D, Codullo V, Walker UA, Manolaraki C, Guiducci S, Truchetet ME, Iannone F, Tofani L, Bruni C, Smith V, Cuomo G, Krusche M, Matucci-Cerinic M, Allanore Y. Systemic sclerosis and primary biliary cholangitis: Longitudinal data to determine the outcomes. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2023; 8:210-220. [PMID: 37744053 PMCID: PMC10515998 DOI: 10.1177/23971983231155948] [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: 11/07/2022] [Accepted: 12/15/2022] [Indexed: 09/26/2023]
Abstract
Background Several studies described the cross-sectional characteristics of systemic sclerosis patients and coexisting primary biliary cholangitis, but longitudinal prognostic data are lacking. Aims To describe the systemic sclerosis-primary biliary cholangitis phenotype, including baseline characteristics and outcomes. Methods We performed a multicentre the European Scleroderma Trials and Research Group study of systemic sclerosis patients with primary biliary cholangitis or with primary biliary cholangitis-specific antibodies, matched with systemic sclerosis controls free from hepatobiliary involvement matched for disease duration and cutaneous subset. Data were recorded at baseline and at the last available visit. Results A total of 261 patients were enrolled (115 primary biliary cholangitis-systemic sclerosis, 161 systemic sclerosis). At baseline, systemic sclerosis-primary biliary cholangitis patients had a higher prevalence of anti-centromere antibodies (p = 0.0023) and a lower prevalence of complete absence of digital ulcers. The milder vascular involvement was confirmed at follow-up when crucial differences emerged in the percentage of patients experiencing digital ulcers; a significantly higher number of patients who never experienced digital ulcers were observed among primary biliary cholangitis-systemic sclerosis patients (p = 0.0015). Moreover, a greater incidence of pulmonary arterial hypertension (p < 0.001) and of conduction blocks (p = 0.0256) was observed in systemic sclerosis patients without primary biliary cholangitis. Patients with primary biliary cholangitis had higher levels of liver enzymes at baseline than systemic sclerosis patients; a significant decrease in liver enzymes was observed at follow-up. Out of 18 patients with cholangitis, one received a liver transplant at follow-up. Conclusion Our data show that systemic sclerosis-primary biliary cholangitis exhibit a mild systemic sclerosis and primary biliary cholangitis phenotype with outcomes being in general favourable.
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Affiliation(s)
- Gemma Lepri
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Paolo Airò
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Brescia, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Kristofer Andréasson
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Yolanda Braun-Moscovici
- Rheumatology Department, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Eric Hachulla
- Department of Internal Medicine, Hôpital Claude Huriez, Lille, France
| | - Alexandra Balbir-Gurman
- Rheumatology Department, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ellen De Langhe
- ERN ReCONNET, Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Simona Rednic
- Department of Rheumatology, Emergency County Teaching Hospital, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Francesca Ingegnoli
- Clinical Rheumatology Unit, ASST Pini-CTO, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Laura Groseanu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ruxandra Ionescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Silvia Bellando-Randone
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Liudmila Garzanova
- Laboratory of Microcirculation and Inflammation, VA Nasonova Institute of Rheumatology, Moscow, Russian Federation
| | - Lorenzo Beretta
- Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Chiara Bellocchi
- Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Sergey Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Pavel Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Iulia Szabo
- Department of Rheumatology, Emergency County Teaching Hospital, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Dorota Krasowska
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | | | - Ulrich A. Walker
- Department of Rheumatology, Universitätsspital Basel, Basel, Switzerland
| | | | - Serena Guiducci
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Florenzo Iannone
- Rheumatology Unit – DETO, School of Medicine, University of Bari, Bari, Italy
| | - Lorenzo Tofani
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Cosimo Bruni
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital and Department of Internal Medicine, Ghent University, Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Giovanna Cuomo
- Department of Precision of Medicine, University of Campania – L. Vanvitelli, Naples, Italy
| | - Martin Krusche
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Yannick Allanore
- Rheumatology, Cochin Hospital, APHP, Paris Cité University, Paris, France
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Lescoat A, Huang S, Carreira PE, Siegert E, de Vries-Bouwstra J, Distler JHW, Smith V, Del Galdo F, Anic B, Damjanov N, Rednic S, Ribi C, Bancel DF, Hoffmann-Vold AM, Gabrielli A, Distler O, Khanna D, Allanore Y. Cutaneous Manifestations, Clinical Characteristics, and Prognosis of Patients With Systemic Sclerosis Sine Scleroderma: Data From the International EUSTAR Database. JAMA Dermatol 2023; 159:837-847. [PMID: 37378994 PMCID: PMC10308295 DOI: 10.1001/jamadermatol.2023.1729] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/01/2023] [Indexed: 06/29/2023]
Abstract
Importance Systemic sclerosis (SSc) sine scleroderma (ssSSc) is a subset of SSc defined by the absence of skin fibrosis. Little is known about the natural history and skin manifestations among patients with ssSSc. Objective To characterize the clinical phenotype of patients with ssSSc compared with patients with limited cutaneous SSc (lcSSc) and diffuse cutaneous SSc (dcSSc) within the EUSTAR database. Design, Setting, and Participants This longitudinal observational cohort study based on the international EUSTAR database included all patients fulfilling the classification criteria for SSc assessed by the modified Rodnan Skin score (mRSS) at inclusion and with at least 1 follow-up visit; ssSSc was defined by the absence of skin fibrosis (mRSS = 0 and no sclerodactyly) at all available visits. Data extraction was performed in November 2020, and data analysis was performed from April 2021 to April 2023. Main Outcomes and Measures Main outcomes were survival and skin manifestations (onset of skin fibrosis, digital ulcers, telangiectasias, puffy fingers). Results Among the 4263 patients fulfilling the inclusion criteria, 376 (8.8%) were classified as having ssSSc (mean [SD] age, 55.3 [13.9] years; 345 [91.8%] were female). At last available visit, in comparison with 708 patients with lcSSc and 708 patients with dcSSc with the same disease duration, patients with ssSSc had a lower prevalence of previous or current digital ulcers (28.2% vs 53.1% in lcSSc; P < .001; and 68.3% in dcSSc; P < .001) and puffy fingers (63.8% vs 82.4% in lcSSc; P < .001; and 87.6% in dcSSc; P < .001). By contrast, the prevalence of interstitial lung disease was similar in ssSSc and lcSSc (49.8% and 57.1%; P = .03) but significantly higher in dcSSc (75.0%; P < .001). Skin telangiectasias were associated with diastolic dysfunction in patients with ssSSc (odds ratio, 4.778; 95% CI, 2.060-11.081; P < .001). The only independent factor for the onset of skin fibrosis in ssSSc was the positivity for anti-Scl-70 antibodies (odds ratio, 3.078; 95% CI, 1.227-7.725; P = .02). Survival rate was higher in patients with ssSSc (92.4%) compared with lcSSc (69.4%; P = .06) and dcSSc (55.5%; P < .001) after up to 15 years of follow-up. Conclusions and Relevance Systemic sclerosis sine scleroderma should not be neglected considering the high prevalence of interstitial lung disease (>40%) and SSc renal crisis (almost 3%). Patients with ssSSc had a higher survival than other subsets. Dermatologists should be aware that cutaneous findings in this subgroup may be associated with internal organ dysfunction. In particular, skin telangiectasias in ssSSc were associated with diastolic heart dysfunction.
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Affiliation(s)
- Alain Lescoat
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor
- Scleroderma Program, University of Michigan, Ann Arbor
| | - Suiyuan Huang
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor
- Scleroderma Program, University of Michigan, Ann Arbor
| | | | | | | | | | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Francesco Del Galdo
- Institute of Rheumatic and Musculoskeletal Medicine and NIHR Biomedical Research Centre, University of Leeds, Leeds, United Kingdom
| | - Branimir Anic
- Division of Clinical Immunology and Rheumatology, University of Zagreb School of Medicine and University Hospital Centre, Zagreb, Croatia
| | - Nemanja Damjanov
- Institute of Rheumatology, Faculty of Medicine University of Belgrade, Belgrade, Serbia
| | - Simona Rednic
- Department of Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Camillo Ribi
- Department of Clinical Immunology and Allergy, Lausanne, Switzerland
| | - Dominique Farge Bancel
- Department of Internal Medicine: CRMR MATHEC, Maladies Auto-Immunes et Thérapie Cellulaire, Centre de Référence des Maladies Auto-Immunes Systémiques Rares d’Ile-de-France, FAI2R, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris, France
- Department of Medicine, McGill University, Montreal, Quebec, Canada
- Université de Paris-Cité, Paris, France
| | | | - Armando Gabrielli
- Arche Polytechnic University, Institute of Clinical Medicine, University of Ancona, Ancona, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dinesh Khanna
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor
- Scleroderma Program, University of Michigan, Ann Arbor
| | - Yannick Allanore
- Service de Rhumatologie, Hôpital Cochin, AP-HP.CUP, Paris, France
- INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
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Ouchene L, Muntyanu A, Assayag D, Veilleux È, Abril A, Ferrara G, Yacyshyn E, Pineau CA, O'Brien E, Baron M, Osman M, Gniadecki R, Netchiporouk E. Skin disorders and interstitial lung disease: Part II-The spectrum of cutaneous diseases with lung disease association. J Am Acad Dermatol 2023; 88:767-782. [PMID: 36228940 DOI: 10.1016/j.jaad.2022.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/30/2022] [Accepted: 09/07/2022] [Indexed: 11/06/2022]
Abstract
Part 2 of this 2-part CME introduces dermatologists to noninfectious inflammatory skin diseases associated with pulmonary involvement. In many cases, dermatologists may be the first physicians recognizing respiratory complications associated with these diagnoses. Because pulmonary involvement is often the leading cause of morbidity and mortality, dermatologists should be comfortable screening and monitoring for lung disease in high-risk patients, recognizing cutaneous stigmata of lung disease in these patients and referring to pulmonary specialists, when appropriate, for prompt treatment initiation. Some treatments used for skin disease may not be appropriate in the context of lung disease and hence, choosing a holistic approach is important. Interstitial lung disease and pulmonary hypertension are the most common pulmonary complications and a significant cause of mortality in autoimmune connective tissue diseases, especially systemic sclerosis, dermatomyositis, and mixed connective tissue disease. Pulmonary complications, notably interstitial lung disease, are also common and life-threatening in sarcoidosis and vasculitis, while they are variable in neutrophilic and autoimmune blistering diseases.
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Affiliation(s)
- Lydia Ouchene
- Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Anastasiya Muntyanu
- Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Deborah Assayag
- Division of Pulmonary Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Èvicka Veilleux
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Andy Abril
- Division of Rheumatology, Mayo Clinic, Jacksonville, Florida
| | - Giovanni Ferrara
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Elaine Yacyshyn
- Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
| | - Christian A Pineau
- Division of Rheumatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Elizabeth O'Brien
- Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Murray Baron
- Division of Rheumatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Mohammed Osman
- Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Gniadecki
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
| | - Elena Netchiporouk
- Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada.
