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Ferrari HM, Kale-Pradhan P, Konja J, Dierker M, Martirosov AL. Systemic-Sclerosis-Related Interstitial Lung Disease: A Review of the Literature and Recommended Approach for Clinical Pharmacists. Ann Pharmacother 2024; 58:956-971. [PMID: 38095621 DOI: 10.1177/10600280231213672] [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] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVE To describe the efficacy, safety, and clinical utility of pharmacologic agents in the treatment of systemic sclerosis-related interstitial lung disease (SSc-ILD). DATA SOURCES A review of the literature was performed using the terms lung diseases, (interstitial/therapy) AND (scleroderma, systemic/therapy) OR (scleroderma, systemic) AND (lung diseases, interstitial/therapy) in PubMed, Ovid MEDLINE, CINAHL, and Web of Science. ClinicalTrials.gov was also searched to identify ongoing studies. The initial search was performed in October 2022, with follow-up searches performed in October 2023. STUDY SELECTION AND DATA ABSTRACTION Articles reviewed were limited to those written in the English language, human studies, and adult populations. DATA SYNTHESIS A variety of therapeutic agents, including mycophenolate, azathioprine, cyclophosphamide (CYC), rituximab (RTX), nintedanib, and tocilizumab (TCZ) have slowed the rate of decline in forced vital capacity (FVC) and disease progression. Only nintedanib and TCZ have a labeled indication for SSc-ILD. Two agents, belimumab and pirfenidone, have shown encouraging results in smaller phase II and phase III studies, but have yet to be approved by the Food and Drug Administration. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Patients with pulmonary manifestations of SSc-ILD have worse outcomes and lower survival rates compared with those without. It is imperative that disease management be individualized to achieve optimal patient-centered care. Pharmacists are uniquely suited to support this individualized management. CONCLUSION Numerous pharmacologic agents have been studied and repurposed in the treatment of SSc-ILD, with nintedanib and TCZ gaining approval to slow the rate of decline in pulmonary function in SSc-ILD. Other agents, including belimumab and pirfenidone, are on the horizon as potential treatment options; but further studies are needed to compare their efficacy and safety with the current standard of care.
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Affiliation(s)
- Hannah Marie Ferrari
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University and and Henry Ford Hospital, Detroit, MI, USA
| | - Pramodini Kale-Pradhan
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University and Ascension St. John Hospital, Detroit, MI, USA
| | - Jewel Konja
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University and and Henry Ford Hospital, Detroit, MI, USA
| | - Michelle Dierker
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University and and Henry Ford Hospital, Detroit, MI, USA
| | - Amber Lanae Martirosov
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University and and Henry Ford Hospital, Detroit, MI, USA
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Tarchi SM, Salvatore M, Lichtenstein P, Sekar T, Capaccione K, Luk L, Shaish H, Makkar J, Desperito E, Leb J, Navot B, Goldstein J, Laifer S, Beylergil V, Ma H, Jambawalikar S, Aberle D, D'Souza B, Bentley-Hibbert S, Marin MP. Radiology of fibrosis. Part I: Thoracic organs. J Transl Med 2024; 22:609. [PMID: 38956586 PMCID: PMC11218337 DOI: 10.1186/s12967-024-05244-1] [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: 02/12/2024] [Accepted: 04/27/2024] [Indexed: 07/04/2024] Open
Abstract
Sustained injury from factors such as hypoxia, infection, or physical damage may provoke improper tissue repair and the anomalous deposition of connective tissue that causes fibrosis. This phenomenon may take place in any organ, ultimately leading to their dysfunction and eventual failure. Tissue fibrosis has also been found to be central in both the process of carcinogenesis and cancer progression. Thus, its prompt diagnosis and regular monitoring is necessary for implementing effective disease-modifying interventions aiming to reduce mortality and improve overall quality of life. While significant research has been conducted on these subjects, a comprehensive understanding of how their relationship manifests through modern imaging techniques remains to be established. This work intends to provide a comprehensive overview of imaging technologies relevant to the detection of fibrosis affecting thoracic organs as well as to explore potential future advancements in this field.
