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Pawar A, Joshi P, Singhai A. Study on disease activity of immunological disorders to correlate with thyroid function and other associated correlations. J Family Med Prim Care 2024; 13:896-902. [PMID: 38736834 PMCID: PMC11086795 DOI: 10.4103/jfmpc.jfmpc_1053_23] [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: 06/25/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 05/14/2024] Open
Abstract
Background Organ-specific immunological disorders involving organ/gland like the thyroid, liver, muscles, pancreas, etc., is a result of autoimmunity which can be with or without association with systemic immunological disorders. The thyroid gland is most commonly involved. We evaluated thyroid dysfunction and ESR among various immunological disorders and their correlation with disease activity and hemoglobin respectively. Material and Methods A cross-sectional/observational study was conducted by including 110 patients with different immunological disorders who came in as in-patients and outpatients in our institute for 18 months and various data were collected and evaluated to analyze the targeted parameters among the study group. Results We found a positive correlation between disease activity and thyroid dysfunction in different immunological disorders (only in Rheumatoid arthritis [P = 0.004) and Systemic lupus erythematosus (0.009) and not in other immunological disorders] among the study group. A positive correlation was found between ESR (Mean value - 19.63 and Standard Deviation (SD) - 09.473) and disease activity (only in Rheumatoid arthritis P = 0.0001) where a negative correlation was found between ESR and Hemoglobin (Mean value - 11.07 and SD - 01.91 (P = 0.001) in patients under study. Conclusion Our study demonstrated a positive correlation between thyroid dysfunction and ESR with disease activity, whereas demonstrated a negative correlation between ESR and Hemoglobin in patients with various immunological disorders under study.
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Affiliation(s)
- Akash Pawar
- Department of General Medicine, AIIMS, Bhopal, Madhya Pradesh, India
| | - Prakash Joshi
- Department of Medicine, Sri Aurobindo Institute of Medical Sciences and PGI, Indore, Madhya Pradesh, India
| | - Abhishek Singhai
- Department of General Medicine, AIIMS, Bhopal, Madhya Pradesh, India
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2
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Hafez AE, Taha AM, Moshrif A, Aly HM, Abdel Noor R, Mortada M, Elkhouli R. Ultrasound abnormalities of the major salivary glands in Egyptian patients with systemic sclerosis. Clin Rheumatol 2023; 42:3351-3360. [PMID: 37721645 PMCID: PMC10640493 DOI: 10.1007/s10067-023-06763-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/20/2023] [Accepted: 08/27/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION/OBJECTIVES systemic sclerosis (SSc) is an autoimmune disorder with multiple organs destruction. This study aimed to identify the ultrasonographic changes of major salivary glands in Egyptian scleroderma patients and to detect their association to different disease manifestations. METHODS Forty-seven SSc patients and 43 apparent healthy volunteers were enrolled. Demographics, inflammatory markers, and autoimmune status were recorded. Ultrasound evaluation of salivary glands was performed. Salivary gland changes' associations were statistically examined with SSc susceptibility and disease manifestations. RESULTS Thirty-one SSc patients exhibited glandular pathology (p < 0.0001), compared to controls. Of these abnormalities, SSc patients showed a total parotid gray scale of 2, total submandibular gray scale of 2, total glandular gray scale of 4, and total glandular Doppler signal of 1 at p < 0.0001, compared to the control group. Patients with SSc and glandular pathology had a higher prevalence of arthritis (p = 0.029) and ESR (p = 0.002) than those with normal glandular ultrasound. Significant associations were reported between gray scale ultrasound (GSUS) of total parotid (odds ratio "OR" = 0.4), total submandibular (OR = 0.36), and total glandular (OR = 0.53) with susceptibility to SSc at p < 0.0001. Total glandular GSUS (p = 0.039) and total submandibular power Doppler (p = 0.044) correlated with the SSc duration. Total parotid GSUS (p = 0.008) and total glandular GSUS (p < 0.0001) correlated with Schirmer's test. CONCLUSIONS Major salivary glands are affected in SSc. Hence, scanning these glands with ultrasound is an additive tool besides the current practice. Key Points • Major salivary gland changes, observed by ultrasonography, are new findings in Egyptian SSc patients. • Ultrasound changes of major salivary glands are associated with inflammatory markers and clinical manifestations of SSc. • Scleroderma ultrasonography scans of the main salivary glands could be added to the routine work.
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Affiliation(s)
- Ahmed E Hafez
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Minia University, Minia, Egypt.
| | - AlShaimaa M Taha
- Department of Biochemistry, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Abdelhfeez Moshrif
- Department of Rheumatology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Hany M Aly
- Rheumatology and Rehabilitation, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Rasha Abdel Noor
- Department of Internal Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Mortada
- Department of Rheumatology and Rehabilitation, Zagazig University, Zagazig, Egypt
| | - Radwa Elkhouli
- Department of Rheumatology, Rehabilitation, and Physical Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
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3
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Ross L, Nikpour M. Composite measures to assess disease damage, disease severity and treatment response in systemic sclerosis clinical trials. Curr Opin Rheumatol 2023; 35:334-340. [PMID: 37650689 DOI: 10.1097/bor.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to summarize the composite outcome measures available to assess disease damage, severity and treatment response in systemic sclerosis (SSc). RECENT FINDINGS There have been many recent efforts to rigorously develop and validate composite outcome measures to assess the totality of the impact of SSc on patients. All initiatives have used both consensus and data-driven methods. Recently developed are a SSc-specific damage index, a patient-reported disease impact questionnaire (ScleroID) and a treatment response index (ACR-CRISS). SUMMARY Multiorgan, composite measures are being increasingly applied to assess treatment efficacy in clinical trials. Although a fully validated, disease-specific composite measure is not yet available, there has been significant recent progress towards developing measures of treatment response, damage and overall impact of SSc for application in randomized controlled trials.
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Affiliation(s)
- Laura Ross
- Department of Medicine at St Vincent's Hospital, University of Melbourne
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Mandana Nikpour
- Department of Medicine at St Vincent's Hospital, University of Melbourne
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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4
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Klotsche J, Torok KS, Kasapcopur O, Adrovic A, Terreri MT, Sakamoto AP, Katsicas M, Sztajnbok F, Marrani E, Sifuentes-Giraldo A, Stanevicha V, Anton J, Feldmann B, Kostik M, Nemcova D, Santos MJ, Appenzeller S, Avcin T, Battagliotti C, Berntson L, Bica B, Brunner J, Eleftheriou D, Harel L, Horneff G, Kallinich T, Minden K, Nielsen S, Patwardhan A, Helmus N, Foeldvari I. Application and performance of disease activity indices proposed for patients with systemic sclerosis in an international cohort of patients with juvenile systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2023; 8:183-191. [PMID: 37744052 PMCID: PMC10515993 DOI: 10.1177/23971983231164700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/25/2023] [Indexed: 09/26/2023]
Abstract
Objectives Juvenile systemic sclerosis is a rare childhood disease. Three disease activity indices have been published for adult patients with systemic sclerosis: the European Scleroderma Study Group Index, a modified version of the European Scleroderma Study Group Index and the revised European Scleroderma Trials and Research index. The objective of this study was to determine the feasibility and performance of the three disease activity indices in a prospectively followed cohort of patients with juvenile systemic sclerosis. Methods The analysis cohort was selected from the prospective international inception cohort enrolling juvenile systemic sclerosis patients. The correlation of the disease activity indices with the physicians' and the patients' global assessment of disease activity was determined. The disease activity indices were compared between patients with active and inactive disease. Sensitivity to change between 6- and 12-month follow-up was investigated by mixed models. Results Eighty percent of the 70 patients had a diffuse cutaneous subtype. The revised European Scleroderma Trials and Research index was highly correlated with the physician-reported global disease activity/parents-reported global disease activity (r = 0.74/0.64), followed by the European Scleroderma Study Group activity index (r = 0.61/0.55) and the modified version of the European Scleroderma Study Group activity index (r = 0.51/0.43). The disease activity indices significantly differed between active and inactive patients. The disease activity indices showed sensitivity to change between 6- and 12-month follow-up among patients who improved or worsened according to the physician-reported global disease activity and the parents-reported global disease activity. Conclusion Overall, no disease activity score is superior to the other, and all three scores have limitations in the application in juvenile systemic sclerosis patients. Furthermore, research on the concept of disease activity and suitable scores to measure disease activity in patients with juvenile systemic sclerosis is necessary in future.