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7
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Erectile Dysfunction in a Male Patient With Limited Cutaneous Systemic Sclerosis. Urology 2023; 174:126-127. [PMID: 36796545 DOI: 10.1016/j.urology.2023.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/13/2022] [Accepted: 01/24/2023] [Indexed: 02/16/2023]
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8
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Khanna D, Maher TM, Volkmann ER, Allanore Y, Smith V, Assassi S, Kreuter M, Hoffmann-Vold AM, Kuwana M, Stock C, Alves M, Sambevski S, Denton CP. Effect of nintedanib in patients with systemic sclerosis-associated interstitial lung disease and risk factors for rapid progression. RMD Open 2023; 9:rmdopen-2022-002859. [PMID: 36796874 PMCID: PMC9936273 DOI: 10.1136/rmdopen-2022-002859] [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: 11/11/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE To investigate the rate of decline in forced vital capacity (FVC), and the effect of nintedanib on the rate of decline in FVC, in subjects with systemic sclerosis-associated interstitial lung disease (SSc-ILD) who had risk factors for rapid decline in FVC. METHODS The SENSCIS trial enrolled subjects with SSc and fibrotic ILD of ≥10% extent on high-resolution CT. The rate of decline in FVC over 52 weeks was analysed in all subjects and in those with early SSc (<18 months since first non-Raynaud symptom), elevated inflammatory markers (C reactive protein ≥6 mg/L and/or platelets ≥330×109/L) or significant skin fibrosis (modified Rodnan skin score (mRSS) 15-40 or mRSS ≥18) at baseline. RESULTS In the placebo group, the rate of decline in FVC was numerically greater in subjects with <18 months since first non-Raynaud symptom (-167.8 mL/year), elevated inflammatory markers (-100.7 mL/year), mRSS 15-40 (-121.7 mL/year) or mRSS ≥18 (-131.7 mL/year) than in all subjects (-93.3 mL/year). Nintedanib reduced the rate of FVC decline across subgroups, with a numerically greater effect in patients with these risk factors for rapid FVC decline. CONCLUSION In the SENSCIS trial, subjects with SSc-ILD who had early SSc, elevated inflammatory markers or extensive skin fibrosis had a more rapid decline in FVC over 52 weeks than the overall trial population. Nintedanib had a numerically greater effect in patients with these risk factors for rapid ILD progression.
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Affiliation(s)
- Dinesh Khanna
- Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Toby M Maher
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Elizabeth R Volkmann
- Division of Rheumatology, University of California, David Geffen School of Medicine, Los Angeles, California, USA
| | - Yannick Allanore
- Department of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.,Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium.,Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Shervin Assassi
- Division of Rheumatology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Care Medicine, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany.,Department of Pneumology, RKH Clinic Ludwigsburg, Ludwigsburg, Germany
| | - Anna-Maria Hoffmann-Vold
- Inflammatory and Fibrotic Rheumatic Disease Research Area, Oslo University Hospital, Oslo, Norway
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Christian Stock
- Global Biostatistics and Data Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
| | - Margarida Alves
- TA Inflammation Med, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Steven Sambevski
- TA Inflammation Med, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Christopher P Denton
- University College London Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, London, UK
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9
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Farrell J, Ho L. Management of Patients with Systemic Sclerosis-Associated Interstitial Lung Disease: A Focus on the Role of the Pharmacist. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2023; 12:101-112. [PMID: 37163188 PMCID: PMC10164394 DOI: 10.2147/iprp.s399518] [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: 11/30/2022] [Accepted: 03/23/2023] [Indexed: 05/11/2023] Open
Abstract
Interstitial lung disease (ILD) is a common manifestation of systemic sclerosis (SSc), which becomes fibrosing and progressive in some patients. Regular monitoring of patients with SSc-ILD is important to assess progression and inform treatment decisions. Therapy for SSc-ILD may include immunomodulatory and antifibrotic therapies. Therapeutic decisions should be made on a case-by-case basis, ideally following multidisciplinary discussion. Most patients with SSc-ILD have several organ manifestations of SSc or comorbidities and are taking a complex medication regimen. Patients with SSc are particularly susceptible to gastrointestinal side-effects of medications due to the gastrointestinal manifestations of the disease. Pharmacists play an important role in the management of patients with SSc-ILD by assisting patients with access to medications, optimizing medication regimens, and advising on alternative dosage forms. Pharmacists can also contribute to patient education to help patients better understand their treatment and how to prevent and manage potential side effects.
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Affiliation(s)
- Jessica Farrell
- Albany College of Pharmacy and Health Sciences and Albany Medical Center Division of Rheumatology, Albany, NY, USA
- Correspondence: Jessica Farrell, Albany College of Pharmacy and Health Sciences and Albany Medical Center Division of Rheumatology, Albany, NY, USA, Email
| | - Lawrence Ho
- Center for Interstitial Lung Disease, University of Washington, Seattle, WA, USA
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10
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Viewpoint: a multidisciplinary approach to the assessment of patients with systemic sclerosis-associated interstitial lung disease. Clin Rheumatol 2023; 42:653-661. [PMID: 36271064 PMCID: PMC9935731 DOI: 10.1007/s10067-022-06408-4] [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: 06/06/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/03/2022]
Abstract
Systemic sclerosis (SSc) is a rare and heterogeneous disease affecting the skin and internal organs. SSc-associated ILD (SSc-ILD) is a common and often early manifestation of SSc. This article discusses the rationale for a multidisciplinary approach (MDA) to the early identification and assessment of patients with SSc-ILD. Diagnosis of SSc-ILD is often challenging as patients with early disease can be asymptomatic, and SSc-ILD symptoms, such as exertional dyspnea and cough, are non-specific. High-resolution computed tomography (HRCT) of the lungs is the gold standard for diagnosis of SSc-ILD since pulmonary function tests lack sensitivity and specificity, especially in early disease. On HRCT, most patients with SSc-ILD have a non-specific interstitial pneumonia (NSIP) pattern. In addition, findings of pulmonary hypertension and esophageal dysmotility may be present. The multi-organ involvement of SSc and the diverse spectrum of symptoms support an MDA for the diagnosis and assessment of patients with SSc-ILD, with input from rheumatologists, pulmonologists, gastroenterologists, radiologists, and other specialists. Key Points • Interstitial lung disease (ILD) is a common manifestation of systemic sclerosis (SSc). • Early diagnosis is key to reducing the morbidity and mortality associated with SSc-ILD and other manifestations of SSc. • The multi-organ involvement of SSc supports a multidisciplinary approach to the diagnosis and assessment of patients with SSc-ILD, with input from rheumatologists, pulmonologists, gastroenterologists, radiologists, and other specialists.
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11
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Zanatta E, Huscher D, Ortolan A, Avouac J, Airò P, Balbir-Gurman A, Siegert E, Matucci Cerinic M, Cozzi F, Riemekasten G, Hoffmann-Vold AM, Distler O, Gabrielli A, Heitmann S, Hunzelmann N, Montecucco C, Morovic-Vergles J, Ribi C, Doria A, Allanore Y. Phenotype of limited cutaneous systemic sclerosis patients with positive anti-topoisomerase I antibodies: data from the EUSTAR cohort. Rheumatology (Oxford) 2022; 61:4786-4796. [PMID: 35348643 DOI: 10.1093/rheumatology/keac188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/09/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To characterize patients with positive anti-topoisomerase I (ATA) in lcSSc. METHODS SSc patients enrolled in the EUSTAR cohort with a disease duration of ≤3 years at database entry were considered. We assessed the risk of major organ involvement in the following groups: ATA-lcSSc vs ACA-lcSSc and vs ANA without specificity (ANA)-lcSSc, and ATA-lcSSc vs ATA-dcSSc. Cox regression models with time-dependent covariates were performed with the following outcomes: new-onset interstitial lung disease (ILD), ILD progression [forced vital capacity (FVC) decline ≥10% and ≥5% vs values at ILD diagnosis), primary myocardial involvement (PMI), pulmonary hypertension (PH), any organ involvement and all-cause mortality. RESULTS We included 1252 patients [194 ATA-lcSSc (15.5%)], with 7.7 years (s.d. 3.5) of follow-up. ILD risk was higher in ATA-lcSSc vs ACA- and ANA-lcSSc and similar to ATA-dcSSc, although with less frequent restrictive lung disease. The risk of FVC decline ≥10% (35% of ATA-lcSSc) was lower in ATA-lcSSc than in ATA-dcSSc, whereas FVC decline ≥5% occurs similarly between ATA-lcSSc (58% of patients) and other SSc subsets, including ATA-dcSSc. The risk of PMI was similar in ATA-lcSSc and ANA-lcSSc but lower than in ACA-lcSSc; no difference in PH and mortality risk was observed among lcSSc subsets. The risk of any organ involvement, PMI and PH was lower and the mortality tended to be lower in ATA-lcSSc vs ATA-dcSSc. CONCLUSION ATA-lcSSc patients have a high risk of ILD, albeit with a lower risk of progression compared with ATA-dcSSc, supporting careful screening for ILD in this subgroup.