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Affiliation(s)
- Sofia Maria Tarchi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA.
| | - Mary Salvatore
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Philip Lichtenstein
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Thillai Sekar
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Kathleen Capaccione
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Lyndon Luk
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Hiram Shaish
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Jasnit Makkar
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Elise Desperito
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Jay Leb
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Benjamin Navot
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Jonathan Goldstein
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Sherelle Laifer
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Volkan Beylergil
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Hong Ma
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Sachin Jambawalikar
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Dwight Aberle
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Belinda D'Souza
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Stuart Bentley-Hibbert
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
| | - Monica Pernia Marin
- Department of Radiology, Columbia University Irving Medical Center, 630 W 168th Street, New York, NY, 10032, USA
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Fernández-Lázaro D, Iglesias-Lázaro M, Garrosa E, Rodríguez-García S, Jerves Donoso D, Gutiérrez-Abejón E, Jorge-Finnigan C. Impact of Innovative Treatment Using Biological Drugs for the Modulation of Diffuse Cutaneous Systemic Sclerosis: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020247. [PMID: 36837449 PMCID: PMC9967997 DOI: 10.3390/medicina59020247] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023]
Abstract
Scleroderma or systemic sclerosis (SSc) is an autoimmune disease affecting the connective tissue, characterized by fibrosis of the skin and internal organs. There is currently no curative treatment available, so therapeutic action is aimed at a symptomatic treatment of the affected organs. The development of biotechnology has made it possible to implement certain biological drugs that could represent a window of opportunity to modulate the evolution and symptomatology of scleroderma with greater efficacy and less toxicity than conventional treatments. This study aimed to review the current evidence critically and systematically on the effects of biological drugs on the pulmonary function, skin disease, and health status of patients afflicted by diffuse cutaneous systemic sclerosis (dcSSc). Three electronic databases (Pubmed, Dialnet, and Cochrane Library Plus) were systematically searched until the cut-off date of October 2022. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included original articles in English and Spanish with a controlled trial design, comparing biological drug treatments (tocilizumab, belimumab, riociguat, abatacept, and romilkimab) with a control group. The methodological quality of the studies was assessed using the McMaster quantitative form and the PEDro scale. A total of 383 studies were identified, 6 of them met the established criteria and were included in the present systematic review. A total of 426 patients treated with tocilizumab, belimumab, riociguat, abatacept, and romilkimab were included. The results showed substantial non-significant (p < 0.05) improvement trends after treatment with the biological drugs included in this review for the modified Rodnan Scale Value, Forced Vital Capacity, and Carbon Monoxide Diffusion Test; however, no benefits were shown on the Health Assessment Questionnaire-Disability Index when compared to the control group. Biological drugs, therefore, maybe a new therapeutic strategy for dcSSc and could be recommended as an additional and/or adjunctive treatment that promotes anti-fibrotic activity. This review could further define the clinical rationale for the use of biologics in the treatment of dcSSc and could provide key details on the study protocol, design, and outcome reporting.
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Affiliation(s)
- Diego Fernández-Lázaro
- Department of Cellular Biology, Genetics, Histology and Pharmacology, Faculty of Health Sciences, University of Valladolid, Campus of Soria, 42004 Soria, Spain
- Neurobiology Research Group, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain
- Correspondence: (D.F.-L.); (E.G.)
| | - María Iglesias-Lázaro
- Department of Cellular Biology, Genetics, Histology and Pharmacology, Faculty of Health Sciences, University of Valladolid, Campus of Soria, 42004 Soria, Spain
| | - Evelina Garrosa
- Neurobiology Research Group, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain
- Correspondence: (D.F.-L.); (E.G.)