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Affiliation(s)
- Jens Klotsche
- German Rheumatism Research Center, A Leibniz Institute, Berlin, Germany
| | - Kathryn S Torok
- University of Pittsburgh, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | | | - Maria Katsicas
- Hospital de Pediatria J.P. Garrahan, Buenos Aires, Argentine
| | | | | | | | - Valda Stanevicha
- Department of Pediatrics, Riga Stradins University, University Children Hospital, Riga, Latvia
| | - Jordi Anton
- Pediatric Rheumatology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Brian Feldmann
- SickKids, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mikhail Kostik
- Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | | | | | - Simone Appenzeller
- School of Medical Science, State University of Campinas, Campinas, Brazil
| | - Tadej Avcin
- University Children’s Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
| | | | - Lillemor Berntson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Blanca Bica
- Hospital Universitário Clementino Fraga Filho (HUCFF), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jürgen Brunner
- Department of Pediatrics, Pediatric Rheumatology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Liora Harel
- Schneider Children’s Medical Center, Tel Aviv University, Petah Tikva, Israel
| | - Gerd Horneff
- Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany
| | - Tilmann Kallinich
- Charité University Medicine and German Rheumatism Research Center Berlin, Berlin, Germany
| | - Kirsten Minden
- German Rheumatism Research Center, A Leibniz Institute, Berlin, Germany
- Charité University Medicine and German Rheumatism Research Center Berlin, Berlin, Germany
| | | | | | - Nicola Helmus
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Schön Klinik Hamburg Eilbek, Hamburg, Germany
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5
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Ross L, Nikpour M, D'Aoust J, Khanna D, Merkel PA, Pauling JD, Baron M. Patient and Physician Global Assessments of Disease Status in Systemic Sclerosis. Arthritis Care Res (Hoboken) 2022. [PMID: 36342397 DOI: 10.1002/acr.25056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/11/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
Global assessments of disease by both patients and physicians are widely used in clinical studies of systemic sclerosis (SSc). They are commonly secondary end points in randomized controlled trials (RCTs) and are considered important items in composite measures of treatment response. A comprehensive literature review was conducted of the formats, wording, and clinimetric properties of the patient global assessment of disease status (PtGA) and physician global assessment of disease status (PhGA) used in RCTs of SSc. Marked heterogeneity was found in the wording and measurement scales of the global assessments applied in RCTs. These instruments were not developed using rigorous methodology and have not been fully validated. There is a pressing need for standardization and validation of patient and physician global assessment tools in SSc to enable universal application of these measures across RCTs in SSc.
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Affiliation(s)
- Laura Ross
- The University of Melbourne at St Vincent's Hospital and St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Mandana Nikpour
- The University of Melbourne at St Vincent's Hospital and St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Julie D'Aoust
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | | | - Murray Baron
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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6
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Wuttge DM, Chaplin JE, Sandqvist G. Validation of the Swedish version of PROMIS-29v2 and FACIT-Dyspnea Index in patients with systemic sclerosis. Disabil Rehabil 2022:1-9. [PMID: 36129325 DOI: 10.1080/09638288.2022.2096124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate the reliability, internal consistency, and construct validity of the Swedish versions of PROMIS-29 and Functional Assessment of Chronic Illness Therapy-Dyspnea (FACIT-Dyspnea) instruments in patients with systemic sclerosis (SSc). METHODS In a cross-sectional study, consecutive SSc patients completed a paper-based survey. Internal consistency was assessed using Cronbach's alpha. Test-retest reliability was tested employing weighted Kappa (Kw) and intra-class correlation coefficient (ICC). Construct validity was evaluated by hypotheses testing using RAND-36, MRC Dyspnea score, Scleroderma Health Assessment Questionnaire (SHAQ) and clinical measurements. RESULTS Forty-nine patients (86% female; 73% limited cutaneous SSc) completed the survey. The mean disease duration was 11 years and mean SHAQ was 0.5. Internal consistency and test-retest reliability were good with the exception of PROMIS-29 anxiety. PROMIS-29, FACIT-Dyspnea, and Functional limitation showed strong correlations to corresponding RAND-36 domains (|rs|=0.67 to -0.85). Relevant PROMIS-29 domains, FACIT-Dyspnea and Functional limitation correlated strongly to SHAQ and VAS overall disease severity (|rs|=0.60 to -0.75). Ceiling effects (>15%) were found in six PROMIS-29 domains and in both FACIT-Dyspnea and Functional limitations. Four (4/5) hypotheses were confirmed. CONCLUSIONS PROMIS-29 and FACIT-Dyspnea meet the requirements for reliability and have adequate construct validity in Swedish patients with SSc.Implications for rehabilitationPROMIS-29v2 and Functional Assessment of Chronic Illness Therapy-Dyspnea (FACIT-Dyspnea) Index are patient outcome measures that gain increasing interest for the evaluation of patient with rheumatologic diseases.PROMIS-29v2 and FACIT-Dyspnea Index meet the requirements for reliability and have adequate construct validity compared to legacy measures in Swedish patients with systemic sclerosis.Translation and validation of PROMs is important for studies of rare diseases in multi-center collaborations.
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Affiliation(s)
- Dirk M Wuttge
- Department of Clinical Sciences Lund, Rheumatology, Lund University and Skåne University Hospital, Lund, Sweden
| | - John E Chaplin
- Institution of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Gunnel Sandqvist
- Department of Clinical Sciences Lund, Rheumatology, Lund University and Skåne University Hospital, Lund, Sweden
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7
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Gokcen N, Badak SO, Sarpel T, Sertdemir Y, Erken E. The Efficacy of a Home-Based, Self-Administered Hand Exercise Program for Patients With Systemic Sclerosis: A Randomized Controlled, Evaluator-Blind, Clinical Trial. J Clin Rheumatol 2022; 28:e422-e429. [PMID: 34030163 DOI: 10.1097/rhu.0000000000001752] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND For patients with systemic sclerosis (SSc), hand involvement is an underrated clinical manifestation. Therefore, the aim of this study was to investigate the efficacy of a hand exercise program and to demonstrate its effect on hand function, quality of life, anxiety, and depression in patients with SSc. METHODS This study was designed as a single blind, randomized controlled comparative study. Sixty-two female patients with SSc were randomized into an exercise group (n = 32) or a control group (n = 30). After some were lost to follow-up, 25 patients were analyzed in each group. In the exercise group, the 8-week intervention consisted of isometric hand exercises and self-administered stretching repeated 10 times/2 sets per day. All patients were assessed using the Hand Mobility in Scleroderma (HAMIS) test, the Duruoz Hand Index (DHI), grip strength, the 36-item short form, Health Assessment Questionnaire-Disability Index (HAQ-DI), Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI) at baseline and then again 4 and 8 weeks later. Within-group comparisons over time were analyzed using the Friedman test. Post hoc analysis was performed using the Wilcoxon signed rank test. A multiple linear regression analysis was used to define the impact of exercise on clinical status. RESULTS Of the 50 total patients, the median age and the median body mass index were 55.5 years and 25.9 kg/m2. The median disease duration was 10.0 years. Thirty-four patients (68.0%) were diffuse cutaneous systemic sclerosis (dcSSC), whereas 16 (32.0%) were limited cutaneous systemic sclerosis (lcSSc). The primary outcome of handgrip strength, as well as the HAMIS, DHI, HAQ-DI, and BDI, significantly improved over time (p < 0.001, p < 0.001, p < 0.001, p < 0.001, and p = 0.005, respectively). The between-group comparison indicated significant improvement in DHI, handgrip strength, HAQ-DI, BAI, and BDI in the exercise group (p = 0.02, p = 0.013, p < 0.001, p = 0.015, and p = 0.036, respectively). In the multiple linear regression analysis, exercise was found to be the most efficient factor affecting the improvement in HAMIS, DHI, HAQ-DI, and grip strength. CONCLUSIONS The 8-week intervention composed of isometric hand exercises and self-administered stretching provided a significant improvement in handgrip strength, general health, quality of life, and psychological status for patients with SSc.