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Affiliation(s)
- Elisabetta Zanatta
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Augusta Ortolan
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Jérôme Avouac
- Service de Rhumatologie, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France
| | - Paolo Airò
- Rheumatology and Clinical Immunology, Spedali Civili, Brescia, Italy
| | - Alexandra Balbir-Gurman
- B. Shine Rheumatology Institute Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité-Universitatsmedizin Berlin, Berlin, Germany
| | - Marco Matucci Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence
| | - Franco Cozzi
- Internal Medicine Unit, Ospedale Classificato Villa Salus, Venice, Italy
| | - Gabriela Riemekasten
- Department of Rheumatology, Universitatsklinikum Schleswig Holstein-Campus Lübeck, Lübeck, Germany
| | | | - Oliver Distler
- Department of Rheumatology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Armando Gabrielli
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - Stefan Heitmann
- Department of Rheumatology, Marienhospital Stuttgart, Stuttgart
| | - Nicolas Hunzelmann
- Department of Dermatology, University of Cologne, Köln, Nordrhein-Westfalen, Germany
| | | | - Jadranka Morovic-Vergles
- Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia
| | - Camillo Ribi
- Service d'immunologie et Allergie, Département de Médecine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Yannick Allanore
- Service de Rhumatologie, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France
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12
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Elhai M, Sritharan N, Boubaya M, Balbir-Gurman A, Siegert E, Hachulla E, de Vries-Bouwstra J, Riemekasten G, Distler JHW, Rosato E, Del Galdo F, Mendoza FA, Furst DE, de la Puente C, Hoffmann-Vold AM, Gabrielli A, Distler O, Bloch-Queyrat C, Allanore Y. Stratification in systemic sclerosis according to autoantibody status versus skin involvement: a study of the prospective EUSTAR cohort. THE LANCET. RHEUMATOLOGY 2022; 4:e785-e794. [PMID: 38265945 DOI: 10.1016/s2665-9913(22)00217-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The current subclassification of systemic sclerosis into cutaneous subtypes does not fully capture the heterogeneity of the disease. We aimed to compare the performances of stratification into LeRoy's cutaneous subtypes versus stratification by autoantibody status in systemic sclerosis. METHODS For this cohort study, we assessed people with systemic sclerosis in the multicentre international European Scleroderma Trials and Research (EUSTAR) database. Individuals positive for systemic-sclerosis autoantibodies of two specificities were excluded, and remaining individuals were classified by cutaneous subtype, according to their systemic sclerosis-specific autoantibodies, or both. We assessed the performance of each model to predict overall survival, progression-free survival, disease progression, and different organ involvement. The three models were compared by use of the area under the curve (AUC) of the receiver operating characteristic and the net reclassification improvement (NRI). Missing data were imputed. FINDINGS We assessed the database on July 26, 2019. Of 16 939 patients assessed for eligibility, 10 711 patients were included: 1647 (15·4%) of 10 709 were male, 9062 (84·6%) were female, mean age was 54·4 (SD 13·8) years, and mean disease duration was 7·9 (SD 8·2) years. Information regarding cutaneous subtype was available for 10 176 participants and antibody data were available for 9643 participants. In the prognostic analysis, there was no difference in AUC for overall survival (0·82, 95% CI 0·81-0·84 for cutaneous only vs 0·84, 0·82-0·85 for antibody only vs 0·84, 0·83-0·86 for combined) or for progression-free survival (0·70, 0·69-0·71 vs 0·71, 0·70-0·72 vs 0·71, 0·70-0·72). However, at 4 years the NRI showed substantial improvement for the antibody-only model compared with the cutaneous-only model in prediction of overall survival (0·57, 0·46-0·71 for antibody only vs 0·29, 0·19-0·39 for cutaneous only) and disease progression (0·36, 0·29-0·46 vs 0·21, 0·14-0·28). The antibody-only model did better than the cutaneous-only model in predicting renal crisis (AUC 0·72, 0·70-0·74 for antibody only vs 0·66, 0·64-0·69 for cutaneous only) and lung fibrosis leading to restrictive lung function (AUC 0·76, 0·75-0·77 vs 0·71, 0·70-0·72). The combined model improved the prediction of digital ulcers and elevated systolic pulmonary artery pressure, but did poorly for cardiac involvement. INTERPRETATION The autoantibody-only model outperforms cutaneous-only subsetting for risk stratifying people with systemic sclerosis in the EUSTAR cohort. Physicians should be aware of these findings at the time of decision making for patient management. FUNDING World Scleroderma Foundation.
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Affiliation(s)
- Muriel Elhai
- INSERM U1016, Cochin Hospital, AP-HP, University of Paris, Paris, France; Department of Rheumatology, University Hospital Zürich, Zürich, Switzerland
| | - Nanthara Sritharan
- Department of Clinical Research, Paris Seine Saint Denis Hospital, AP-HP, Bobigny, France
| | - Marouane Boubaya
- Department of Clinical Research, Paris Seine Saint Denis Hospital, AP-HP, Bobigny, France
| | - Alexandra Balbir-Gurman
- B Shine Rheumatology Institute, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Elise Siegert
- Department of Rheumatology, Charité University Hospital, Berlin, Germany
| | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Rare Systemic Auto-immune Diseases North and North-West of France, Inserm, CHU Lille, U1286 - INFINITE, University of Lille, Lille, France
| | | | | | - Jörg H W Distler
- Department of Rheumatology and Hiller Research Unit, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Del Galdo
- Scleroderma Programme, Institute of Molecular Medicine, Division of Musculoskeletal Diseases, University of Leeds, Leeds, UK
| | - Fabian A Mendoza
- Thomas Jefferson Scleroderma Center Division of Rheumatology and Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel E Furst
- Arthritis Association of Southern California, Los Angeles, CA, USA
| | | | | | - Armando Gabrielli
- Università Politecnica delle Marche, Ancona, Italy; Azienda Ospedali Riuniti, Ancona, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zürich, Zürich, Switzerland
| | - Coralie Bloch-Queyrat
- Department of Clinical Research, Paris Seine Saint Denis Hospital, AP-HP, Bobigny, France
| | - Yannick Allanore
- INSERM U1016, Cochin Hospital, AP-HP, University of Paris, Paris, France.
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13
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Campochiaro C, Lazzaroni MG, Bruni C, Zanatta E, De Luca G, Matucci-Cerinic M. Open questions on the management of targeted therapies for the treatment of systemic sclerosis-interstitial lung disease: results of a EUSTAR survey based on a systemic literature review. Ther Adv Musculoskelet Dis 2022; 14:1759720X221116408. [PMID: 36051631 PMCID: PMC9425887 DOI: 10.1177/1759720x221116408] [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: 01/11/2022] [Accepted: 07/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background The results of randomized controlled (RCT) and retrospective studies have expanded the armamentarium of drugs for systemic sclerosis (SSc) - interstitial lung disease (ILD) treatment. The correct positioning of these drugs is not yet clarified. Objectives Systemic literature review (SLR) on rituximab (RTX), tocilizumab (TCZ), nintedanib and abatacept (ABT) for the treatment of SSc-ILD. The results of the SLR were used to create a dedicated survey. Design The study was performed as a systematic review. Data sources and methods the SLR was performed using the following terms: "(systemic sclerosis OR scleroderma) AND (interstitial lung disease OR lung fibrosis OR pulmonary fibrosis) AND (rituximab OR tocilizumab OR abatacept OR nintedanib)". The results of the SLR were integrated in a survey including 8 domains. These were sent to all EUSTAR members and to the participants of the 2020 Scleroderma World Congress. Results 41 studies (34 on RTX, 5 on TCZ, 2 on ABT, and 1 on nintedanib) were identified. RCTs supported the use of TCZ and nintedanib, while retrospective studies supported the use of RTX for SSc-ILD. No clear data were obtained about ABT. The survey showed that RTX is the most available option (96%) whereas the most frequent reason for targeted therapy introduction is lung progression while on csDMARDs (86% RTX, 59% TCZ and 63% nintedanib). Combination therapy was the most frequently mentioned therapeutic scheme for nintedanib (75%) and RTX (63%). Physicians' perception of safety was similar for all drugs, while drug efficacy was the same for RTX and nintedanib, followed by TCZ (4.8 ± 2). The most frequently raised concerns pertained to efficacy, safety and combination regimens. Conclusion Our SLR supports the use of RTX, TCZ and nintedanib for SSc-ILD patients and underlines the need for more data about upfront combination versus monotherapy. It also highlighted the need to identify predictors supporting drug choice according to both pulmonary and extra-pulmonary manifestations.
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Affiliation(s)
- Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Disease, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy. Via Olgettina 60, 20132, Milan, Italy
| | - Maria Grazia Lazzaroni
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili of Brescia, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Department of Geriatric Medicine, Division of Rheumatology AOUC, Florence, Italy.,Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Elisabetta Zanatta
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Giacomo De Luca
- Unit of Immunology, Rheumatology, Allergy and Rare Disease, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare Disease, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Department of Geriatric Medicine, Division of Rheumatology AOUC, Florence, Italy
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14
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Assassi S, Shao N, Yin Z, Volkmann ER, Zoz DF, Leonard TB. Understanding diagnostic pathways in systemic sclerosis and systemic sclerosis-associated interstitial lung disease: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e29993. [PMID: 35960051 PMCID: PMC9371507 DOI: 10.1097/md.0000000000029993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Systemic sclerosis-associated interstitial lung disease (SSc-ILD) is usually detected in a patient known to have SSc but may be diagnosed prior to SSc. We probed an insurance database to investigate documentation of ILD prior to SSc. Using Optum's Clinformatics® Data Mart Database, we identified patients with an SSc index date between January 1, 2010, and September 30, 2015, based on International Classification of Diseases (ICD)-9-Clinical Modification (CM) codes, ≥2 medical claims associated with SSc on different dates within 1 year, and ≥3 years of continuous enrollment prior to SSc index date (ICD-9-CM cohort). We identified an ICD-10-CM cohort comprising patients with an SSc index date between October 1, 2017, and June 30, 2019, based on ICD-10-CM codes, ≥2 medical claims associated with SSc on different dates within 1 year, and ≥2 years of continuous enrollment prior to SSc index date. ILD was defined as ≥2 medical claims associated with ILD on different dates. The ICD-9-CM and ICD-10-CM cohorts comprised 1779 and 1032 patients, respectively. In these cohorts, respectively, 7.6% and 9.3% of patients had their second medical claim associated with ILD prior to their SSc index date, and 4.3% and 5.6% of patients had their second medical claim associated with ILD >1 year prior to the SSc index date. In this analysis, 4% to 6% of patients with SSc had claims for ILD >1 year prior to a claim for SSc. These data show that SSc can affect the lung early and demonstrate the importance of screening patients with SSc for ILD and patients with ILD for SSc.
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Affiliation(s)
- Shervin Assassi
- Division of Rheumatology, University of Texas McGovern Medical School, Houston, TX, USA
| | - Nan Shao
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Ziwei Yin
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Elizabeth R. Volkmann
- Department of Medicine, Division of Rheumatology, University of California, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Donald F. Zoz
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
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15
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Lescoat A, Sandler RD, Zimmermann F, Roofeh D, Hughes M, Pauling JD, Murphy SL, Chen YT, Townsend W, Buch MH, Khanna D. Domains and outcome measures for the assessment of limited cutaneous systemic sclerosis: an international collaborative scoping review. Rheumatology (Oxford) 2022; 61:3132-3148. [PMID: 35094049 PMCID: PMC9338174 DOI: 10.1093/rheumatology/keac049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/15/2021] [Accepted: 01/14/2022] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES The aim of this study was to comprehensively identify instruments within relevant domains employed to assess lcSSc since the endorsement of its consensus definition in 1988. The overall objective is to inform the creation of a Combined Response Index for Scleroderma Trials Assessing lcSSc (CRISTAL). METHODS MEDLINE and Embase were searched using terms selected to comprehensively retrieve titles and abstracts mentioning both lcSSc and dcSSc, along with those only mentioning lcSSc, SSc sine scleroderma, limited SSc and/or CREST/CRST. Because our initial assessment of the literature revealed that very few studies included only lcSSc subjects, we also assessed literature that included both cutaneous subsets. A total of 3964 titles and abstracts were screened by two reviewers, and 270 articles were selected for data extraction. RESULTS We identified 27 domains encompassing 459 instruments. Instruments from 'Skin involvement', 'Pulmonary involvement' and 'Health-related quality of life and general functioning' were the most frequently retrieved. Among the 15 most represented instruments announced as primary end points in efficacy or effectiveness studies, 7 were clinician-reported outcomes (ROs), 7 were patient ROs, and one was a performance outcome (6 min-walk test). The mean proportion of lcSSc patients in studies of lcSSc, including studies that mention both lcSSc and dcSSc, was 56.4%, demonstrating that this subset is underrepresented in the literature, given that the prevalence of lcSSc ranges from 60% to 80% in national registries and international cohorts. CONCLUSION This scoping literature review provides a comprehensive identification of domains and outcomes used to assess lcSSc. Our results also highlight that lcSSc is underrepresented in the literature.