| | - Saray Rodríguez-García
- Department of Medicine, Faculty of Health Sciences, University of Valladolid, Campus of Soria, 42003 Soria, Spain
- Internal Medicine Department of Soria University Assistance Complex (CAUSO), Santa Bárbara Hospital, Castile and Leon Health (SACyL), 42005 Soria, Spain
| | - David Jerves Donoso
- Pneumology Department of Soria University Assistance Complex (CAUSO), Santa Bárbara Hospital, Castile and Leon Health (SACyL), 42003 Soria, Spain
- Department of Anatomy and Radiology, Faculty of Health Sciences, University of Valladolid, Campus of Soria, 42004 Soria, Spain
| | - Eduardo Gutiérrez-Abejón
- Pharmacological Big Data Laboratory, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain
- Pharmacy Directorate, Castile and Leon Health Council, 47007 Valladolid, Spain
| | - Conrado Jorge-Finnigan
- Department of Anatomy and Radiology, Faculty of Health Sciences, University of Valladolid, Campus of Soria, 42004 Soria, Spain
- Dermatology Department of Soria University Assistance Complex (CAUSO), Santa Bárbara Hospital, Castile and Leon Health (SACyL), 42005 Soria, Spain
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Wulani V, Budianto T, Amal MY. Variation of usual interstitial pneumonia using HRCT in Scleroderma Patients. Radiol Case Rep 2022; 17:336-339. [PMID: 34876961 PMCID: PMC8633518 DOI: 10.1016/j.radcr.2021.10.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 12/04/2022] Open
Abstract
Progressive Systemic Sclerosis or Scleroderma is a systemic inflammation marked by endothelial damaged, fibrosis, and inflammation in skin, joints, and visceral organs. Pulmonary hypertension and interstitial pulmonary disease (Ssc-ILD) are the most reported pulmonary complications in scleroderma patients. The pathogenesis of SSc- ILD is not well understood and the spectrum of SSc-ILD ranges from minimal lung involvement, which is often non-progressive, to severe illnesses. Usual Interstitial Pneumonia's (UIP) is one pattern of Ssc-ILD, marked in one-third of the patients with characteristic of honeycomb appearance and bronchiectasis. It is very important to determine the UIP based on radiology imaging especially with the presence of a poor prognosis in patients with UIP. This case report will discuss the importance of finding UIP-type ILD patterns based on HRCT in patients with scleroderma and different outcome.
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Affiliation(s)
- Vally Wulani
- Department of Radiology, Faculty of Medicine, University of Indonesia- Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Taufik Budianto
- Department of Radiology, Faculty of Medicine, University of Indonesia- Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Mohamad Yanuar Amal
- Department of Radiology, Faculty of Medicine, University of Indonesia- Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Caminati A, Vigone B, Cozzaglio S, De Nigris P, Galetti I, Nunzio SD, Verzeletti V, Cighetti J, Garbagnati C, Paleari L, Tabaglio E, Pirri S. Expert opinion and patients' in-depth interviews on the impact of pulmonary complications in systemic sclerosis. Curr Med Res Opin 2021; 37:17-26. [PMID: 34726093 DOI: 10.1080/03007995.2021.1992370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To qualitatively explore the perceptions and opinions of experts dealing with systemic sclerosis (SSc) and patients with SSc on the impact of the disease and pulmonary complications on economic status, psycho-social wellbeing and the diagnostic and therapeutic journey, and to identify which strategies/interventions may be useful to address patients' and their family's needs. METHODS An expert meeting was conducted using the NGT to discuss the consequences of pulmonary complications on the Italian SSc community. The direct experience of five patients with SSc and pulmonary complications was described through in-depth interviews conducted by psychologists. RESULTS The experts' meeting and patients' in-depth interviews underline the complexity of SSc and the consequences of pulmonary involvement on patients' and caregivers' health-related quality of life, working ability, psychological wellbeing and social interactions. Panellists suggest that improved communication between physicians, associations and institutions could help protect the working status of patients with SSc. Granting patients disability benefits, providing access to part-time jobs and productivity-focused training could also help decrease the economic burden of the disease. A multidisciplinary approach is recommended to reduce treatment burden, together with the implementation of standard diagnostic and therapeutic paths and increased use of telemedicine via platforms that ensure secure health data sharing. Both patients and caregivers may benefit from psychological support. CONCLUSION SSc and pulmonary fibrosis have profound consequences on patients' and caregivers' health-related quality of life, working ability, psychological wellbeing and social interactions. Some activities may help patients and families deal with these aspects of the disease.