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Affiliation(s)
- Neslihan Gokcen
- From the Division of Rheumatology, Department of Physical Medicine and Rehabilitation
| | | | - Tunay Sarpel
- Department of Physical Medicine and Rehabilitation
| | - Yasar Sertdemir
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Eren Erken
- Division of Rheumatology, Department of Internal Medicine
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8
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Ross L, Stevens W, Wilson M, Huq M, Strickland G, Walker J, Sahhar J, Ngian GS, Roddy J, Youssef P, Proudman S, Nikpour M. Performance of the 2017 EUSTAR activity index in an scleroderma cohort. Clin Rheumatol 2020; 39:3701-3705. [PMID: 32696281 DOI: 10.1007/s10067-020-05126-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 11/28/2022]
Abstract
Assessment of disease activity in systemic sclerosis (SSc) is limited by the absence of a fully validated, multisystem measure of disease activity. The European Scleroderma Trials and Research Group (EUSTAR) SSc activity index (EScSG-AI) was recently revised, and a validation study within the EUSTAR cohort was performed. In this study, we evaluated the performance of the revised EScSG-AI in an external Australian cohort. The association between the EScSG-AI and the physician global assessment of disease activity (PhGA), both collected prospectively at each annual visit over up to 12 years follow-up, was evaluated using Pearson's correlation coefficient and Cohen's kappa coefficient. Generalized linear modelling and time-dependent Cox regression analysis were performed to determine the association of disease activity measured by the EScSG-AI and the summed Medsger Severity Scale (MSS) and death, respectively. There was a moderate correlation between EScSG-AI and PhGA scores (r 0.42, p < 0.001) and moderate association between rising EScSG-AI and summed MSS (r 0.60, p < 0.001). High disease activity, measured by the EScSG-AI at any time during follow-up, was associated with a hazard ratio of 2.07 (95% CI 1.51-2.79) for mortality. The EScSG-AI has a moderate correlation with physician-assessed SSc disease activity. This suggests that the criterion and construct validity of the EScSG-AI are yet to be demonstrated in an external cohort of SSc patients. Key Points •There remains no gold standard measure of SSc disease activity. •The revised 2017 EUSTAR SSc disease activity index shows moderate correlation with physician-rated global disease activity. •Significant work remains to develop a validated multisystem measure of disease activity in SSc.
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Affiliation(s)
- Laura Ross
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, Australia.,Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Michelle Wilson
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Molla Huq
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, Australia
| | - Gemma Strickland
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Jennifer Walker
- Rheumatology Unit, Flinders Medical Centre, Adelaide, Australia
| | - Joanne Sahhar
- Department of Rheumatology, Monash Health & Monash University, Melbourne, Australia.,Department of Medicine, Monash Health & Monash University, Melbourne, Australia
| | - Gene-Siew Ngian
- Department of Rheumatology, Monash Health & Monash University, Melbourne, Australia.,Department of Medicine, Monash Health & Monash University, Melbourne, Australia
| | - Janet Roddy
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Australia
| | - Peter Youssef
- Department of Rheumatology, Royal Prince Alfred Hospital, Sydney, Australia.,Department of Medicine, University of Sydney, Sydney, Australia
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, Australia. .,Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia.
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9
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Vadasz Z, Balbir Gurman A, Meroni P, Farge D, Levi Y, Ingegnoli F, Braun-Moscovici Y, Rosner I, Slobodin G, Rozenbaum M, Jiries N, Kaly L, Boulman N, Zilber K, Ginsberg S, Awisat A, Goldberg Y, Lurie M, Ghigna MR, Guignabert C, Humbert M, Rimar D. Lysyl oxidase-a possible role in systemic sclerosis-associated pulmonary hypertension: a multicentre study. Rheumatology (Oxford) 2020; 58:1547-1555. [PMID: 30770717 DOI: 10.1093/rheumatology/kez035] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 01/09/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Lysyl oxidase (LOX) is an extracellular enzyme that cross-links collagen fibrils. LOX was found to be increased in serum of SSc patients and was suggested to be related to skin fibrosis, yet a vascular source of LOX has been demonstrated in idiopathic pulmonary arterial hypertension (iPAH). We aimed to validate elevated LOX serum levels in SSc and to study its correlation with clinical characteristics and investigate its main source at the tissue level. METHODS A total of 86 established SSc patients were compared with 86 patients with very early diagnosis of systemic sclerosis (VEDOSS), 110 patients with primary RP (PRP) and 80 healthy controls. LOX serum levels were determined by ELISA. Five lung and 12 skin biopsies from SSc patients were stained for LOX and compared with controls. RESULTS Serum levels of LOX in SSc were significantly higher than in VEDOSS, PRP and healthy controls (P < 0.001). LOX inversely correlated with the diffusing capacity of the lung for carbon monoxide diffusing capacity (DLCO) in diffuse SSc (r = -0.376, P = 0.02). Patients with moderate to severe estimated systolic PAH had higher LOX levels (P < 0.01). Lung biopsies demonstrated intense LOX staining in SSc patients with PAH that was predominantly located in the endothelium of the remodelled pulmonary vessels. CONCLUSION Serum LOX levels are increased in established SSc and inversely correlate with the DLCO. LOX is elevated in patients with moderate to severe PAH and is located in the proliferating endothelium in lung arterioles, suggesting a possible role for LOX in SSc-associated PAH.
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Affiliation(s)
- Zahava Vadasz
- Division of Allergy and Clinical Immunology, Bnai-Zion Medical Center, Haifa, Israel
| | | | - Pierluigi Meroni
- Department of Clinical Sciences and Community Health, University of Milan, Division of Rheumatology, Milan, Italy
| | - Dominique Farge
- Internal Medicine, St-Louis Hospital, AP-HP, CRMR for Rare Systemic Autoimmune Diseases, Paris, France.,Internal Medicine, McGill University, Montreal, Québec, Canada
| | - Yair Levi
- Department of Medicine E, Meir Medical Center, Kfar-Saba, Israel
| | - Francesca Ingegnoli
- Department of Clinical Sciences and Community Health, University of Milan, Division of Rheumatology, Milan, Italy
| | | | - Itzhak Rosner
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Gleb Slobodin
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | | | - Nizar Jiries
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Lisa Kaly
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Nina Boulman
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Karina Zilber
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Shira Ginsberg
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Abid Awisat
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Yair Goldberg
- Department of Statistics, University of Haifa, Haifa, Israel
| | - Michael Lurie
- Pathology Department, Bnai-Zion Medical Center, Haifa, Israel
| | - Maria-Rosa Ghigna
- Pathology Department, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.,INSERM UMR_S 999, Le Plessis-Robinson, France.,Faculté de Médecine, Université Paris-Sud and Université Paris-Saclay, Kremlin-Bicêtre, France
| | - Christophe Guignabert
- INSERM UMR_S 999, Le Plessis-Robinson, France.,Faculté de Médecine, Université Paris-Sud and Université Paris-Saclay, Kremlin-Bicêtre, France
| | - Marc Humbert
- INSERM UMR_S 999, Le Plessis-Robinson, France.,Faculté de Médecine, Université Paris-Sud and Université Paris-Saclay, Kremlin-Bicêtre, France.,AP-HP Hôpital Bicêtre, Service de Pneumologie, Le Kremlin-Bicêtre, France
| | - Doron Rimar
- Rheumatology Unit, Bnai-Zion Medical Center, Haifa, Israel
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10
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NEMO score in nailfold videocapillaroscopy is a good tool to assess both steady state levels and overtime changes of disease activity in patients with systemic sclerosis: a comparison with the proposed composite indices for this disease status entity. Arthritis Res Ther 2019; 21:258. [PMID: 31783890 PMCID: PMC6884889 DOI: 10.1186/s13075-019-2032-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/14/2019] [Indexed: 11/30/2022] Open
Abstract
Background In previous studies, we demonstrated that the NEMO score, i.e. the cumulative number of microhaemorrhages (MHEs) and microthromboses (MTs), observed in nailfold videocapillaroscopy was a good indicator of the steady state level of disease activity (DA) in patients with systemic sclerosis (SSc) when the European Scleroderma Study Group (EScSG) index was considered the gold standard. Aim of the study To verify whether the NEMO score could be (i) a valid tool to assess DA, even when the modified European Scleroderma Trials and Research (EUSTAR) index was considered to be the comparator, and (ii) a sensitive method to capture the DA overtime changes. Patients and methods The NEMO score and the EScSG and EUSTAR indices were contemporarily assessed at baseline (T0) and after a follow-up of 4–56 months (T1) in 98 patients with SSc. The differences (Δ) between the T1 and T0 values of the NEMO score and the EScSG and EUSTAR indices were calculated and compared to each other. Results NEMO score values were very closely correlated with the corresponding values of the EScSG and EUSTAR indices both at T0 and T1 observations (p < 0.0001 in all cases with the exception of the correlation with EScSG values at T1 (p < 0.03)). The values of the two composite DA indices were also strictly related to each other in both T0 and T1 observations (p < 0.0001). Receiver operating characteristic (ROC) curve analysis showed the NEMO score had a good sensitivity and specificity in classifying patients with a predefined level of DA (scores ≥ 3.0 and ≥ 2.5 for the EScSG and EUSTAR indices, respectively, p < 0.0001 in both cases). Δ values of the NEMO score were significantly correlated with the corresponding values of both the EScSG and EUSTAR indices. Weighted Cohen’s k level of agreement between Δ values of the NEMO score and those of the EScSG and EUSTAR indices was moderate (0.55 and 0.59, respectively). Conclusions NEMO score proves to be a feasible, non-invasive, and valid tool to assess steady state levels and changes over time of DA in patients with SSc. Thus, it can represent an alternative or complementary method to measure this disease status entity in this disorder.
