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Sampaio-Barros MM, Alvarenga JC, Takayama L, Assad APL, Sampaio-Barros PD, Pereira RMR. Distal radius and tibia bone microarchitecture impairment in female patients with diffuse systemic sclerosis. Osteoporos Int 2019; 30:1679-1691. [PMID: 31030240 DOI: 10.1007/s00198-019-04965-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 04/07/2019] [Indexed: 01/01/2023]
Abstract
UNLABELLED Radius and tibia bone microarchitecture, analyzed through a high-resolution peripheral quantitative computed tomography, were significantly impaired in female patients with diffuse systemic sclerosis compared with healthy controls. Acroosteolysis, quality of life-grip strength, hand disability, and disease duration were significantly associated with this bone deterioration. INTRODUCTION The effect of diffuse systemic sclerosis (dSSc) on the bone is not completely understood. The objective of this study was to analyze the volumetric bone mineral density (vBMD), microarchitecture, and biomechanical parameters at the distal radius and tibia using high-resolution peripheral quantitative computed tomography (HR-pQCT, XtremeCT) in female patients with dSSc and identify clinical and laboratory variables associated with these parameters. METHODS Thirty-eight women with dSSc and 76 healthy controls were submitted to HR-pQCT at the distal radius and tibia. Clinical and laboratory findings, bone mineral density(BMD), nailfold capillaroscopy (NC), total passive range of motion(ROM), and quality of life (health assessment questionnaire-HAQ) were associated with HR-pQCT (Scanco Medical AG, Brüttisellen, Switzerland) parameters. Multiple linear regression models adjusted for clinical and laboratory variables, ROM and HAQ, were performed. RESULTS Density, microarchitecture, and biomechanical parameters at the distal radius and tibia were significantly impaired in dSSc patients compared with healthy controls (p < 0.001). Multiple linear regression models showed that lower trabecular density (Tb.vBMD) (radius R2 = 0.561, p = 0.002; and tibia R2 = 0.533, p = 0.005), and lower trabecular number (Tb.N) (tibia R2 = 0.533, p = 0.005) were significantly associated with acroosteolysis. Higher trabecular separation (Tb.Sp) was associated with disease duration and higher HAQ-grip strength (radius R2 = 0.489, p = 0.013), while cortical density (Ct.vBMD) was associated with ROM (radius R2 = 0.294, p = 0.002). CONCLUSION Bone microarchitecture in patients with dSSc, analyzed through HR-pQCT, showed impairment of trabecular and cortical bone at distal radius and tibia. Variables associated with hand involvement (acroosteolysis, quality of life-grip strength, and ROM) and disease duration may be considered prognostic factors of this bone impairment.
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Affiliation(s)
- M M Sampaio-Barros
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3193, São Paulo, SP, 01246-903, Brazil
| | - J C Alvarenga
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3193, São Paulo, SP, 01246-903, Brazil
| | - L Takayama
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3193, São Paulo, SP, 01246-903, Brazil
| | - A P L Assad
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3193, São Paulo, SP, 01246-903, Brazil
| | - P D Sampaio-Barros
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3193, São Paulo, SP, 01246-903, Brazil
| | - R M R Pereira
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3193, São Paulo, SP, 01246-903, Brazil.
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Buni M, Joseph J, Pedroza C, Theodore S, Nair D, McNearney TA, Draeger HT, Reveille JD, Assassi S, Mayes MD. Predictors of Hand Contracture in Early Systemic Sclerosis and the Effect on Function: A Prospective Study of the GENISOS Cohort. J Rheumatol 2019; 46:1597-1604. [PMID: 30709959 DOI: 10.3899/jrheum.180093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify baseline features that predict progression of hand contractures and to assess the effect of contractures on functional status in the prospective GENISOS cohort. METHODS Rate of decline in hand extension, as an indicator of hand contracture, was the primary outcome. We assessed longitudinal hand extension measurements, modified Health Assessment Questionnaire (MHAQ) score, Medical Outcomes Study Short Form-36 (SF-36) physical function score, and demographic, clinical, and serological variables. Subjects with ≥ 2 hand measurements at least 6 months apart were included. RESULTS A total of 1087 hand measurements for 219 patients were available over an average of 8.1 ± 4.8 years. Hand extension decreased on average by 0.11 cm/year. Antitopoisomerase I antibody (ATA) positivity and higher modified Rodnan Skin Score (mRSS) were predictive of faster decline in hand extension (p = 0.009 and p = 0.046, respectively). In a subgroup analysis of 62 patients with ≤ 2 years from SSc onset, ATA and diffuse disease type were associated with faster decline in hand extension; anticentromere positivity was associated with slower rate of decline. Although the rate of decline in patients with disease duration ≤ 2 years was numerically higher, the difference was not statistically significant. Hand extension continued to decline in a linear fashion over time and was inversely related to overall functional status. CONCLUSION ATA was predictive of contracture development in both early disease (≤ 2 yrs) and in the overall cohort. Hand extension declined linearly over time and was inversely associated with MHAQ and SF-36 scores. ATA positivity and higher baseline mRSS were predictive of faster decline in hand extension.