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Affiliation(s)
- Alain Lescoat
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
- Department of Internal Medicine, Division of Rheumatology
- Department of Internal Medicine, Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
| | - Robert D Sandler
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - François Zimmermann
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - David Roofeh
- Department of Internal Medicine, Division of Rheumatology
- Department of Internal Medicine, Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
| | - Michael Hughes
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - John D Pauling
- Department of Pharmacy and Pharmacology, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals, Bath, UK
| | - Susan L Murphy
- Department of Internal Medicine, Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
- Department of Physical Medicine & Rehabilitation, University of Michigan
- VA Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center, GRECC
| | - Yen T Chen
- Department of Internal Medicine, Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
- Department of Physical Medicine & Rehabilitation, University of Michigan
- VA Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center, GRECC
| | - Whitney Townsend
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, USA
| | - Maya H Buch
- Department of Rheumatology, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University Foundation Trust, Manchester, UK
| | - Dinesh Khanna
- Department of Internal Medicine, Division of Rheumatology
- Department of Internal Medicine, Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
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16
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Bruni C, Heidenreich S, Duenas A, Hoffmann-Vold AM, Gabrielli A, Allanore Y, Chatelus E, Distler JHW, Hachulla E, Hsu VM, Hunzelmann N, Khanna D, Truchetet ME, Walker UA, Alves M, Schoof N, Saketkoo LA, Distler O. Patient preferences for the treatment of systemic sclerosis-associated interstitial lung disease: a discrete choice experiment. Rheumatology (Oxford) 2022; 61:4035-4046. [PMID: 35238334 PMCID: PMC9536797 DOI: 10.1093/rheumatology/keac126] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/17/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives Treatments for SSc-associated interstitial lung disease (SSc-ILD) differ in attributes, i.e. mode of administration, adverse events (AEs) and efficacy. As physicians and patients may perceive treatments differently, shared decision-making can be essential for optimal treatment provision. We therefore aimed to quantify patient preferences for different treatment attributes. Methods Seven SSc-ILD attributes were identified from mixed-methods research and clinician input: mode of administration, shortness of breath, skin tightness, cough, tiredness, risk of gastrointestinal AEs (GI-AEs) and risk of serious and non-serious infections. Patients with SSc-ILD completed an online discrete choice experiment (DCE) in which they were asked to repeatedly choose between two alternatives characterized by varying severity levels of the included attributes. The data were analysed using a multinomial logit model; relative attribute importance and maximum acceptable risk measures were calculated. Results Overall, 231 patients with SSc-ILD completed the DCE. Patients preferred twice-daily oral treatments and 6–12 monthly infusions. Patients’ choices were mostly influenced by the risk of GI-AEs or infections. Improvement was more important in respiratory symptoms than in skin tightness. Concerning trade-offs, patients accepted different levels of increase in GI-AE risk: +21% if it reduced the infusions’ frequency; +15% if changing to an oral treatment; up to +37% if it improved breathlessness; and up to +36% if it reduced the risk of infections. Conclusions This is the first study to quantitatively elicit patients’ preferences for treatment attributes in SSc-ILD. Patients showed willingness to make trade-offs, providing a firm basis for shared decision-making in clinical practice.
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Affiliation(s)
- Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | | | | | | | - Armando Gabrielli
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Yannick Allanore
- Department of Rheumatology A, Cochin Hospital, Paris Descartes University, Paris, France
| | - Emmanuel Chatelus
- Department of Rheumatology, University Hospital of Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | - Jörg H W Distler
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO), CHU Lille, Univ. Lille, Inserm, U1286 - INFINITE-Institute for Translational Research in Inflammation, Lille, F-59000, France
| | - Vivien M Hsu
- Department of Medicine, Division of Rheumatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Dinesh Khanna
- Scleroderma Program, University of Michigan, Ann Arbor, MI, USA.,Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Margarida Alves
- TA Inflammation, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Nils Schoof
- TA Inflammation, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, USA.,Departments of Internal Medicine, Louisiana State University, and Tulane University Schools of Medicine, New Orleans, LA, USA
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Lescoat A, Murphy SL, Chen YT, Vann N, Galdo FD, Cella D, Buch MH, Khanna D. Symptom experience of limited cutaneous systemic sclerosis from the Patients' perspective: A qualitative study ✰,✰✰,★,★★. Semin Arthritis Rheum 2022; 52:151926. [PMID: 34785028 PMCID: PMC9131352 DOI: 10.1016/j.semarthrit.2021.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/30/2021] [Accepted: 11/04/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Limited cutaneous systemic sclerosis (lcSSc) is the largest subgroup of people with SSc, but little is known about symptom experience from the patients' perspective. This study aimed to comprehensively identify domains and symptoms reported as bothersome by patients with lcSSc and to analyze themes and sub-themes capturing symptom experience in this population. METHODS Focus groups of patients with lcSSc were conducted using a structured guide. Patients were recruited based on an a priori purposive framework to include men and women with SSc. Focus groups were recorded, transcribed, anonymized, and analyzed using the RADaR technique (rigorous and accelerated data reduction) combined with iterative, deductive and inductive approaches. RESULTS Four 2-hour Focus groups comprising participants with lcSSc were conducted (N = 26). Ninety-four symptoms were identified with 22 domains. Symptoms from the following domains were mentioned in all Focus groups: skin, musculoskeletal (MSK), cardiac, pulmonary, gastro-intestinal (GI) manifestations, fatigue, sleep, Raynaud's phenomenon (RP), pain, and digital ulcers. The three most cited domains in a pre-meeting survey were GI, RP and MSK. Seven themes defining symptom experience were identified: difficulty attributing symptoms to this complex systemic disease, influence of symptom temporality, impairment of emotional well-being, limitations in functioning (including several sub-themes of functioning), survival, symptoms management and uncertainty. CONCLUSION This study comprehensively identified domains and symptoms considered bothersome from the perspective of patients with lcSSc and summarized patient experience of lcSSc-related symptoms. This study is the first step in the design of a future combined response index dedicated to lcSSc that could foster specific research on this subpopulation of patients.
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Affiliation(s)
- Alain Lescoat
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France; Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France; Michigan Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
| | - Susan L Murphy
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, MI, USA; Department of Physical Medicine & Rehabilitation, University of Michigan, USA; VA Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center, GRECC, Ann Arbor, MI USA.
| | - Yen T Chen
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, MI, USA; Department of Physical Medicine & Rehabilitation, University of Michigan, USA
| | - Nadia Vann
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
| | - Francesco Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Leeds Biomedical Research Centre, National Institute for Health Research, Leeds, UK
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 21st Floor, Chicago, IL, 60611, USA
| | - Maya H Buch
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.; NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University Foundation Trust, Manchester, UK
| | - Dinesh Khanna
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, MI, USA; Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
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18
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Hoa S, Baron M, Hudson M. Screening and management of subclinical interstitial lung disease in systemic sclerosis: an international survey. Rheumatology (Oxford) 2021; 61:3401-3407. [PMID: 34918033 DOI: 10.1093/rheumatology/keab929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Interstitial lung disease (ILD) is the leading cause of mortality in systemic sclerosis (SSc). Experts now recommend HRCT screening in all SSc patients and treatment of subclinical ILD in SSc patients with high-risk phenotypes. We undertook an international survey to understand current screening and treatment practices in subclinical SSc-ILD. METHODS An electronic REDCap survey was distributed to 611 general rheumatologists, 348 national and international SSc experts, 285 general respirologists and 57 ILD experts. RESULTS 198 participants responded to the survey, including 135 (68%) rheumatologists and 54 (27%) respirologists. Over half (59%) of respondents routinely ordered HRCTs in all newly diagnosed SSc patients, although this practice was more common in Europe (83%), the United States (68%), Asia (73%) and Latin America (100%) compared to Canada (40%) and Australia (40%). Nearly half (48%) of respondents would not treat subclinical SSc-ILD, whereas 52% would treat or consider treatment. At least 70% would likely treat subclinical ILD in the setting of diffuse SSc, anti-topoisomerase-I autoantibodies, disease duration below 18 months, ground-glass opacities, oxygen desaturation, or significant ILD progression on imaging or pulmonary function tests. The majority (67%) of respirologists would not treat subclinical ILD. Mycophenolate mofetil was the preferred first-line drug for the treatment of subclinical SSc-ILD. CONCLUSION This international survey highlights important regional variations in SSc-ILD screening and significant heterogeneity among rheumatologists and respirologists in the treatment of subclinical SSc-ILD. High-quality research addressing these questions is needed to produce evidence-based guidelines and harmonize the approach to identification and treatment of subclinical SSc-ILD.
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Affiliation(s)
- Sabrina Hoa
- Division of Rheumatology, Department of Medicine, Centre hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Murray Baron
- Division of Rheumatology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Marie Hudson
- Division of Rheumatology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Hoffmann-Vold AM, Bendstrup E, Dimitroulas T, Hesselstrand R, Morais A, Peltomaa R, Smith V, Welling J, Vonk MC, Wuyts WA. Identifying unmet needs in SSc-ILD by semi-qualitative in-depth interviews. Rheumatology (Oxford) 2021; 60:5601-5609. [PMID: 33587103 PMCID: PMC8788003 DOI: 10.1093/rheumatology/keab154] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/03/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Interstitial lung disease is frequent in SSc (SSc-ILD) and associates with significantly reduced quality of life. Here we aimed to analyse patient pathways, and experiences of patients and healthcare providers (HCPs) in order to identify unmet needs in the management of SSc-ILD patients. METHODS Semi-structured qualitative interviews conducted in eight European countries looked at HCP (n = 95) and patient perspectives (n = 47) using two sets of 70 research questions. Pre-diagnostic, diagnostic and post-diagnostic phases of the patient pathway were systematically explored. RESULTS (i) In the pre-diagnostic phase several gaps were identified by HCPs and patients in all participating countries: limited disease knowledge among primary care physicians and specialists, lack of accurate patient information, and delayed and/or inappropriate referral. (ii) The diagnostic phase is in most countries coordinated by rheumatologists, who are also the main point of care. Depending on the local health system, organization of multidisciplinary collaboration varies. HCPs issued lack of national guidelines, while patients stated difficulties obtaining disease-related information. (iii) In the post-diagnostic phase, HCPs and patients indicated lack of curative treatment, specialized nurses, and paramedical and psychological support. Patients and caregivers additionally expressed the need for clear information on SSc-ILD. CONCLUSION Lack of disease specific knowledge, gaps in national healthcare systems and insufficient information and support for patients and caregivers were identified as unmet needs to ensure timely diagnosis, provide better patient management and to improve quality of life in SSc-ILD patients.