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Selifanova EI, Makeeva MK, Turkina AY, Esayan MS. [Oral health in patients with systemic sclerosis]. STOMATOLOGII︠A︡ 2019; 98:104-108. [PMID: 31322605 DOI: 10.17116/stomat201998031104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to conduct literature review about oral manifestations of scleroderma. Systemic sclerosis is a multisystem autoimmune disorder characterized by widespread fibrosis, vascular alterations and inflammation. Systemic sclerosis mainly affects people in age from 30 to 50 years, but the onset of disease can occur in any age. The disturbance of microcirculation with the activation and proliferation of endothelium and smooth muscle cells plays an important role in pathogenesis of sclerodrma. These changes lead to sclerosis and fibrosis of various part in human body. Orofacial manifestations of scleroderma include: reduced mouth opening, widening of periodontal ligament, teleangiectasia, bone lesions. Systemic scleroderma is often accompanied by Sjogren's syndrome. Oral manifestations of Sjogren's syndrome are recurrent parotitis, angular cheilitis, xerostomia and multiple caries. Sjogren's syndrome leads to negative impact on patients health and mental status. Orofacial manifestations of systemic sclerosis are still poorly known, that is why more researches should be made to improve dental treatment of patients with systemic sclerosis.
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Affiliation(s)
| | - M K Makeeva
- Peoples friendship university of Russia, Moscow, Russia
| | - A Yu Turkina
- First Moscow State Medical University, Moscow, Russia
| | - M S Esayan
- First Moscow State Medical University, Moscow, Russia
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Basta F, Margiotta DPE, Mazzuca C, Batani V, Dolcini G, Moras P, Vadacca M, Afeltra A. Factors related to alexithymia in patients with systemic sclerosis: a tight relationship with facial image dissatisfaction. Rheumatol Int 2018; 39:461-467. [PMID: 30498976 DOI: 10.1007/s00296-018-4214-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/26/2018] [Indexed: 12/11/2022]
Abstract
To assess clinical and psychosocial factors related to alexithymia in systemic sclerosis (SSc). We enrolled 40 consecutive SSc patients in a cross-sectional study evaluating alexithymia with Toronto Alexithymia scale (TAS-20). We measured Beck Depression inventory (BDI), Hamilton Anxiety rating scale (HAM-H), 36-Items Short-Form Healthy Survey (SF-36), Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue, Visual Analog Scale (VAS) pain, Pittsburgh Sleep Quality Index (PSQI), Satisfaction with Appearance Scale (SWAP), and Mouth Handicap in Systemic Sclerosis (MHISS). The prevalence of alexithymia was 42%. Alexithymic patients presented increased depressive (p = ≤ 0.001) and anxiety symptoms (p = ≤ 0.001), sleep disorders (p = 0.03), pain (p = 0.02), esthetic concerns (p = 0.03), disability in activities (p = 0.03) and reduced scores of SF-36 in mental components summary (MCS) (p = ≤ 0.001) and physical components summary (PCS) (p = 0.01). We found significant correlations with sleep disorders (r = 0.41, p = ≤ 0.001), BID (r = 0.35, p = 0.04), facial image dissatisfaction (r = 0.35, p = 0.04), mouth disability (r = 0.51, p = 0.005), depressive (r = 0.6, p = ≤ 0.001), and anxiety symptoms (r = 0.48, p = ≤ 0.001), fatigue (r = - 0.45 p = 0.005), SF-36 PCS (r = - 0.51, p = ≤ 0.001) and MCS (r = - 0.65, p = ≤ 0.001). In multiple linear regression analysis, SWAP facial was the only variable associated with TAS-20 [0.99 (0.48) p = 0.05]. Alexithymia correlates with several psychosocial factors but seems strongly related to facial image dissatisfaction.
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Affiliation(s)
- Fabio Basta
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio, 4, 00165, Rome, Italy.
| | - Domenico Paolo Emanuele Margiotta
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Carmen Mazzuca
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Veronica Batani
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Giulio Dolcini
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Patrizio Moras
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Marta Vadacca
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Antonella Afeltra
- Unit of Allergology, Immunology and Rheumatology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy
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Bombini MF, Peres FA, Lapa AT, Sinicato NA, Quental BR, Pincelli ÁDSM, Amaral TN, Gomes CC, Del Rio AP, Marques-Neto JF, Costallat LTL, Fernandes PT, Cendes F, Rittner L, Appenzeller S. Olfactory function in systemic lupus erythematosus and systemic sclerosis. A longitudinal study and review of the literature. Autoimmun Rev 2018; 17:405-412. [PMID: 29444467 DOI: 10.1016/j.autrev.2018.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND/PURPOSE To evaluate olfactory function in systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and healthy controls over a 2-year period, and to determine the association of olfactory dysfunction with age, disease activity, disease damage, treatment, anxiety and depression symptoms and limbic structures volumes. METHODS Consecutive SLE and SSc patients were enrolled in this study. Clinical, laboratory disease activity and damage were assessed according to diseases specific guidelines. Olfactory functions were evaluated using the Sniffin' Sticks test (TDI). Volumetric magnetic resonance imaging (MRI) was obtained in a 3T Phillips scanner. Amygdalae and hippocampi volumes were analyzed using FreeSurfer® software. RESULTS We included 143 SLE, 57 SSc and 166 healthy volunteers. Olfactory dysfunction was observed in 78 (54.5%) SLE, 35 (59.3%) SSc patients and in 24 (14.45%) controls (p<0.001) at study entry. SLE and SSc patients had significantly lower mean in all three phases (TDI) of the olfactory assessment when compared with healthy volunteers. In SLE, the presence of olfactory dysfunction was associated with older age, disease activity, higher anxiety and depression symptoms score, smaller left hippocampus volume, smaller left and right amygdalae volume and the presence of anti-ribosomal P (anti-P) antibodies. In SSc the presence of olfactory impairment was associated with older age, disease activity, smaller left and right hippocampi volumes and smaller right amygdala volume. Olfactory function was repeated after a 2-year period in 90 SLE, 35 SSc and 62 controls and was stable in all three groups. CONCLUSION Both SLE and SSc patients with longstanding disease had significant reduction in all stages of TDI that maintained stable over a 2-year period. Olfactory dysfunction was associated with age, inflammation and hippocampi and amygdalae volumes. In SLE, additional association with anti-P, anxiety and depression symptoms was observed.