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Affiliation(s)
- Maryam Buni
- From the Department of Internal Medicine, Center for Clinical Research and Evidence-Based Medicine, and Department of Pediatrics, University of Texas McGovern Medical School, Houston, Texas, USA.,M. Buni, MD, Rheumatology Fellow, McGovern Medical School; J. Joseph, MD, Washington DC VA Medical Center; C. Pedroza, PhD, Associate Professor, McGovern Medical School; S. Theodore, MD, Research Coordinator I, McGovern Medical School; D. Nair, MS, Data Manager Contractor; T.A. McNearney, MD; H.T. Draeger, MD, University Health System - University Medicine Associates; J.D. Reveille, MD, Professor, McGovern Medical School; S. Assassi, MD, Associate Professor, McGovern Medical School; M.D. Mayes, MD, Professor, McGovern Medical School. Dr. Buni and Dr. Joseph contributed equally to this paper and are co-first authors
| | - Joyce Joseph
- From the Department of Internal Medicine, Center for Clinical Research and Evidence-Based Medicine, and Department of Pediatrics, University of Texas McGovern Medical School, Houston, Texas, USA.,M. Buni, MD, Rheumatology Fellow, McGovern Medical School; J. Joseph, MD, Washington DC VA Medical Center; C. Pedroza, PhD, Associate Professor, McGovern Medical School; S. Theodore, MD, Research Coordinator I, McGovern Medical School; D. Nair, MS, Data Manager Contractor; T.A. McNearney, MD; H.T. Draeger, MD, University Health System - University Medicine Associates; J.D. Reveille, MD, Professor, McGovern Medical School; S. Assassi, MD, Associate Professor, McGovern Medical School; M.D. Mayes, MD, Professor, McGovern Medical School. Dr. Buni and Dr. Joseph contributed equally to this paper and are co-first authors
| | - Claudia Pedroza
- From the Department of Internal Medicine, Center for Clinical Research and Evidence-Based Medicine, and Department of Pediatrics, University of Texas McGovern Medical School, Houston, Texas, USA.,M. Buni, MD, Rheumatology Fellow, McGovern Medical School; J. Joseph, MD, Washington DC VA Medical Center; C. Pedroza, PhD, Associate Professor, McGovern Medical School; S. Theodore, MD, Research Coordinator I, McGovern Medical School; D. Nair, MS, Data Manager Contractor; T.A. McNearney, MD; H.T. Draeger, MD, University Health System - University Medicine Associates; J.D. Reveille, MD, Professor, McGovern Medical School; S. Assassi, MD, Associate Professor, McGovern Medical School; M.D. Mayes, MD, Professor, McGovern Medical School. Dr. Buni and Dr. Joseph contributed equally to this paper and are co-first authors
| | - Sam Theodore
- From the Department of Internal Medicine, Center for Clinical Research and Evidence-Based Medicine, and Department of Pediatrics, University of Texas McGovern Medical School, Houston, Texas, USA.,M. Buni, MD, Rheumatology Fellow, McGovern Medical School; J. Joseph, MD, Washington DC VA Medical Center; C. Pedroza, PhD, Associate Professor, McGovern Medical School; S. Theodore, MD, Research Coordinator I, McGovern Medical School; D. Nair, MS, Data Manager Contractor; T.A. McNearney, MD; H.T. Draeger, MD, University Health System - University Medicine Associates; J.D. Reveille, MD, Professor, McGovern Medical School; S. Assassi, MD, Associate Professor, McGovern Medical School; M.D. Mayes, MD, Professor, McGovern Medical School. Dr. Buni and Dr. Joseph contributed equally to this paper and are co-first authors
| | - Deepthi Nair
- From the Department of Internal Medicine, Center for Clinical Research and Evidence-Based Medicine, and Department of Pediatrics, University of Texas McGovern Medical School, Houston, Texas, USA.,M. Buni, MD, Rheumatology Fellow, McGovern Medical School; J. Joseph, MD, Washington DC VA Medical Center; C. Pedroza, PhD, Associate Professor, McGovern Medical School; S. Theodore, MD, Research Coordinator I, McGovern Medical School; D. Nair, MS, Data Manager Contractor; T.A. McNearney, MD; H.T. Draeger, MD, University Health System - University Medicine Associates; J.D. Reveille, MD, Professor, McGovern Medical School; S. Assassi, MD, Associate Professor, McGovern Medical School; M.D. Mayes, MD, Professor, McGovern Medical School. Dr. Buni and Dr. Joseph contributed equally to this paper and are co-first authors