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Affiliation(s)
| | - Elisabeth Bendstrup
- Department of Respiratory Disease and Allergy, Centre for Rare Lung Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Roger Hesselstrand
- Section of Rheumatology, Department of Clinical Sciences, Skåne University Hospital, Lund, Sweden
| | - Antonio Morais
- Department of Pulmonology Centro Hospitalar, Universitário de São João, Faculdade de Medicina do Porto, Porto, Portugal
| | - Ritva Peltomaa
- Department of Rheumatology, Helsinki University Hospital, Helsinki, Finland
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University; Department of Rheumatology, Ghent University Hospital; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre (IRC), Gent, Belgium
| | - Joep Welling
- FESCA Federation of European Scleroderma Associations, NVLE, Utrecht
| | - Madelon C Vonk
- Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wim A Wuyts
- Department of Pulmonology, University Hospitals Leuven, Leuven, Belgium
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20
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Schneider U, Siegert E, Gläser S, Krüger K, Krause A. [Importance of mycophenolate mofetil for treatment of interstitial lung disease in systemic sclerosis]. Z Rheumatol 2021; 80:868-878. [PMID: 34545432 PMCID: PMC8575738 DOI: 10.1007/s00393-021-01088-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 11/28/2022]
Abstract
Interstitial lung disease in systemic sclerosis (SSc-ILD) is a frequent organ complication with considerable mortality. Therapeutically, immunosuppressants are primarily used, particularly cyclophosphamide (CYC) and mycophenolate mofetil (MMF). Recently acquired data also showed an efficacy of the biologics rituximab and tocilizumab. The therapeutic options have most recently been expanded by the approval of the antifibrotic drug nintedanib. It is particularly beneficial in progressive fibrosing courses of ILD despite immunosuppression. The data from controlled trials on the efficacy and safety of CYC and MMF compiled in this review argue for a preferential use of MMF; however, the approval of MMF for this indication is still lacking. This is urgently needed for improved and simplified care of patients with SSc-ILD.
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Affiliation(s)
- Udo Schneider
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Elise Siegert
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- Berlin Institute of Health, Berlin, Deutschland
| | - Sven Gläser
- Klinik für Innere Medizin - Pneumologie und Infektiologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
- Klinik für Innere Medizin - Pneumologie, Vivantes Klinikum Spandau, Berlin, Deutschland
| | - Klaus Krüger
- Rheumatologisches Praxiszentrum, München, Deutschland
| | - Andreas Krause
- Klinik für Innere Medizin, Abteilung Rheumatologie, Klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
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21
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Kuwana M, Allanore Y, Denton CP, Distler JH, Steen V, Khanna D, Matucci-Cerinic M, Mayes MD, Volkmann ER, Miede C, Gahlemann M, Quaresma Lic M, Alves M, Distler O. Nintedanib in patients with systemic sclerosis-associated interstitial lung disease: subgroup analyses by autoantibody status and skin score. Arthritis Rheumatol 2021; 74:518-526. [PMID: 34514739 PMCID: PMC9306495 DOI: 10.1002/art.41965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 06/16/2021] [Accepted: 08/31/2021] [Indexed: 11/08/2022]
Abstract
Objective Using data from the SENSCIS trial, these analyses were undertaken to assess the effects of nintedanib versus placebo in subgroups of patients with systemic sclerosis–associated interstitial lung disease (SSc‐ILD), based on characteristics previously identified as being associated with the progression of SSc‐ILD. Methods Patients with SSc‐ILD were randomized to receive either nintedanib or placebo, stratified by anti–topoisomerase I antibody (ATA) status. We assessed the rate of decline in forced vital capacity (FVC) (expressed in ml/year) over 52 weeks in subgroups based on baseline ATA status, modified Rodnan skin thickness score (MRSS) (<18 versus ≥18), and SSc subtype (limited cutaneous SSc [lcSSc] versus diffuse cutaneous SSc [dcSSc]). Results At baseline, 60.8% of 576 patients who received treatment with either nintedanib or placebo were positive for ATA, 51.9% had dcSSc, and 77.5% of 574 patients with MRSS data available had an MRSS of <18. The effect of nintedanib versus placebo on reducing the rate of decline in FVC (ml/year) was numerically more pronounced in ATA‐negative patients compared to ATA‐positive patients (adjusted difference in the rate of FVC decline, 57.2 ml/year [95% confidence interval (95% CI) –3.5, 118.0] versus 29.9 ml/year [95% CI –19.1, 78.8]), in patients with a baseline MRSS ≥18 compared to those with a baseline MRSS of <18 (adjusted difference in the rate of FVC decline, 88.7 ml/year [95% CI 7.7, 169.8] versus 26.4 ml/year [95% CI –16.8, 69.6]), and in patients with dcSSc compared to those with lcSSc (adjusted difference in the rate of FVC decline, 56.6 ml/year [95% CI 3.2, 110.0] versus 25.3 ml/year [95% CI –28.9, 79.6]). However, all exploratory interaction P values were nonsignificant (all P > 0.05), indicating that there was no heterogeneity in the effect of nintedanib versus placebo between these subgroups of patients. Conclusion In patients with SSc‐ILD, reduction in the annual rate of decline in FVC among patients receiving nintedanib compared to those receiving placebo was not found to be heterogenous across subgroups based on ATA status, MRSS, or SSc subtype. Video Abstract
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Affiliation(s)
- Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Yannick Allanore
- Department of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
| | - Christopher P Denton
- University College London Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, London, UK
| | | | - Virginia Steen
- Division of Rheumatology, Georgetown University, Washington, D.C, USA
| | - Dinesh Khanna
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Maureen D Mayes
- Division of Rheumatology and Clinical Immunogenetics, University of Texas McGovern Medical School, Houston, TX, USA
| | - Elizabeth R Volkmann
- Department of Medicine, Division of Rheumatology, University of California, David Geffen School of Medicine, Los Angeles, CA, USA
| | | | | | | | | | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Abstract
Based on the PubMed data, we have been performing a yearly evaluation of the publications related to autoimmune diseases and immunology to ascertain the relative weight of the former in the scientific literature. It is particularly intriguing to observe that despite the numerous new avenues of immune-related mechanisms, such as cancer immunotherapy, the proportion of immunology manuscripts related to autoimmunity continues to increase and has been approaching 20% in 2019. As in the previous 13 years, we performed an arbitrary selection of the peer-reviewed articles published by the major dedicated Journals and discussed the common themes which continue to outnumber peculiarites in autoimmune diseases. The investigated areas included systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), psoriatic arthritis (PsA), autoantibodies (autoAbs), and common therapeutic avenues and novel pathogenic mechanisms for autoimmune conditions. Some examples include new pathogenetic evidence which is well represented by IL21 or P2X7 receptor (P2X7R) in SLE or the application of single-cell RNA sequencing (scRNA-seq), mass cytometry, bulk RNA sequencing (RNA-seq), and flow cytometry for the analysis of different cellular populations in RA. Cumulatively and of interest to the clinicians, a large number of findings continue to underline the importance of a strict relationship between basic and clinical science to define new pathogenetic and therapeutic developments. The therapeutic pipeline in autoimmunity continues to grow and maintain a constant flow of new molecules, as well illustrated in RA and PsA, and this is most certainly derived from the new basic evidence and the high-throughput tools applied to autoimmune diseases.
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23
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Jaafar S, Lescoat A, Huang S, Gordon J, Hinchcliff M, Shah AA, Assassi S, Domsic R, Bernstein EJ, Steen V, Elliott S, Hant F, Castelino FV, Shanmugam VK, Correia C, Varga J, Nagaraja V, Roofeh D, Frech T, Khanna D. Clinical characteristics, visceral involvement, and mortality in at-risk or early diffuse systemic sclerosis: a longitudinal analysis of an observational prospective multicenter US cohort. Arthritis Res Ther 2021; 23:170. [PMID: 34127049 PMCID: PMC8201684 DOI: 10.1186/s13075-021-02548-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/24/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Early diffuse cutaneous systemic sclerosis (dcSSc) has the highest case fatality among rheumatic diseases. We report baseline characteristics, current immunosuppressive therapies, progression of skin and internal organ involvement, and mortality in a multicenter prospective cohort from the United States (US) of America. METHODS We performed a longitudinal analysis of participants from 12 US centers, from April 2012 to July 2020. All participants had early dcSSc or were at-risk for dcSSc, with ≤2 years since the first non-Raynaud's phenomenon (RP) symptom. RESULTS Three hundred one patients were included with a baseline median disease duration of 1.2 years since RP and a mean modified skin score of 21.1 units. At baseline, 263 (87.3%) had definite dcSSc and 38 (12.7%) were classified as at-risk; 112 (49.6%) patients were positive for anti-RNA polymerase III antibodies. The median follow-up duration was 24.5 months (IQR = 10.3-40.7 months). One hundred ninety (63.1%) participants were treated with an immunosuppressive therapy, of which mycophenolate mofetil was most used at baseline and follow-up. Of 38 who were classified as at-risk at baseline, 27 (71%) went on to develop dcSSc; these patients were characterized by higher baseline mean HAQ-DI (0.8 versus 0.4, p = 0.05) and higher baseline mRSS (8.8 versus 4.4, p < 0.01) in comparison with those who remained as limited cutaneous SSc. In the overall cohort, 48 participants (21.1%) had clinically significant worsening of skin fibrosis, mainly occurring in the first year of follow-up; 41 (23.3%) had an absolute forced vital capacity decline of ≥10%. Twenty participants (6.6%) died, of which 18 died in the first 3 years of follow-up. Cardiac involvement (33.3%), gastrointestinal dysmotility (22.2%), and progressive interstitial lung disease (ILD) (16.7%) were the main causes of death. CONCLUSION This US cohort highlights the management of early SSc in the current era, demonstrating progression of skin and lung involvement despite immunosuppressive therapy and high mortality due to cardiac involvement.
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Affiliation(s)
- Sara Jaafar
- Division of Rheumatology and Scleroderma Program, Department of Internal Medicine, University of Michigan, Suite 7C27 300 North Ingalls Street, SPC 5422, Ann Arbor, MI, 48109, USA
| | - Alain Lescoat
- Division of Rheumatology and Scleroderma Program, Department of Internal Medicine, University of Michigan, Suite 7C27 300 North Ingalls Street, SPC 5422, Ann Arbor, MI, 48109, USA
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, Univ Rennes, Rennes, France
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail, Rennes, France
| | - Suiyuan Huang
- School of Public Health, University of Michigan, Ann Arbor, USA
| | - Jessica Gordon
- Department of Medicine, Hospital for Special Surgery, New York, NY, USA
| | | | - Ami A Shah
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Shervin Assassi
- Department of Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Robyn Domsic
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Elana J Bernstein
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Virginia Steen
- Department of Medicine, Georgetown University, Washington, DC, USA
| | - Sabrina Elliott
- Department of Medicine, Georgetown University, Washington, DC, USA
| | - Faye Hant
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Chase Correia
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - John Varga
- Division of Rheumatology and Scleroderma Program, Department of Internal Medicine, University of Michigan, Suite 7C27 300 North Ingalls Street, SPC 5422, Ann Arbor, MI, 48109, USA
| | - Vivek Nagaraja
- Division of Rheumatology and Scleroderma Program, Department of Internal Medicine, University of Michigan, Suite 7C27 300 North Ingalls Street, SPC 5422, Ann Arbor, MI, 48109, USA
| | - David Roofeh
- Division of Rheumatology and Scleroderma Program, Department of Internal Medicine, University of Michigan, Suite 7C27 300 North Ingalls Street, SPC 5422, Ann Arbor, MI, 48109, USA
| | - Tracy Frech
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Dinesh Khanna
- Division of Rheumatology and Scleroderma Program, Department of Internal Medicine, University of Michigan, Suite 7C27 300 North Ingalls Street, SPC 5422, Ann Arbor, MI, 48109, USA.