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Affiliation(s)
- Antonella Caminati
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, MultiMedica IRCCS, Milan, Italy
| | - Barbara Vigone
- Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
- UOC Medicina Generale Allergologia e Immunologia Clinica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Sergio Cozzaglio
- Gruppo Italiano per la Lotta alla Sclerodermia (GILS), Milano, Italy
| | | | - Ilaria Galetti
- Gruppo Italiano per la Lotta alla Sclerodermia (GILS), Milano, Italy
| | | | | | | | - Carla Garbagnati
- Gruppo Italiano per la Lotta alla Sclerodermia (GILS), Milano, Italy
| | - Laura Paleari
- Gruppo Italiano per la Lotta alla Sclerodermia (GILS), Milano, Italy
| | | | - Salvatore Pirri
- Institute of Management, Scuola Superiore Sant'Anna di Pisa, Pisa, Italy
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Hoffmann-Vold AM, Maher TM, Philpot EE, Ashrafzadeh A, Distler O. Assessment of recent evidence for the management of patients with systemic sclerosis-associated interstitial lung disease: a systematic review. ERJ Open Res 2021; 7:00235-2020. [PMID: 33644224 PMCID: PMC7897846 DOI: 10.1183/23120541.00235-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022] Open
Abstract
This systematic review summarises current evidence to help guide treatment decisions for patients with systemic sclerosis (SSc)-associated interstitial lung disease (ILD). A systematic search of the literature (January 2012 to April 2018), including grey literature (searched between 1992 and 2011), was conducted using multiple electronic databases. Guidelines, meta-analyses, randomised controlled trials and observational studies reporting on risk stratification, screening, diagnosis, treatment and management outcomes for patients with SSc-ILD were included. A quality assessment of the included evidence was undertaken. In total, 2464 publications were identified and 280 included. Multiple independent risk factors for ILD in patients with SSc were identified, including older age, male sex and baseline pulmonary function. High-resolution computed tomography (HRCT) has been used for characterising ILD in patients with SSc, and pulmonary function tests are a key adjunctive component in the diagnostic and monitoring pathway. The clinical value of biomarkers relating to SSc-ILD diagnosis or assessment for disease progression is unknown at present. Immunosuppressive therapy (monotherapy or combined therapy) is the current standard of care for SSc-ILD; long-term evidence for effective and safe treatment of SSc-ILD is limited. Identification of patients at risk for SSc-ILD remains challenging. HRCT and pulmonary function tests are key to diagnosing and monitoring for disease progression. Although immunosuppressive therapy is considered current first-line treatment, it is partly associated with adverse effects and long-term follow-up evidence is limited. Novel therapies and biomarkers should be further explored in well-controlled clinical studies.
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Affiliation(s)
- Anna-Maria Hoffmann-Vold
- Dept of Rheumatology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
- These authors contributed equally
| | - Toby M. Maher
- National Institute of Health Research Respiratory Clinical Research Facility, Royal Brompton Hospital, London, UK
- Fibrosis Research Group, National Heart and Lung Institute, Imperial College London, London, UK
- These authors contributed equally
| | | | - Ali Ashrafzadeh
- Rheumatology Center of Excellence, IQVIA, San Diego, CA, USA
| | - Oliver Distler
- Dept of Rheumatology, University Hospital Zurich, Zurich, Switzerland
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Vaiarello V, Schiavetto S, Foti F, Gigante A, Iannazzo F, Paone G, Palange P, Rosato E. Mycophenolate Mofetil Improves Exercise Tolerance in Systemic Sclerosis Patients with Interstitial Lung Disease: A Pilot Study. Rheumatol Ther 2020; 7:1037-1044. [PMID: 32862407 PMCID: PMC7695784 DOI: 10.1007/s40744-020-00232-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Systemic sclerosis (SSc) is an autoimmune disease characterized by the overproduction of collagen leading to fibrosis of the skin and internal organs. Interstitial lung disease (ILD) is one of the major causes of death in patients with SSc. Exercise tolerance can be investigated by cardio-pulmonary exercise testing (CPET). First-line