| | - Terry A McNearney
- From the Department of Internal Medicine, Center for Clinical Research and Evidence-Based Medicine, and Department of Pediatrics, University of Texas McGovern Medical School, Houston, Texas, USA.,M. Buni, MD, Rheumatology Fellow, McGovern Medical School; J. Joseph, MD, Washington DC VA Medical Center; C. Pedroza, PhD, Associate Professor, McGovern Medical School; S. Theodore, MD, Research Coordinator I, McGovern Medical School; D. Nair, MS, Data Manager Contractor; T.A. McNearney, MD; H.T. Draeger, MD, University Health System - University Medicine Associates; J.D. Reveille, MD, Professor, McGovern Medical School; S. Assassi, MD, Associate Professor, McGovern Medical School; M.D. Mayes, MD, Professor, McGovern Medical School. Dr. Buni and Dr. Joseph contributed equally to this paper and are co-first authors
| | - Hilda T Draeger
- From the Department of Internal Medicine, Center for Clinical Research and Evidence-Based Medicine, and Department of Pediatrics, University of Texas McGovern Medical School, Houston, Texas, USA.,M. Buni, MD, Rheumatology Fellow, McGovern Medical School; J. Joseph, MD, Washington DC VA Medical Center; C. Pedroza, PhD, Associate Professor, McGovern Medical School; S. Theodore, MD, Research Coordinator I, McGovern Medical School; D. Nair, MS, Data Manager Contractor; T.A. McNearney, MD; H.T. Draeger, MD, University Health System - University Medicine Associates; J.D. Reveille, MD, Professor, McGovern Medical School; S. Assassi, MD, Associate Professor, McGovern Medical School; M.D. Mayes, MD, Professor, McGovern Medical School. Dr. Buni and Dr. Joseph contributed equally to this paper and are co-first authors
| | - John D Reveille
- From the Department of Internal Medicine, Center for Clinical Research and Evidence-Based Medicine, and Department of Pediatrics, University of Texas McGovern Medical School, Houston, Texas, USA.,M. Buni, MD, Rheumatology Fellow, McGovern Medical School; J. Joseph, MD, Washington DC VA Medical Center; C. Pedroza, PhD, Associate Professor, McGovern Medical School; S. Theodore, MD, Research Coordinator I, McGovern Medical School; D. Nair, MS, Data Manager Contractor; T.A. McNearney, MD; H.T. Draeger, MD, University Health System - University Medicine Associates; J.D. Reveille, MD, Professor, McGovern Medical School; S. Assassi, MD, Associate Professor, McGovern Medical School; M.D. Mayes, MD, Professor, McGovern Medical School. Dr. Buni and Dr. Joseph contributed equally to this paper and are co-first authors
| | - Shervin Assassi
- From the Department of Internal Medicine, Center for Clinical Research and Evidence-Based Medicine, and Department of Pediatrics, University of Texas McGovern Medical School, Houston, Texas, USA.,M. Buni, MD, Rheumatology Fellow, McGovern Medical School; J. Joseph, MD, Washington DC VA Medical Center; C. Pedroza, PhD, Associate Professor, McGovern Medical School; S. Theodore, MD, Research Coordinator I, McGovern Medical School; D. Nair, MS, Data Manager Contractor; T.A. McNearney, MD; H.T. Draeger, MD, University Health System - University Medicine Associates; J.D. Reveille, MD, Professor, McGovern Medical School; S. Assassi, MD, Associate Professor, McGovern Medical School; M.D. Mayes, MD, Professor, McGovern Medical School. Dr. Buni and Dr. Joseph contributed equally to this paper and are co-first authors
| | - Maureen D Mayes
- From the Department of Internal Medicine, Center for Clinical Research and Evidence-Based Medicine, and Department of Pediatrics, University of Texas McGovern Medical School, Houston, Texas, USA. .,M. Buni, MD, Rheumatology Fellow, McGovern Medical School; J. Joseph, MD, Washington DC VA Medical Center; C. Pedroza, PhD, Associate Professor, McGovern Medical School; S. Theodore, MD, Research Coordinator I, McGovern Medical School; D. Nair, MS, Data Manager Contractor; T.A. McNearney, MD; H.T. Draeger, MD, University Health System - University Medicine Associates; J.D. Reveille, MD, Professor, McGovern Medical School; S. Assassi, MD, Associate Professor, McGovern Medical School; M.D. Mayes, MD, Professor, McGovern Medical School. Dr. Buni and Dr. Joseph contributed equally to this paper and are co-first authors.
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