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Lescoat A, Varga J, Matucci-Cerinic M, Khanna D. New promising drugs for the treatment of systemic sclerosis: pathogenic considerations, enhanced classifications, and personalized medicine. Expert Opin Investig Drugs 2021; 30:635-652. [PMID: 33909517 PMCID: PMC8292968 DOI: 10.1080/13543784.2021.1923693] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023]
Abstract
Introduction: Systemic sclerosis (SSc), also known as scleroderma, is a complex orphan disease characterized by early inflammatory features, vascular hyper-reactivity, and fibrosis of the skin and internal organs. Although substantial progress has been made in the understanding of the pathogenesis of SSc, there is still no disease-modifying drug that could significantly impact the natural history of the disease.Areas covered: This review discusses the rationale, preclinical evidence, first clinical eevidence,and pending issues concerning new promising therapeutic options that are under investigation in SSc. The search strategy was based on PubMed database and clinical trial.gov, highlighting recent key pathogenic aspects and phase I or II trials of investigational drugs in SSc.Expert opinion: The identification of new molecular entities that potentially impact inflammation and fibrosis may constitute promising options for a disease modifying-agent in SSc. The early combinations of antifibrotic drugs (such as pirfenidone) with immunomodulatory agents (such as mycophenolate mofetil) may also participate to achieve such a goal. A more refined stratification of patients, based on clinical features, molecular signatures, and identification of subpopulations with distinct clinical trajectories, may also improve management strategies in the future.
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Affiliation(s)
- Alain Lescoat
- Department of internal medicine, Division of rheumatology and Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of internal medicine, Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut De Recherche En Santé, Environnement Et Travail) - UMR_S 1085, Rennes, France
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - John Varga
- Department of internal medicine, Division of rheumatology and Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Dinesh Khanna
- Department of internal medicine, Division of rheumatology and Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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David C, Chaigne B, Hollande C, Terris B, Cohen P, Dunogue B, Terrier B, Sogni P, Goulvestre C, Mouthon L. Primary biliary cholangitis and systemic sclerosis (Reynolds syndrome): A case-control study. Autoimmun Rev 2021; 20:102842. [PMID: 33971338 DOI: 10.1016/j.autrev.2021.102842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Clémence David
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), France; APHP-CUP, Hôpital Cochin, Université de Paris, F-75014 Paris, France
| | - Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), France; APHP-CUP, Hôpital Cochin, Université de Paris, F-75014 Paris, France.
| | - Clémence Hollande
- APHP-CUP, Hôpital Cochin, Université de Paris, F-75014 Paris, France; Service d'Hépatologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), France
| | - Benoit Terris
- APHP-CUP, Hôpital Cochin, Université de Paris, F-75014 Paris, France; Département d'Anatomopathologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), France
| | - Pascal Cohen
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), France; APHP-CUP, Hôpital Cochin, Université de Paris, F-75014 Paris, France
| | - Bertrand Dunogue
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), France; APHP-CUP, Hôpital Cochin, Université de Paris, F-75014 Paris, France
| | - Benjamin Terrier
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), France; APHP-CUP, Hôpital Cochin, Université de Paris, F-75014 Paris, France
| | - Philippe Sogni
- APHP-CUP, Hôpital Cochin, Université de Paris, F-75014 Paris, France; Service d'Hépatologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), France
| | - Claire Goulvestre
- APHP-CUP, Hôpital Cochin, Université de Paris, F-75014 Paris, France; Laboratoire d'Immunologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), France; APHP-CUP, Hôpital Cochin, Université de Paris, F-75014 Paris, France
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Novel classifications for systemic sclerosis: challenging historical subsets to unlock new doors. Curr Opin Rheumatol 2021; 32:463-471. [PMID: 32941248 DOI: 10.1097/bor.0000000000000747] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Systemic sclerosis (SSc) is a severe rheumatic disease characterized by a considerable heterogeneity in clinical presentations and pathophysiological mechanisms. This variability has a substantial impact on morbidity and mortality and limits the generalizability of clinical trial results. This review aims to highlight recent studies that have proposed new innovative approaches to decipher this heterogeneity, in particular, by attempting to optimize disease classification. RECENT FINDINGS The historical dichotomy limited/diffuse subsets based on cutaneous involvement has been challenged by studies highlighting an underestimated heterogeneity between these two subtypes and showing that presence of organ damage and autoantibody profiles markedly influenced survival beyond skin extension. Advanced computational methods using unsupervised machine learning analyses of clinical variables and/or high-throughput omics technologies, clinical variables trajectories modelling overtime or radiomics have provided significant insights on key pathogenic processes that could help defining new subgroups beyond the diffuse/limited subsets. SUMMARY We can anticipate that a future classification of SSc patients will integrate innovative approaches encompassing clinical phenotypes, variables trajectories, serological features and innovative omics molecular signatures. It nevertheless seems crucial to also pursue the implementation and standardization of readily available and easy to use tools that can be used in clinical practice.
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Vonk MC, Walker UA, Volkmann ER, Kreuter M, Johnson SR, Allanore Y. Natural variability in the disease course of SSc-ILD: implications for treatment. Eur Respir Rev 2021; 30:30/159/200340. [PMID: 33762426 DOI: 10.1183/16000617.0340-2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/04/2021] [Indexed: 11/05/2022] Open
Abstract
Interstitial lung disease (ILD) affects approximately 50% of patients with systemic sclerosis (SSc) and is the leading cause of death in SSc. Our objective was to gain insight into the progression of SSc-associated ILD (SSc-ILD). Using data from longitudinal clinical trials and observational studies, we assessed definitions and patterns of progression, risk factors for progression, and implications for treatment. SSc-ILD progression was commonly defined as exceeding specific thresholds of lung function worsening and/or increasing radiographic involvement. One definition used in several studies is decline in forced vital capacity (FVC) of ≥10%, or ≥5-10% plus a decline in diffusing capacity of the lung for carbon monoxide ≥15%. Based on these criteria, 20-30% of patients in observational cohorts develop progressive ILD, starting early in the disease course and progressing at a highly variable rate.Risk factors such as age, FVC, extent of fibrosis and presence of anti-topoisomerase I antibodies can help predict progression of SSc-ILD, though composite risk scores may offer greater predictive power. Whilst the variability of the disease course in SSc-ILD makes risk stratification of patients challenging, the decision to initiate, change or stop treatment should be based on a combination of the current disease state and the speed of progression.
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Affiliation(s)
- Madelon C Vonk
- Dept of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ulrich A Walker
- Dept of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Elizabeth R Volkmann
- Dept of Medicine, Division of Rheumatology, University of California, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Care Medicine, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Sindhu R Johnson
- University Health Network, Mount Sinai Hospital, Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Yannick Allanore
- Dept of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
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Hysa E, Cutolo CA, Gotelli E, Paolino S, Cimmino MA, Pacini G, Pizzorni C, Sulli A, Smith V, Cutolo M. Ocular microvascular damage in autoimmune rheumatic diseases: The pathophysiological role of the immune system. Autoimmun Rev 2021; 20:102796. [PMID: 33722750 DOI: 10.1016/j.autrev.2021.102796] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 02/07/2023]
Abstract
Pathological eye involvement represents a quite common finding in a broad spectrum of autoimmune rheumatic diseases (ARDs). Ocular signs, often occur as early manifestations in ARDs, ranging from symptoms related to the mild dry eye disease to sight-threatening pathologies, linked to the immune response against retinal and choroidal vessels. Retinovascular damage driven by markedly inflammatory reactivity need a prompt diagnosis and treatment. Immune-complexes formation, complement activation and antibody-mediated endothelial damage seem to play a key role, particularly, in microvascular damage and ocular symptoms, occurring in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and Sjögren's syndrome (SS). Conversely, early alterations of retinal and choroidal vessels in the asymptomatic patient, often detectable coincidentally, might be indicators of widespread vascular injury in other connective tissue diseases. Particularly, endothelin-induced hypoperfusion and pathological peri-choroidal extracellular matrix deposition, might be responsible for the micro-architectural alterations and loss of capillaries detected in systemic sclerosis (SSc). Instead, interferon alpha-mediated microvascular rarefaction, combined with endothelial lesions caused by specific autoantibodies and immune-complexes, appear to play a significant role in retinal vasculopathy associated to inflammatory idiopathic myopathies (IIM). The immuno-pathophysiological mechanisms of ocular microcirculatory damage associated with the major ARDs will be discussed under the light of the most recent achievements.
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Affiliation(s)
- Elvis Hysa
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Carlo Alberto Cutolo
- Ophtalmology Clinic DiNOGMI, University of Genoa, IRCCS San Martino Polyclinic, Genoa, Italy.
| | - Emanuele Gotelli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Sabrina Paolino
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Marco Amedeo Cimmino
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Greta Pacini
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Carmen Pizzorni
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, Ghent, Belgium; Department of Rheumatology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS Rheumatology Unit San Martino Polyclinic, Genoa, Italy.
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Lescoat A, Roofeh D, Townsend W, Hughes M, Sandler RD, Zimmermann F, Pauling JD, Buch MH, Khanna D. Domains and outcome measures for the assessment of limited cutaneous systemic sclerosis: a scoping review protocol. BMJ Open 2021; 11:e044765. [PMID: 33707273 PMCID: PMC7957124 DOI: 10.1136/bmjopen-2020-044765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/21/2021] [Accepted: 01/28/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Limited cutaneous systemic sclerosis (lcSSc) is the most frequent subset of systemic sclerosis. Despite this, lcSSc is not the major focus of clinical studies. The lack of interventional studies in lcSSc is due, in part, to a paucity of relevant outcome measures to effectively evaluate this subset. A combined response index dedicated to lcSSc would facilitate development of well-designed trials and approval of new drugs. The objective of this scoping review is to perform a broad and comprehensive identification of the outcome measures (core set items) within relevant domains, which have been used so far to assess lcSSc. METHODS AND ANALYSIS The planned scoping review will be based on the approach proposed by Arksey et al and further developed by Levac et al. Development and reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews checklist and guidelines. The development of the search strategy was guided by the concepts of domains and outcomes based on the Outcome Measures in Rheumatology approach and by the different names and definitions of SSc, with a specific emphasis on their occurrence in clinical trial studies. Two databases will be searched: MEDLINE and Embase. Studies in English, published from the year 1988 onwards, will be included, since 1988 corresponds to the publication of LeRoy's first consensus definition of lcSSc. Data will be extracted and analysed using a standardised charting tool. ETHICS AND DISSEMINATION No ethical approval is required for this study. The results will be submitted to an international peer-reviewed journal and scientific conferences, informing the discussion on which items should be included in a combined response index dedicated to lcSSc (the CRISTAL project: Combined Response Index for Scleroderma Trial Assessing lcSSc).