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Affiliation(s)
- Mariana Freschi Bombini
- Physiopathology Graduate Program, School of Medical Sciences, University of Campinas, Brazil; Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil
| | - Fernando Augusto Peres
- Medicine Graduate Program, School of Medical Sciences, University of Campinas, Brazil; Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil
| | - Aline Tamires Lapa
- Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil; Child and Adolescent Health Graduate Program, School of Medical Sciences, University of Campinas, Brazil
| | - Nailú Angélica Sinicato
- Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil; Child and Adolescent Health Graduate Program, School of Medical Sciences, University of Campinas, Brazil
| | - Beatriz Ricato Quental
- Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil
| | - Ágatha de Souza Melo Pincelli
- Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil
| | - Tiago Nardi Amaral
- Medicine Graduate Program, School of Medical Sciences, University of Campinas, Brazil; Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil; Department of Medicine, Rheumatology Unit, School of Medical Sciences, University of Campinas, Brazil
| | | | - Ana Paula Del Rio
- Department of Medicine, Rheumatology Unit, School of Medical Sciences, University of Campinas, Brazil
| | | | - Lilian T L Costallat
- Department of Medicine, Rheumatology Unit, School of Medical Sciences, University of Campinas, Brazil
| | | | - Fernando Cendes
- Medical Imaging Computing Laboratory, School of Electrical and Computer Engineering, University of Campinas, Brazil
| | - Leticia Rittner
- Department of Neurology, School of Medical Sciences, University of Campinas, Brazil
| | - Simone Appenzeller
- Rheumatology Lab, School of Medical Sciences, University of Campinas, Brazil; Autoimmunity Lab School of Medical Sciences, University of Campinas, Brazil; Department of Medicine, Rheumatology Unit, School of Medical Sciences, University of Campinas, Brazil.
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14
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Valentini G, Iudici M, Walker UA, Jaeger VK, Baron M, Carreira P, Czirják L, Denton CP, Distler O, Hachulla E, Herrick AL, Kowal-Bielecka O, Pope J, Müller-Ladner U, Riemekasten G, Avouac J, Frerix M, Jordan S, Minier T, Siegert E, Ong VH, Vettori S, Allanore Y. The European Scleroderma Trials and Research group (EUSTAR) task force for the development of revised activity criteria for systemic sclerosis: derivation and validation of a preliminarily revised EUSTAR activity index. Ann Rheum Dis 2016; 76:270-276. [PMID: 27621285 DOI: 10.1136/annrheumdis-2016-209768] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/13/2016] [Accepted: 08/21/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Validity of European Scleroderma Study Group (EScSG) activity indexes currently used to assess disease activity in systemic sclerosis (SSc) has been criticised. METHODS Three investigators assigned an activity score on a 0-10 scale for 97 clinical charts. The median score served as gold standard. Two other investigators labelled the disease as inactive/moderately active or active/very active. Univariate-multivariate linear regression analyses were used to define variables predicting the 'gold standard', their weight and derive an activity index. The cut-off point of the index best separating active/very active from inactive/moderately active disease was identified by a receiver-operating curve analysis. The index was validated on a second set of 60 charts assessed by three different investigators on a 0-10 scale and defined as inactive/moderately active or active/very active by other two investigators. One hundred and twenty-three were investigated for changes over time in the index and their relationships with those in the summed Medsger severity score (MSS). RESULTS A weighted 10-point activity index was identified and validated: Δ-skin=1.5 (Δ=patient assessed worsening during the previous month), modified Rodnan skin score (mRss) >18=1.5, digital ulcers=1.5, tendon friction rubs=2.25, C-reactive protein >1 mg/dL=2.25 and diffusing capacity of the lung for CO (DLCO) % predicted <70%=1.0. A cut-off ≥2.5 was found to identify patients with active disease. Changes in the index paralleled those of MSS (p=0.0001). CONCLUSIONS A preliminarily revised SSc activity index has been developed and validated, providing a valuable tool for clinical practice and observational studies.
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Affiliation(s)
- Gabriele Valentini
- Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Michele Iudici
- Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Ulrich A Walker
- Department of Rheumatology, Basel University, Basel, Switzerland
| | | | - Murray Baron
- Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Patricia Carreira
- Department of Rheumatology, 12 de Octubre University Hospital, Madrid, Spain
| | - László Czirják
- Department of Rheumatology and Immunology, University of Pécs, Medical Centre, Pécs, Hungary
| | - Christopher P Denton
- Division of Medicine, Centre for Rheumatology and Connective Tissue Disease, Royal Free Campus, University College London, London, UK
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Eric Hachulla
- Internal Medicine Department, Claude Huriez Hospital, Lille University, Lille, France
| | - Ariane L Herrick
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Janet Pope
- Department of Medicine, St. Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Bad Neuheim, Germany
| | | | - Jerome Avouac
- Department of Rheumatology and Clinical Immunology, University Hospital Charité, Berlin, Germany
| | - Marc Frerix
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Bad Neuheim, Germany
| | - Suzana Jordan
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Tünde Minier
- Department of Rheumatology and Immunology, University of Pécs, Medical Centre, Pécs, Hungary
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, University Hospital Charité, Berlin, Germany
| | - Voon H Ong
- Division of Medicine, Centre for Rheumatology and Connective Tissue Disease, Royal Free Campus, University College London, London, UK
| | - Serena Vettori
- Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Yannick Allanore
- Rheumatology A Department, INSERM U1016 UMR8104, Cochin Hospital, Paris Descartes University, Paris, France
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15
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Arana-Ruiz JC, Amezcua-Guerra LM. Acro-osteolysis as an indicator of severity in systemic sclerosis. REUMATOLOGIA CLINICA 2016; 12:263-266. [PMID: 26746600 DOI: 10.1016/j.reuma.2015.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 10/16/2015] [Accepted: 11/02/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Systemic sclerosis is a rare disease that predominantly affects women. The Medsger severity scale has been used to assess the severity, but it requires expensive and poorly accessible studies and it does not include complications such acrosteolysis, calcinosis, pericardial disease or hypothyroidism that occur on a relatively frequent basis in this disease. There is no study that considers if comorbidities, such as primary biliary cirrhosis, are related to gravity. OBJECTIVES To determine the correlation between severity and the presence of such complications. METHODS 40 patients with systemic sclerosis, dividing them into tertiles according to severity were studied. Dichotomous variables were described using percentages, while dimensional by averages+SD. Statistical inference was performed using chi square test or Kruskal-Wallis test with Dunn post-test, as appropriate. A significance at P<.05 was set. RESULTS Of all the complications studied there were only differences in severity with acrosteolysis. Within comorbidities, primary biliary cirrhosis is not associated with gravity.
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Affiliation(s)
- Juan Carlos Arana-Ruiz
- Residencia de Reumatología, Instituto Nacional de Cardiología, Ciudad de México, México.
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Tay T, Ferdowsi N, Baron M, Stevens W, Hudson M, Proudman SM, Nikpour M. Measures of disease status in systemic sclerosis: A systematic review. Semin Arthritis Rheum 2016; 46:473-487. [PMID: 27765344 DOI: 10.1016/j.semarthrit.2016.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 06/18/2016] [Accepted: 07/18/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To identify and appraise measures of disease status in systemic sclerosis (SSc). METHODS A systematic review of Medline (1966-2015), EMBASE (1974-2015), and Cochrane Library (inception-2015) was undertaken to identify indices of disease status in SSc. We focused on objective measures and excluded non-English articles. Measures were reviewed for content, whether they measured activity, damage and/or severity and whether they were validated according to the OMERACT filter. RESULTS Of the 4558 articles retrieved through the search, we identified 58 articles for review. We found a further 44 articles through a search of the bibliography of relevant articles. We identified the following 10 "composite" (multi-organ) indices: two disease activity indices, six disease severity scales, and two combined response indices. There was no disease damage index for SSc. CONCLUSIONS We identified a number of composite and organ-specific indices in SSc, incorporating mostly objective measures, developed to quantify disease activity, severity, and response in clinical trials. However, none of the indices was developed to exclusively quantify organ damage. Most of the existing indices require further validation according to the OMERACT filter. There is a need to develop and validate a disease damage index in SSc.