therapies in patients with SSc associated with ILD (SSc-ILD) include cyclophosphamide and mycophenolate mofetil (MMF). The aim of this study was to evaluate the response of patients with SSc-ILD to MMF by means of CPET. METHODS Ten consecutive SSc patients were enrolled in this study. All SSc patients underwent clinical evaluation, echocardiography, pulmonary function tests, high-resolution computed tomography (HRCT) and CPET at baseline and after 2 years of therapy with MMF. RESULTS After 24 months of treatment with MMF (target dose 1500 mg twice daily), forced vitality capacity, diffusing capacity of the lungs for carbon monoxide and systolic pulmonary arterial pressure had not improved significantly and there were no significant differences in HRCT findigns. In addition, peak oxygen uptake (V'O2 peak) and ventilatory equivalents for carbon dioxide production (V'E/V'CO2 slope) had not improved significantly. In contrast, there was a significant improvement from baseline to 24 months of treatment in the respiratory exchange ratio [median (interquartile range): 1.07 (0.92-1.22) vs. 1.26 (1.22-1.28), respectively; p < 0.01] and in the Borg scale for leg discomfort [median (interquartile range): 5 (5-7) vs. 4 (3-4), respectively; p < 0.01] . CONCLUSION These data from our pilot study on a small cohort of SSc patients are the first to demonstrate that treatment with MMF can improves exercise tolerance and leg discomfort in patients with SSc-ILD. These preliminary results need to be confirmed in large randomized studies.
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Affiliation(s)
- Valentina Vaiarello
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Stefano Schiavetto
- Department of Public Health and Infectious Diseases, Lung Function and Exercise Section, Sapienza University, Rome, Italy
| | - Federica Foti
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Francesco Iannazzo
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Gregorino Paone
- Department of Public Health and Infectious Diseases, Lung Function and Exercise Section, Sapienza University, Rome, Italy
| | - Paolo Palange
- Department of Public Health and Infectious Diseases, Lung Function and Exercise Section, Sapienza University, Rome, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy.
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Orlandi M, Lepri G, Bruni C, Wang Y, Bartoloni A, Zammarchi L, Cometi L, Guiducci S, Matucci-Cerinic M, Bellando-Randone S. The systemic sclerosis patient in the COVID-19 era: the challenging crossroad between immunosuppression, differential diagnosis and long-term psychological distress. Clin Rheumatol 2020; 39:2043-2047. [PMID: 32514674 PMCID: PMC7276334 DOI: 10.1007/s10067-020-05193-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/07/2020] [Accepted: 05/19/2020] [Indexed: 12/18/2022]
Abstract
COVID-19 is a world health emergency which may inevitably affect the management of a complex autoimmune disease such as systemic sclerosis (SSc). Several SSc patients are frail and, in this pandemic, need a careful protection. The COVID-19 infection might complicate the clinical scenario of interstitial lung disease (ILD) in SSc because it determines a severe pneumonia characterized by radiological features similar to SSc-ILD. The striking CT similarities between the 2 diseases make it difficult to distinguish a worsening of SSc-ILD from COVID-19-ILD superinfection. Moreover, other aspects, like isolation during lock down, may cause a significant psychological stress which will pile up on the already difficult contact with the patients for a routine check-up. Moreover, the drug shortage is a real problem in these times. For these reasons, the rheumatologist in daily clinical practice should carefully differentiate the possible COVID-19 infection in order to optimize the patient management. Therefore, the challenge in everyday life will be to achieve in due time the differential diagnosis as well as the long-term psychological impact.Key Points• SSc patients should be encouraged to continue their chronic therapy; in case of immunosuppressive therapy it must be discontinued for safety in case of COVID-19 infection.• Psychological support must be guaranteed to every SSc patients.• COVID-19 pneuminia is hard to distinguish from an interstitial lung disease due to SSc lung involvment.• Data sharing is fundamental for an optimal managment of SSc patients during COVID-19 pandemia.