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Affiliation(s)
- Alain Lescoat
- Internal Medicine & Clinical Immunology, CHU Rennes, Rennes, France
- Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - David Roofeh
- Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Whitney Townsend
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Hughes
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robert D Sandler
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - John D Pauling
- Department of Rheumatology, Royal National Hospital For Rheumatic Diseases (at Royal United Hospitals), University of Bath, Bath, UK
| | - Maya H Buch
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University Foundation Trust, Manchester, UK
| | - Dinesh Khanna
- Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
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Furst D, Varga J, Roofeh D, Pauling JD, Hughes M, Sandler R, Zimmermann F, Wessel R, Townsend W, Chung L, Denton CP, Merkel PA, Steen V, Allanore Y, Del Galdo F, Godard D, Cella D, Farrington S, Buch MH, Khanna D. Considerations for a combined index for limited cutaneous systemic sclerosis to support drug development and improve outcomes. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2021; 6:66-76. [PMID: 34316516 PMCID: PMC8313014 DOI: 10.1177/2397198320961967] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Systemic sclerosis (SSc; systemic scleroderma) is characterized by a heterogeneous range of clinical manifestations. SSc is classified into limited cutaneous SSc (lcSSc) and diffuse cutaneous subgroups (dcSSc) based on the extent of skin involvement. Randomized controlled trials in scleroderma have mainly focused on dcSSc partly because the measurement of skin involvement, critical for evaluating a therapeutic intervention is more dynamic in this subset. Nonetheless, lcSSc, the most common cutaneous subset (about 2/3), is also associated with significant morbidity and detrimental impact on health-related quality of life. The lack of interventional studies in lcSSc is partly due to a lack of relevant outcome measures to evaluate this subgroup. Combining several clinically meaningful outcomes selected specifically for lcSSc may improve representativeness in clinical trials and responsiveness of outcomes measured in randomized controlled trials. A composite index dedicated to lcSSc combining such relevant outcomes could advance clinical trial development for lcSSc by providing the opportunity to test and select among candidate drugs that could act as disease-modifying treatments for this neglected subgroup of SSc. This proposed index would include items selected by expert physicians and patients with lcSSc across domains grounded in the lived experience of lcSSc. This article reviews the reasons behind the relative neglect of lcSSc, discusses the current state of outcome measures for lcSSc, identifies challenges, and proposes a roadmap for a combined lcSSc-specific treatment response index.
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Affiliation(s)
| | | | - David Roofeh
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - John D Pauling
- Royal National Hospital for Rheumatic Diseases (at Royal United Hospitals), Bath, UK
| | - Michael Hughes
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robert Sandler
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - François Zimmermann
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - Rachel Wessel
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Whitney Townsend
- Taubman Health Sciences Library, University of Michigan. Ann Arbor, Michigan, USA
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA.,Division of Immunology and Rheumatology, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Christopher P Denton
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, Division of Clinical Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Virginia Steen
- Division of Rheumatology, Georgetown University Medical Center, Washington, DC, USA
| | - Yannick Allanore
- Rheumatology A department, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | - Francesco Del Galdo
- Institute of Rheumatic and Musculoskeletal Medicine and NIHR Biomedical Research Centre, University of Leeds, Leeds LS7 4SA, UK
| | | | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 Michigan Ave, 21st Floor, Chicago, IL, 60611, USA
| | - Sue Farrington
- Federation of European Scleroderma Associations (FESCA), Tournai, Belgium
| | - Maya H Buch
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University Foundation Trust, Manchester, UK
| | - Dinesh Khanna
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
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Abstract
PURPOSE OF REVIEW Systemic sclerosis (scleroderma, SSc) is a rare multisystem autoimmune disease characterized by autoantibodies, vasculopathy, and fibrosis of the skin and internal organs. This review aims to provide an overview and summary of the recent epidemiological studies in systemic sclerosis. RECENT FINDINGS Global trends of scleroderma demonstrate greater prevalence of SSc in European, North, and South American patients compared with East Asian patients. However, the greatest prevalence (47 in 100 000), was found among the indigenous peoples in Canada. Phenotypical differences exist depending on the age of presentation with greater internal organ involvement and disease acceleration present in older patients. Sex differences include greater severity of disease expression, relative prevalence of diffuse cutaneous SSc, and organ involvement in males versus females. New studies conflict with previous data reporting greater proportion of pulmonary arterial hypertension in females. Furthermore, the effect of low median household income is demonstrated as a factor increasing risk of death in SSc patients. SUMMARY Understanding the epidemiological factors in SSc enables patient care through patient classification, prognostication, and monitoring. Future research may emphasize enrichment of SSc patients in randomized trials who are more likely to progress or be treatment responsive, focused screening, and personalized patient care through the creation and validation of new SSc criteria and subsets.
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Scherlinger M, Lutz J, Galli G, Richez C, Gottenberg JE, Sibilia J, Arnaud L, Blanco P, Schaeverbeke T, Chatelus E, Truchetet ME. Systemic sclerosis overlap and non-overlap syndromes share clinical characteristics but differ in prognosis and treatments. Semin Arthritis Rheum 2020; 51:36-42. [PMID: 33360228 DOI: 10.1016/j.semarthrit.2020.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/30/2020] [Accepted: 10/23/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To screen for concomitant autoimmune disease in patients with systemic sclerosis (overlap SSc) and to describe their clinical characteristics and prognosis. METHODS This was a two-center retrospective observational study. Patients diagnosed with SSc according to the 2013 ACR-EULAR scleroderma classification criteria were screened for concomitant rheumatoid arthritis (RA), Sjögren syndrome (SgS) and systemic lupus erythematosus (SLE). Patient characteristics were retrieved from the medical records and were compared to those of a non-overlap SSc cohort. RESULTS Among the 534 SSc patients studied, thirty-four (6.4%) were identified as having overlap SSc. There were 21 (3.9%) patients with RA, 14 (2.6%) with SgS and 4 (0.7%) with SLE (5 patients had 2 AISD) . The disease phenotype of overlap SSc was similar to that of non-overlap SSc in terms of cutaneous phenotype, prevalence of pulmonary arterial hypertension, interstitial lung disease, digital ulcers and mortality. Using a multivariate Cox model, age (HR = 1.04, 95% CI [1.02-1.07]), the modified Rodnan skin score (HR = 1.08 per point, 95% CI [1.05-1.11]), and the presence of concomitant SgS (HR = 3.79, 95% CI [1.38-10.40]) were significantly associated with mortality. Overlap SSc were more likely to receive corticosteroids (85.3% vs. 45%, p < 0.001), immunosuppressive drugs (82.4% vs. 49.2%, p < 0.001) and biologics (52.9% vs. 3.8%, p < ZZ0.001). CONCLUSIONS While overlap and non-overlap SSc shared common characteristics, patients with SgS/SSc had a higher risk of mortality, and those with RA/SSc received more corticosteroids, methotrexate and biologics. Screening for an associated AISD should be promoted since their co-occurrence with SSc may affect prognosis and treatments.
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Affiliation(s)
- Marc Scherlinger
- Centre Hospitalier Universitaire de Bordeaux, FHU ACRONIM, Place Amélie Raba Léon, 33076 Bordeaux, France; Centre national de référence des maladies auto-immunes et systémiques rares Est/Sud-Ouest (RESO), France; CNRS-UMR 5164 Immuno ConcEpT, 146 rue Léo Saignat, 33076 Bordeaux, France.
| | - Johanna Lutz
- Centre national de référence des maladies auto-immunes et systémiques rares Est/Sud-Ouest (RESO), France; Service de rhumatologie, Centre Hospitalier Universitaire de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Gael Galli
- Centre Hospitalier Universitaire de Bordeaux, FHU ACRONIM, Place Amélie Raba Léon, 33076 Bordeaux, France; Centre national de référence des maladies auto-immunes et systémiques rares Est/Sud-Ouest (RESO), France; CNRS-UMR 5164 Immuno ConcEpT, 146 rue Léo Saignat, 33076 Bordeaux, France
| | - Christophe Richez
- Centre Hospitalier Universitaire de Bordeaux, FHU ACRONIM, Place Amélie Raba Léon, 33076 Bordeaux, France; Centre national de référence des maladies auto-immunes et systémiques rares Est/Sud-Ouest (RESO), France; CNRS-UMR 5164 Immuno ConcEpT, 146 rue Léo Saignat, 33076 Bordeaux, France
| | - Jacques-Eric Gottenberg
- Centre national de référence des maladies auto-immunes et systémiques rares Est/Sud-Ouest (RESO), France; Service de rhumatologie, Centre Hospitalier Universitaire de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Jean Sibilia
- Centre national de référence des maladies auto-immunes et systémiques rares Est/Sud-Ouest (RESO), France; Service de rhumatologie, Centre Hospitalier Universitaire de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Laurent Arnaud
- Centre national de référence des maladies auto-immunes et systémiques rares Est/Sud-Ouest (RESO), France; Service de rhumatologie, Centre Hospitalier Universitaire de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Patrick Blanco
- Centre Hospitalier Universitaire de Bordeaux, FHU ACRONIM, Place Amélie Raba Léon, 33076 Bordeaux, France; CNRS-UMR 5164 Immuno ConcEpT, 146 rue Léo Saignat, 33076 Bordeaux, France
| | - Thierry Schaeverbeke
- Centre Hospitalier Universitaire de Bordeaux, FHU ACRONIM, Place Amélie Raba Léon, 33076 Bordeaux, France; Centre national de référence des maladies auto-immunes et systémiques rares Est/Sud-Ouest (RESO), France
| | - Emmanuel Chatelus
- Centre national de référence des maladies auto-immunes et systémiques rares Est/Sud-Ouest (RESO), France; Service de rhumatologie, Centre Hospitalier Universitaire de Strasbourg, 1 avenue Molière, 67098 Strasbourg, France
| | - Marie-Elise Truchetet
- Centre Hospitalier Universitaire de Bordeaux, FHU ACRONIM, Place Amélie Raba Léon, 33076 Bordeaux, France; Centre national de référence des maladies auto-immunes et systémiques rares Est/Sud-Ouest (RESO), France; CNRS-UMR 5164 Immuno ConcEpT, 146 rue Léo Saignat, 33076 Bordeaux, France.