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Affiliation(s)
- Tien Tay
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Nava Ferdowsi
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Murray Baron
- Department of Rheumatology, Lady Davis Institute for Medical Research and Jewish General Hospital, Montreal, Canada
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Marie Hudson
- Department of Rheumatology, Lady Davis Institute for Medical Research and Jewish General Hospital, Montreal, Canada
| | - Susanna M Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia; Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Mandana Nikpour
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
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Effectiveness of Thoracic Ultrasonography in the Evaluation of the Severity of Pulmonary Involvement in Patients With Systemic Sclerosis. Arch Rheumatol 2016; 31:364-370. [PMID: 30375580 DOI: 10.5606/archrheumatol.2016.5849] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 02/15/2016] [Indexed: 02/08/2023] Open
Abstract
Objectives This study aims to investigate the effectiveness of thoracic ultrasonography (USG) in a single session in the evaluation of the severity of pulmonary involvement in systemic sclerosis. Patients and methods A total of 48 consecutive systemic sclerosis patients (2 males, 46 females; mean age 50.8±11.9 years; range 21 to 76 years) followed-up in our center were included. A thoracic USG using a linear probe was performed for each patient to evaluate the parenchymal involvement by two pulmonary disease specialists. The number of B-lines (B-lines described USG sign of interstitial lung fibrosis) was recorded. Systolic pulmonary artery pressure was measured by means of using a phase probe to evaluate pulmonary hypertension in the same sequence. The same day, pulmonary function tests were conducted. Warrick score was calculated according high resolution computed tomography (HRCT) images which were evaluated independently from each other by a radiologist and a pulmonary disease specialist. Medsger severity scale was calculated for each patient according to the results of HRCT findings, pulmonary function test, and systolic pulmonary artery pressure. Results The number of B-lines detected on thoracic USG was correlated with the Warrick score (r=0.89; p=0.0001) and Medsger disease scale (r=0.55; p=0.0001) and negatively correlated with diffusing capacity of carbon monoxide (r= -0.56; p=0.0001) and forced vital capacity (r= -0.46; p=0.001). When HRCT was accepted as the gold standard; the sensitivity, specificity, positive predicted value, and negative predicted value for thoracic USG were 100%, 84.2%, 90.6%, and 100%, respectively. If thoracic USG was used instead of HRCT for the evaluation of Medsger scale, the results changed in only one of the 48 patients. Conclusion Thoracic USG showed good correlation with HRCT findings for the evaluation of pulmonary parenchymal involvement in systemic sclerosis. Therefore, USG might be a noninvasive and useful tool for the long-term follow-up of systemic sclerosis patients after initial examination with USG and HRCT.
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Baron M, Hudson M, Dagenais M, Macdonald D, Gyger G, El Sayegh T, Pope J, Fontaine A, Masetto A, Matthews D, Sutton E, Thie N, Jones N, Copete M, Kolbinson D, Markland J, Nogueira-Filho G, Robinson D, Fritzler M, Wang M, Gornitsky M. Relationship Between Disease Characteristics and Oral Radiologic Findings in Systemic Sclerosis: Results From a Canadian Oral Health Study. Arthritis Care Res (Hoboken) 2016; 68:673-80. [DOI: 10.1002/acr.22739] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/11/2015] [Accepted: 09/15/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Murray Baron
- Jewish General Hospital and McGill University; Montreal Quebec Canada
| | - Marie Hudson
- Jewish General Hospital and McGill University; Montreal Quebec Canada
| | - Marie Dagenais
- Jewish General Hospital and McGill University; Montreal Quebec Canada
| | | | - Geneviève Gyger
- Jewish General Hospital and McGill University; Montreal Quebec Canada
| | | | - Janet Pope
- University of Western Ontario; London Ontario Canada
| | - Audrey Fontaine
- Clinique Dentaire Ayotte et Associatees; Sherbrooke Quebec Canada
| | | | | | | | - Norman Thie
- University of Alberta; Edmonton Alberta Canada
| | - Niall Jones
- University of Alberta; Edmonton Alberta Canada
| | - Maria Copete
- University of Saskatchewan; Saskatoon Saskatchewan Canada
| | - Dean Kolbinson
- University of Saskatchewan; Saskatoon Saskatchewan Canada
| | | | | | | | | | - Mianbo Wang
- Mianbo Wang, MD, Lady Davis Institute for Medical Research, Jewish General Hospital; Montreal Quebec Canada
| | - Mervyn Gornitsky
- Jewish General Hospital and McGill University; Montreal Quebec Canada
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19
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Groseanu L, Bojinca V, Gudu T, Saulescu I, Predeteanu D, Balanescu A, Berghea F, Opris D, Borangiu A, Constantinescu C, Negru M, Ionescu R. Low vitamin D status in systemic sclerosis and the impact on disease phenotype. Eur J Rheumatol 2016; 3:50-55. [PMID: 27708971 DOI: 10.5152/eurjrheum.2015.0065] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 10/18/2015] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Vitamin D has pleiotropic effects including immunomodulatory, cardioprotective, and antifibrotic properties and is thus able to modulate the three main links in scleroderma pathogenesis. The aim of the study was to evaluate the level of vitamin D in patients with systemic sclerosis and to analyze the associations between the concentration of vitamin D and the features of systemic sclerosis. MATERIAL AND METHODS Fifty-one consecutive patients were evaluated for visceral involvement, immunological profile, activity, severity scores, and quality of life. The vitamin D status was evaluated by measuring the 25hydroxy-hydroxyvitamin D serum levels. RESULTS The mean vitamin D level was 17.06±9.13 ng/dL. Only 9.8% of the patients had optimal vitamin D levels; 66.66% of them had insufficient 25(OH)D levels, while 23.52% had deficient levels. No correlation was found between vitamin D concentration and age, sex, autoantibody profile, extent of skin involvement, or vitamin D supplementation. Vitamin D levels were correlated with the diffusing capacity of the lung for carbon monoxide (p=0.019, r=0.353), diastolic dysfunction (p=0.033, r=-0.318), digital contractures (p=0.036, r=-0.298), and muscle weakness (p=0.015, r=-0.377) and had a trend for negative correlation with pulmonary hypertension (p=0.053, r=-0.29). CONCLUSION Low levels of vitamin D are very common in systemic sclerosis. Poor vitamin status seems to be related with a more aggressive disease with multivisceral and severe organ involvement, especially pulmonary and cardiac involvement.
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Affiliation(s)
- Laura Groseanu
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Violeta Bojinca
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Tania Gudu
- Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Ioana Saulescu
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Denisa Predeteanu
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Andra Balanescu
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Florian Berghea
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Daniela Opris
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Andreea Borangiu
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Cosmin Constantinescu
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Magda Negru
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
| | - Ruxandra Ionescu
- Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania
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Abstract
Juvenile systemic sclerosis is an orphan disease of the macro- and microvasculature with an unknown etiology. Although pediatric and adult classification systems have been developed, neither has been validated yet. Recent publications have shown a shift in the subset pattern in juvenile-onset adult patients, with a better outcome in these patients as compared with young adult patients. As a first step in assessing activity, damage, and severity, a pediatric severity score--a modification of the adult Medsger scale--was proposed but has not been validated. An activity score also has been developed but has not yet been published. Currently, treatment approaches are based only on adult data, and problems exist in extrapolating these data to a pediatric population.