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MESH Headings
- Betacoronavirus/isolation & purification
- COVID-19
- Comorbidity
- Coronavirus Infections/complications
- Coronavirus Infections/epidemiology
- Coronavirus Infections/physiopathology
- Coronavirus Infections/therapy
- Diagnosis, Differential
- Humans
- Immunosuppressive Agents/therapeutic use
- Lung Diseases, Interstitial/diagnosis
- Lung Diseases, Interstitial/etiology
- Pandemics
- Patient Care Management/methods
- Pneumonia, Viral/complications
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/physiopathology
- Pneumonia, Viral/therapy
- Psychological Distress
- SARS-CoV-2
- Scleroderma, Systemic/epidemiology
- Scleroderma, Systemic/psychology
- Scleroderma, Systemic/therapy
- Social Isolation/psychology
- Tomography, X-Ray Computed/methods
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Affiliation(s)
- Martina Orlandi
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology AOUC & Scleroderma Unit, University of Florence, Florence, Italy
| | - Gemma Lepri
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology AOUC & Scleroderma Unit, University of Florence, Florence, Italy
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology AOUC & Scleroderma Unit, University of Florence, Florence, Italy
| | - Yukai Wang
- Rheumatology and Immunology Department, Shantou Central Hospital, Affiliated Shantou Hospital of SUN YAT-SEN University, Shantou, China
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases Unit, AOUC, University of Florence, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases Unit, AOUC, University of Florence, Florence, Italy
| | - Laura Cometi
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology AOUC & Scleroderma Unit, University of Florence, Florence, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology AOUC & Scleroderma Unit, University of Florence, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology AOUC & Scleroderma Unit, University of Florence, Florence, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology AOUC & Scleroderma Unit, University of Florence, Florence, Italy
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Cheema TJ, Young M, Rabold E, Barbieri AN, Baldwin N, Steen VD. Patient and Physician Perspectives on Systemic Sclerosis-Associated Interstitial Lung Disease. Clin Med Insights Circ Respir Pulm Med 2020; 14:1179548420913281. [PMID: 32214863 PMCID: PMC7081464 DOI: 10.1177/1179548420913281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/23/2020] [Indexed: 12/22/2022] Open
Abstract
Systemic sclerosis-associated interstitial lung disease is challenging to diagnose and treat. Patients and physicians can perceive the disease differently and have different views on its management. Communication issues between them can lead to suboptimal disease management. Despite a clear need for improvement in the speed and accuracy of the diagnostic workup, the heterogeneity of clinical symptoms renders the process long and challenging. When considering treatment options, physicians may be more focused on the evidence supporting a particular treatment or on a patient's pulmonary function test results, as opposed to the realities of the patient's difficulties with symptoms or the psychosocial effects of systemic sclerosis-associated interstitial lung disease. Disease management plans should be determined by the patient's own preferences and goals as well as the objective clinical situation. Health care providers must consider their patients as partners on a journey in which treatment decisions are reached jointly. This review will focus on the perspectives of physicians and patients in relation to the diagnosis and management of systemic sclerosis-associated interstitial lung disease. Similarities and differences in these perspectives will be identified, and strategies for achieving optimal disease management will be proposed.