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Conforti A, Di Cola I, Pavlych V, Ruscitti P, Berardicurti O, Ursini F, Giacomelli R, Cipriani P. Beyond the joints, the extra-articular manifestations in rheumatoid arthritis. Autoimmun Rev 2020; 20:102735. [PMID: 33346115 DOI: 10.1016/j.autrev.2020.102735] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/18/2020] [Indexed: 12/24/2022]
Abstract
Rheumatoid arthritis (RA) is an inflammatory disease typically affecting the joints, but the systemic inflammatory process may involve other tissues and organs. Many extra-articular manifestations are recognized, which are related to worse long outcomes. Rheumatoid nodules are the most common extra-articular feature, found in about 30% of patients. Secondary Sjögren's syndrome and pulmonary manifestations are observed in almost 10% of patients, also in the early disease. Active RA with high disease activity has been associated with an increased risk of such features. Male gender, smoking habit, severe joint disease, worse function, high pro-inflammatory markers levels, high titer of rheumatoid factor, and HLA-related shared epitope have been reported as clinical predictors of occurrence of these rheumatoid complications. In addition, there is a little evidence deriving from randomized controlled trials in this field, thus the therapeutic strategy is mainly empiric and based on small case series and retrospective studies. However, considering that these extra-articular manifestations are usually related to the more active and severe RA, an aggressive therapeutic strategy is usually employed in view of the poor outcomes of these patients. The extra-articular features of RA remain, despite the improvement of joint damage, a major diagnostic and therapeutic challenge, since these are associated with a poor prognosis and need to be early recognized and promptly managed.
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Affiliation(s)
- Alessandro Conforti
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ilenia Di Cola
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Viktoriya Pavlych
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Piero Ruscitti
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Onorina Berardicurti
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesco Ursini
- IRRCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Roberto Giacomelli
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paola Cipriani
- Rheumatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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The growing role of precision medicine for the treatment of autoimmune diseases; results of a systematic review of literature and Experts' Consensus. Autoimmun Rev 2020; 20:102738. [PMID: 33326854 DOI: 10.1016/j.autrev.2020.102738] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/22/2020] [Indexed: 02/07/2023]
Abstract
Autoimmune diseases (AIDs) share similar serological, clinical, and radiological findings, but, behind these common features, there are different pathogenic mechanisms, immune cells dysfunctions, and targeted organs. In this context, multiple lines of evidence suggest the application of precision medicine principles to AIDs to reduce the treatment failure. Precision medicine refers to the tailoring of therapeutic strategies to the individual characteristics of each patient, thus it could be a new approach for management of AIDS which considers individual variability in genes, environmental exposure, and lifestyle. Precision medicine would also assist physicians in choosing the right treatment, the best timing of administration, consequently trying to maximize drug efficacy, and, possibly, reducing adverse events. In this work, the growing body of evidence is summarized regarding the predictive factors for drug response in patients with AIDs, applying the precision medicine principles to provide high-quality evidence for therapeutic opportunities in improving the management of these patients.
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Targeted therapies in interstitial lung disease secondary to systemic autoimmune rheumatic disease. Current status and future development. Autoimmun Rev 2020; 20:102742. [PMID: 33333235 DOI: 10.1016/j.autrev.2020.102742] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/25/2020] [Indexed: 12/22/2022]
Abstract
Autoimmune rheumatic diseases (ARD) are characterized by systemic manifestations and multiple organ involvement, including the lung. Interstitial Lung Disease (ILD) is a cardinal manifestation of lung involvement in patients with ARD and is associated with significant morbidity and mortality. Corticosteroids and immunosuppressive drugs are used as first -line treatment. Targeted therapies, such as biological disease modifying antirheumatic drugs (DMARDS) and anti- fibrotic agents are new treatment options. In this review we discuss the role of targeted therapies in patients with ILD secondary to ARD.
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Benvenuti F, Zanatta E, Avouac J, Müller-Ladner U, Cozzi F, Hoffmann-Vold AM, Gabrielli A, Distler O, Matucci-Cerinic M, Allanore Y, Doria A. The power of the EUSTAR cohort: key findings to date and implications for management of systemic sclerosis patients. Expert Rev Clin Immunol 2020; 16:1065-1074. [DOI: 10.1080/1744666x.2021.1836962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Francesco Benvenuti
- Division of Rheumatology, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Elisabetta Zanatta
- Division of Rheumatology, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Jérôme Avouac
- Rhumatologie, Hôpital Cochin, APHP, Université de Paris, Paris, France
| | - Ulf Müller-Ladner
- Department of Internal Medicine and Rheumatology, Justus‐Liebig University Giessen, Bad Nauheim, Germany
| | - Franco Cozzi
- Internal Medicine Unit, Ospedale Classificato Villa Salus, Venice, Italy
| | | | | | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Yannick Allanore
- Rhumatologie, Hôpital Cochin, APHP, Université de Paris, Paris, France
| | - Andrea Doria
- Division of Rheumatology, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
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Valentini G, Pope JE. Undifferentiated connective tissue disease at risk for systemic sclerosis: Which patients might be labeled prescleroderma? Autoimmun Rev 2020; 19:102659. [PMID: 32942034 DOI: 10.1016/j.autrev.2020.102659] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/12/2020] [Indexed: 02/06/2023]
Abstract
Undifferentiated Connective Tissue Disease at risk for Systemic Sclerosis (UCTD-risk-SSc), otherwise referred to as very early-early SSc (very early-early diagnosis of systemic sclerosis VEDOSS), is a condition characterized by Raynaud's phenomenon (RP) and either SSc serum marker autoantibodies or a capillaroscopic scleroderma pattern or both, but without satisfying classification criteria for SSc neither features consistent with SSc sine scleroderma. Approximately half the UCTD-risk-SSc patients develop definite SSc over 5-10 years of follow-up. Identifying patients who will undergo such evolution is an unmet need. Predicting at onset which patients with RP are going to develop SSc over time has long been a research objective and still is an unaccomplished task. The present review is devoted to the critical analysis of the nosographic boundaries of the condition and of items predictive of evolution including serological, capillaroscopic and circulating markers. A weighted score, based on serum antinuclear antibody titre, serum marker antibodies positivity and avascular areas has been developed and may identify in the meanwhile patients to be labeled prescleroderma i.e. those probably developing SSc over time. Future research should be directed to investigate unexplored features, validate and improve the performance of the score and highlight the involved pathways to be contrasted in order to identify a targeted therapy hampering the development of overt SSc.
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Affiliation(s)
- Gabriele Valentini
- Università degli Studi della Campania "Luigi Vanvitelli", Department of Precision Medicine, Section of Rheumatology, Italy.
| | - Janet E Pope
- Università degli Studi della Campania "Luigi Vanvitelli", Department of Precision Medicine, Section of Rheumatology, Italy; Schulich School of Medicine and Dentistry, University of Western Ontario, Division of Rheumatology, St. Joseph's Health Care, London, Ontario, Canada
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Vanaken L, Landini N, Lenaerts J, Claeys E, Lenaerts J, Wuyts WA, Verschakelen J, De Langhe E. Progressive lung fibrosis and mortality can occur in early systemic sclerosis patients without pulmonary abnormalities at baseline assessment. Clin Rheumatol 2020; 39:3393-3400. [DOI: 10.1007/s10067-020-05105-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/06/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
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Ledoult E, Launay D, Béhal H, Mouthon L, Pugnet G, Lega JC, Agard C, Allanore Y, Jego P, Fauchais AL, Harlé JR, Berthier S, Aouba A, Mekinian A, Diot E, Truchetet ME, Boulon C, Duhamel A, Hachulla E, Sobanski V. Early trajectories of skin thickening are associated with severity and mortality in systemic sclerosis. Arthritis Res Ther 2020; 22:30. [PMID: 32070422 PMCID: PMC7029583 DOI: 10.1186/s13075-020-2113-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/31/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Systemic sclerosis (SSc) is a severe and highly heterogeneous disease. The modified Rodnan skin score (mRSS) is a widely used tool for the assessment of the extent and degree of skin thickness. This study aimed to identify the classes of patients with early similar skin thickening trajectories without any a priori assumptions and study their associations with organ involvement and survival. METHODS From the French SSc national cohort, patients with a disease duration of less than 2 years at inclusion and with at least 2 mRSS available within the first 4 years of follow-up were enrolled. Classes of patients with similar mRSS trajectories were identified based on a latent class mixed model. The clinical characteristics and survival rate were compared between the obtained classes. RESULTS A total of 198 patients fulfilled the inclusion criteria, with a total of 641 mRSS available. The median disease duration and follow-up were 0.8 (interquartile range 0.4; 1.2) and 6.3 (3.8; 8.9) years, respectively. Individual trajectories of mRSS were highly heterogeneous between patients. Models with 1-6 latent classes of trajectories were sequentially assessed, and the 5-class model represented the best fit to data. Each class was characterized by a unique global trajectory of mRSS. The median disease duration did not differ significantly between classes. Baseline organ involvement was more frequent in classes with significant change over time (classes 2-5) than in class 1 (low baseline mRSS without significant change over time). Using Cox regression, we observed a progressively increasing risk of death from classes 1 to 5. CONCLUSIONS Early identification of clinical phenotype based on skin thickening trajectories could predict morbi-mortality in SSc. This study suggested that mRSS trajectories characterization might be pivotal for clinical practice and future trial designs.
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Affiliation(s)
- Emmanuel Ledoult
- Univ. Lille, Institute for Translational Research in Inflammation (INFINITE), F-59000, Lille, France.,CHU Lille, Service de Médecine Interne, Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000, Lille, France.,INSERM, U1286, F-59000, Lille, France
| | - David Launay
- Univ. Lille, Institute for Translational Research in Inflammation (INFINITE), F-59000, Lille, France.,CHU Lille, Service de Médecine Interne, Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000, Lille, France.,INSERM, U1286, F-59000, Lille, France
| | - Hélène Béhal
- Univ. Lille, CHU Lille, EA 2694-Santé publique, épidémiologie et qualité des soins, Unité de Biostatistiques, F-59000, Lille, France
| | - Luc Mouthon
- Hôpital Cochin-APHP, Service de Médecine Interne, Paris, France
| | - Grégory Pugnet
- CHU Toulouse, Service de Médecine Interne, Toulouse, France
| | | | | | | | - Patrick Jego
- CHU Rennes, Service de Médecine Interne, Rennes, France
| | | | - Jean-Robert Harlé
- Hôpital de la Timone, Service de Médecine Interne, Marseille, France
| | - Sabine Berthier
- CHU Dijon, Service de Médecine Interne et Immunologie Clinique, Dijon, France
| | | | - Arsène Mekinian
- Hôpital Saint-Antoine-APHP, Service de Médecine Interne, Paris, France
| | | | | | - Carine Boulon
- CHU Bordeaux, Service de Médecine vasculaire, Bordeaux, France
| | - Alain Duhamel
- Univ. Lille, CHU Lille, EA 2694-Santé publique, épidémiologie et qualité des soins, Unité de Biostatistiques, F-59000, Lille, France
| | - Eric Hachulla
- Univ. Lille, Institute for Translational Research in Inflammation (INFINITE), F-59000, Lille, France.,CHU Lille, Service de Médecine Interne, Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000, Lille, France.,INSERM, U1286, F-59000, Lille, France
| | - Vincent Sobanski
- Univ. Lille, Institute for Translational Research in Inflammation (INFINITE), F-59000, Lille, France. .,CHU Lille, Service de Médecine Interne, Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000, Lille, France. .,INSERM, U1286, F-59000, Lille, France.
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