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21
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van Laar JM, Naraghi K, Tyndall A. Haematopoietic stem cell transplantation for poor-prognosis systemic sclerosis. Rheumatology (Oxford) 2015; 54:2126-33. [PMID: 25953700 DOI: 10.1093/rheumatology/kev117] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Indexed: 12/29/2022] Open
Abstract
Haematopoietic stem cell transplantation (HSCT) following intensive immune suppression has been used in >2000 patients with severe autoimmune diseases for 18 years, including 300 with SSc. The concept is to profoundly reduce the bulk of auto-aggressive immune competent cells and then rescue the patient's ablated haematopoiesis via an autologous HSCT. An early analysis of uncontrolled phase I/II data suggested that approximately one-third of these achieved a substantial improvement, with a relapse rate of 25% and a treatment-related mortality ranging from 6% to 23% across different studies. These early results led to three prospective randomized controlled trials, two of which are completed, confirming that HSCT shows clear advantages over conventional immunosuppression, but with significant toxicity. In some patients, sustained complete normalization of skin changes, reversal of positive autoantibody status and withdrawal of immunosuppressive medication were observed. These results attest to the profound effects of HSCT.
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Affiliation(s)
- Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands,
| | - Kamran Naraghi
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK and
| | - Alan Tyndall
- Department of Rheumatology, University Hospital, Basel, Switzerland
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22
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Baron M, Hudson M, Tatibouet S, Steele R, Lo E, Gravel S, Gyger G, El Sayegh T, Pope J, Fontaine A, Masetto A, Matthews D, Sutton E, Thie N, Jones N, Copete M, Kolbinson D, Markland J, Nogueira G, Robinson D, Fritzler M, Gornitsky M. Relationship between disease characteristics and orofacial manifestations in systemic sclerosis: Canadian Systemic Sclerosis Oral Health Study III. Arthritis Care Res (Hoboken) 2015; 67:681-90. [PMID: 25303223 PMCID: PMC4464822 DOI: 10.1002/acr.22490] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 09/09/2014] [Accepted: 09/30/2014] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Systemic sclerosis (SSc; scleroderma) is associated with decreased saliva production and interincisal distance, more missing teeth, and periodontal disease. We undertook this study to determine the clinical correlates of SSc with these oral abnormalities. METHODS Subjects were recruited from the Canadian Scleroderma Research Group cohort. Detailed dental and clinical examinations were performed according to standardized protocols. Associations between dental abnormalities and selected clinical and serologic manifestations of SSc were examined. RESULTS One hundred sixty-three SSc subjects were included: 90% women, mean ± SD age 56 ± 11 years, mean ± SD disease duration 14 ± 8 years, 72% with limited cutaneous disease, and 28% with diffuse cutaneous disease. Decreased saliva production was associated with Sjögren's syndrome-related autoantibodies (β = -43.32; 95% confidence interval [95% CI] -80.89, -5.75), but not with disease severity (β = -2.51; 95% CI -8.75, 3.73). Decreased interincisal distance was related to disease severity (β = -1.02; 95% CI -1.63, -0.42) and the modified Rodnan skin thickness score (β = -0.38; 95% CI -0.53, -0.23). The number of missing teeth was associated with decreased saliva production (relative risk [RR] 0.97; 95% CI 0.94, 0.99), worse hand function (RR 1.52; 95% CI 1.13, 2.02), and the presence of gastroesophageal reflux disease (GERD; RR 1.68 [95% CI 1.14, 2.46]). No clinical or serologic variables were correlated with periodontal disease. CONCLUSION In SSc, diminished interincisal distance is related to overall disease severity. Decreased saliva production is related to concomitant Sjögren's syndrome antibodies. Tooth loss is associated with poor upper extremity function, GERD, and decreased saliva. The etiology of excess periodontal disease is likely multifactorial and remains unclear.
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Affiliation(s)
- Murray Baron
- Jewish General Hospital and McGill University, Montreal, Quebec, Canada
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23
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QTc interval prolongation in systemic sclerosis: Correlations with clinical variables. Int J Cardiol 2015; 182:20-2. [DOI: 10.1016/j.ijcard.2014.12.069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 12/21/2014] [Indexed: 11/22/2022]
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Lakota K, Carns M, Podlusky S, Mrak-Poljsak K, Hinchcliff M, Lee J, Tomsic M, Sodin-Semrl S, Varga J. Serum amyloid A is a marker for pulmonary involvement in systemic sclerosis. PLoS One 2015; 10:e0110820. [PMID: 25629975 PMCID: PMC4321755 DOI: 10.1371/journal.pone.0110820] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 09/21/2014] [Indexed: 01/19/2023] Open
Abstract
Inflammation in systemic sclerosis (SSc) is a prominent, but incompletely characterized feature in early stages of the disease. The goal of these studies was to determine the circulating levels, clinical correlates and biological effects of the acute phase protein serum amyloid A (SAA), a marker of inflammation, in patients with SSc. Circulating levels of SAA were determined by multiplex assays in serum from 129 SSc patients and 98 healthy controls. Correlations between SAA levels and clinical and laboratory features of disease were analyzed. The effects of SAA on human pulmonary fibroblasts were studied ex vivo. Elevated levels of SAA were found in 25% of SSc patients, with the highest levels in those with early-stage disease and diffuse cutaneous involvement. Significant negative correlations of SAA were found with forced vital capacity and diffusion capacity for carbon monoxide. Patients with elevated SAA had greater dyspnea and more frequent interstitial lung disease, and had worse scores on patient-reported outcome measures. Incubation with recombinant SAA induced dose-dependent stimulation of IL-6 and IL-8 in normal lung fibroblasts in culture. Serum levels of the inflammatory marker SAA are elevated in patients with early diffuse cutaneous SSc, and correlate with pulmonary involvement. In lung fibroblasts, SAA acts as a direct stimulus for increased cytokine production. These findings suggest that systemic inflammation in SSc may be linked to lung involvement and SAA could serve as a potential biomarker for this complication.
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Affiliation(s)
- Katja Lakota
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana,
Slovenia
- Division of Rheumatology, Feinberg School of Medicine, Northwestern
University, Chicago, United States of America
| | - Mary Carns
- Division of Rheumatology, Feinberg School of Medicine, Northwestern
University, Chicago, United States of America
| | - Sofia Podlusky
- Division of Rheumatology, Feinberg School of Medicine, Northwestern
University, Chicago, United States of America
| | - Katjusa Mrak-Poljsak
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana,
Slovenia
| | - Monique Hinchcliff
- Division of Rheumatology, Feinberg School of Medicine, Northwestern
University, Chicago, United States of America
| | - Jungwha Lee
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern
University, Chicago, United States of America
| | - Matija Tomsic
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana,
Slovenia
| | - Snezna Sodin-Semrl
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana,
Slovenia
- University of Primorska, Faculty of Mathematics, Natural Sciences and
Information Technology, Koper, Slovenia
| | - John Varga
- Division of Rheumatology, Feinberg School of Medicine, Northwestern
University, Chicago, United States of America
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25
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Wang Y, Shu Y, Xiao Y, Wang Q, Kanekura T, Li Y, Wang J, Zhao M, Lu Q, Xiao R. Hypomethylation and overexpression of ITGAL (CD11a) in CD4(+) T cells in systemic sclerosis. Clin Epigenetics 2014; 6:25. [PMID: 25414732 PMCID: PMC4237764 DOI: 10.1186/1868-7083-6-25] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/24/2014] [Indexed: 12/17/2022] Open
Abstract
Background The pathogenesis and etiology of systemic sclerosis (SSc) are complex and poorly understood. To date, several studies have demonstrated that the activation of the immune system undoubtedly plays a pivotal role in SSc pathogenesis. Activated immune effector T cells contribute to the release of various pro-inflammatory cytokines and drive the SSc-specific autoantibody responses. This, and a profibrotic environment, are all-important components of abnormal active immune responses that can lead to pathological disorders of SSc. CD11a is essential to inflammatory and immune responses, regulating adhesive and co-stimulatory interactions between CD4+ T cells and other cells. Although CD11a is overexpressed in SSc patients, the mechanisms leading to this overexpression and its consequences remain unclear. DNA methylation, a main epigenetic modification, plays an important role in the regulation of gene expression and is involved in the pathogenesis of autoimmune diseases. This work aims to investigate the effect of DNA demethylation on CD11a expression in SSc CD4+ T cells and to determine its functional significance. CD11a expression was measured using RT-PCR and flow cytometry. Bisulfite sequencing was used to determine the methylation status of the CD11a regulatory region. CD4+ T cells were co-cultured with antigen-presenting cells, B cells, or fibroblasts with and without anti-CD11a, and proliferation of CD4+ T cells, IgG production by B cells, and expression levels of COL1A2 mRNA by fibroblasts were evaluated. Results Elevated CD11a expression levels were observed in CD4+ T cells from SSc patients; these levels were found to be positively correlated with disease activity. The methylation levels of the CD11a regulatory sequences were lower in SSc patients than in controls and inversely correlated with CD11a mRNA expression. Treatment of CD4+ T cells with 5-azacytidine (5-azaC) decreased CD11a promoter methylation and caused CD11a overexpression. SSc CD4+ T cells and 5-azaC-treated CD4+ T cells showed increased proliferation of CD4+ T cells, increased production of IgG by co-cultured B cells, and induced expression of COL1A2 mRNA by co-cultured fibroblasts. These stimulatory effects were abrogated by anti-CD11a. Conclusions Demethylation of CD11a regulatory elements and subsequent CD11a overexpression in CD4+ T cells may mediate immunological abnormalities and fibrotic processes in SSc.