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Affiliation(s)
- Tariq J Cheema
- Division of Pulmonary and Critical Care Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Meilin Young
- Division of Pulmonary and Critical Care Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Erica Rabold
- Division of Pulmonary and Critical Care Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Ashley N Barbieri
- Division of Pulmonary and Critical Care Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | | | - Virginia D Steen
- Division of Rheumatology, Department of Medicine, School of Medicine, Georgetown University, Washington, DC, USA
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10
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Ravanetti F, Ragionieri L, Ciccimarra R, Ruscitti F, Pompilio D, Gazza F, Villetti G, Cacchioli A, Stellari FF. Modeling pulmonary fibrosis through bleomycin delivered by osmotic minipump: a new histomorphometric method of evaluation. Am J Physiol Lung Cell Mol Physiol 2019; 318:L376-L385. [PMID: 31851533 PMCID: PMC7052681 DOI: 10.1152/ajplung.00311.2019] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The systemic delivery of bleomycin (BLM) to mice through subcutaneously implanted osmotic minipumps may be used to experimentally mimic the typical features of systemic sclerosis and related interstitial lung diseases. The published studies on this model principally have focused on induced dermal modifications, probably because lung lesions are typically mild, subpleurally localized, and difficult to analyze. The use of high BLM doses to increase their severity has been proposed but is ethically questionable because of the compromising of animal welfare. We propose a tailored histomorphometric method suitable to detect and quantify this type of mild lung lesions. Using a two-step automated image analysis, a peripheral region of interest with a depth of 250 µm from the pleural edge was defined on whole slide images, and the fibrotic foci were histomorphometrically characterized. The effects of different BLM doses on lung alterations were evaluated in C57BL/6 mice and 60 U/kg resulted in a fair compromise between fibrotic lesions and animal welfare. This dose was also tested in time course experiments. The analysis revealed a peak of histological fibrotic-like alterations, cytokine expression, metalloprotease, and macrophagic activation between the 21st and 28th day after pump implant. The induced dermal fibrosis was characterized by the progressive loss of the white dermal adipose layer, an increase in dermal thickness, dermal hyperplasia, and more compacted collagen fibers. Despite the trend toward spontaneous resolution, our model allowed a double organ readout of the BLM effect and the identification of a therapeutic window for testing pharmacological compounds without using life-threatening doses.
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Affiliation(s)
| | - Luisa Ragionieri
- Department of Veterinary Science, University of Parma, Parma, Italy
| | | | | | - Daniela Pompilio
- Corporate Preclinical R&D, Chiesi Farmaceutici S.p.A., Parma, Italy
| | - Ferdinando Gazza
- Department of Veterinary Science, University of Parma, Parma, Italy
| | - Gino Villetti
- Corporate Preclinical R&D, Chiesi Farmaceutici S.p.A., Parma, Italy
| | | | - Fabio F Stellari
- Corporate Preclinical R&D, Chiesi Farmaceutici S.p.A., Parma, Italy
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11
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Fischer A, Patel NM, Volkmann ER. Interstitial Lung Disease in Systemic Sclerosis: Focus on Early Detection and Intervention. Open Access Rheumatol 2019; 11:283-307. [PMID: 31849543 PMCID: PMC6910104 DOI: 10.2147/oarrr.s226695] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/09/2019] [Indexed: 12/11/2022] Open
Abstract
Systemic sclerosis (SSc) is a progressive and often devastating disease characterized by autoimmune dysfunction, vasculopathy, and fibrosis. Interstitial lung disease (ILD) is identified in the majority of patients with SSc and is the leading cause of SSc-related mortality. Although clinical manifestations and ILD severity vary among patients, lung function typically declines to the greatest extent during the first 3-4 years after disease onset. We aim to provide an overview of SSc-associated ILD (SSc-ILD) with a focus on current and emerging tools for early diagnosis of ILD and current and novel treatments under investigation. Early detection of ILD provides the opportunity for early therapeutic intervention, which could improve patient outcomes. Thoracic high-resolution computed tomography is the most effective method of identifying ILD in patients with SSc; it enables detection of mild lung abnormalities and plays an important role in monitoring disease progression. Cyclophosphamide and mycophenolate mofetil are the most commonly prescribed treatments for SSc-ILD. Recently, nintedanib (an antifibrotic) was approved by the Food and Drug Administration for patients with SSc-ILD; it is indicated for slowing the rate of decline in pulmonary function. However, there is a need for additional effective and well-tolerated disease-modifying therapy. Ongoing studies are evaluating other antifibrotics and novel agents. We envision that early detection of lung involvement, combined with the emergence and integration of novel therapies, will lead to improved outcomes in patients with SSc-ILD.
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Affiliation(s)
- Aryeh Fischer
- Division of Rheumatology, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Denver, CO, USA
| | - Nina M Patel
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Elizabeth R Volkmann
- Division of Rheumatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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