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Affiliation(s)
- YaoYao Wang
- Department of Dermatology, Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha, 410011 China ; Department of Dermatology, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016 China
| | - Ye Shu
- Department of Dermatology, Hunan Children's Hospital, 86 Zi-Yuan Road, Changsha, 410007 China
| | - YangFan Xiao
- Department of Dermatology, Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha, 410011 China
| | - Qing Wang
- Department of Dermatology, Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha, 410011 China
| | - Takuro Kanekura
- Department of Dermatology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan
| | - YaPing Li
- Department of Dermatology, Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha, 410011 China
| | - JiuCun Wang
- Ministry of Education (MOE) Key Laboratory of Contemporary Anthropology and State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, 220 Handan Road, 200433 Shanghai, China
| | - Ming Zhao
- Department of Dermatology, Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha, 410011 China ; Hunan Key Laboratory of Medical Epigenomics, 139 Ren-Min Road, Changsha, 410011 China
| | - QianJin Lu
- Department of Dermatology, Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha, 410011 China ; Hunan Key Laboratory of Medical Epigenomics, 139 Ren-Min Road, Changsha, 410011 China
| | - Rong Xiao
- Department of Dermatology, Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha, 410011 China
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Abstract
The presence of autoimmune diseases, including Systemic Sclerosis (SSc), suggest failure of the normal immune regulatory processes leading to activation and expansion of autoreactive effector immune cells. Recently, stem cell transplantation emerged as a novel rescue therapy for a variety of refractory autoimmune diseases. The therapeutic strategy involves the ablation of the aberrant self-reactive immune cells by chemotherapy and the regeneration of a new self-tolerant immune system formed by the transplanted stem cells. In the last few years, thousands of patients worldwide have received haematopoietic stem cell transplantation (HSCT), mostly autologous, as treatment for severe irreversible autoimmune diseases, with promising results. Here we review the results of published small series of SSc patients treated with allogeneic and autologous HSCT, as well as three randomized trials, exploring the safety and efficacy of autologous HSCT in SSc. Although the results are encouraging, nonetheless, the correct application of stem cell transplantation remains an area of active investigation. Results of larger randomized, double blind clinical trials, will certainly improve our knowledge of the appropriate clinical use of stem cell therapy in SSc patients.
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Affiliation(s)
- Paola Cipriani
- Clinical Immunology and Rheumatology Section, Department of Biotechnological and Applied Clinical Science, School of Medicine, "San Salvatore" University Hospital, University of L'Aquila, L'Aquila, Italy
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27
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Baron M, Hudson M, Tatibouet S, Steele R, Lo E, Gravel S, Gyger G, El Sayegh T, Pope J, Fontaine A, Masseto A, Matthews D, Sutton E, Thie N, Jones N, Copete M, Kolbinson D, Markland J, Nogueira-Filho G, Robinson D, Gornitsky M. The Canadian systemic sclerosis oral health study: orofacial manifestations and oral health-related quality of life in systemic sclerosis compared with the general population. Rheumatology (Oxford) 2014; 53:1386-94. [PMID: 24464709 PMCID: PMC4103515 DOI: 10.1093/rheumatology/ket441] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 11/12/2013] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare oral abnormalities and oral health-related quality of life (HRQoL) of patients with SSc with the general population. METHODS SSc patients and healthy controls were enrolled in a multisite cross-sectional study. A standardized oral examination was performed. Oral HRQoL was measured with the Oral Health Impact Profile (OHIP). Multivariate regression analyses were performed to identify associations between SSc, oral abnormalities and oral HRQoL. RESULTS We assessed 163 SSc patients and 231 controls. SSc patients had more decayed teeth (SSc 0.88, controls 0.59, P = 0.0465) and periodontal disease [number of teeth with pocket depth (PD) >3 mm or clinical attachment level (CAL) ≥5.5 mm; SSc 5.23, controls 2.94, P < 0.0001]. SSc patients produced less saliva (SSc 147.52 mg/min, controls 163.19 mg/min, P = 0.0259) and their interincisal distance was smaller (SSc 37.68 mm, controls 44.30 mm, P < 0.0001). SSc patients had significantly reduced oral HRQoL compared with controls (mean OHIP score: SSc 41.58, controls 26.67, P < 0.0001). Multivariate regression analyses confirmed that SSc was a significant independent predictor of missing teeth, periodontal disease, interincisal distance, saliva production and OHIP scores. CONCLUSION Subjects with SSc have impaired oral health and oral HRQoL compared with the general population. These data can be used to develop targeted interventions to improve oral health and HRQoL in SSc.
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Affiliation(s)
- Murray Baron
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada.Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Sask
| | - Marie Hudson
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada.Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Sask
| | - Solène Tatibouet
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada
| | - Russell Steele
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada.Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Sask
| | - Ernest Lo
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada
| | - Sabrina Gravel
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada
| | - Geneviève Gyger
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada.Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Sask
| | - Tarek El Sayegh
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada
| | - Janet Pope
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada
| | - Audrey Fontaine
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada
| | - Ariel Masseto
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada
| | - Debora Matthews
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada
| | - Evelyn Sutton
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada
| | - Norman Thie
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada
| | - Niall Jones
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada
| | - Maria Copete
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada
| | - Dean Kolbinson
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada
| | - Janet Markland
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada
| | - Getulio Nogueira-Filho
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada
| | - David Robinson
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada
| | - Mervyn Gornitsky
- Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Saskatchewan, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Department of Periodontology, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba and Department of Dentistry, SMBD Jewish General Hospital, Montreal, Quebec, Canada.Division of Rheumatology, Department of Internal Medicine, SMBD Jewish General Hospital, Division of Rheumatology, Faculty of Medicine, McGill University, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Department of Mathematics and Statistics, McGill University, Montreal, Quebec, School of Dentistry, University of Western Ontario, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec, Department of Periodontology, Faculty of Dentistry, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Division of Oro-facial Pain, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Department of Pathology, College of Dentistry, University of Sask
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Wang YY, Wang Q, Sun XH, Liu RZ, Shu Y, Kanekura T, Huang JH, Li YP, Wang JC, Zhao M, Lu QJ, Xiao R. DNA hypermethylation of the forkhead box protein 3 (FOXP3) promoter in CD4+ T cells of patients with systemic sclerosis. Br J Dermatol 2014; 171:39-47. [PMID: 24641670 DOI: 10.1111/bjd.12913] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND Systemic sclerosis (SSc) is a complex autoimmune disease that involves dysregulation of immune homeostasis. The failure of impaired regulatory T cells (Tregs) to maintain immune homeostasis plays a major role in the development of SSc. Transcriptional silencing of the forkhead box protein 3 gene (FOXP3) via hypermethylation of regulatory regions has been identified as a hallmark of committed Tregs and several autoimmune disorders. OBJECTIVES To investigate whether aberrant expression and methylation of FOXP3 occurs in CD4+ T cells of patients with SSc and their roles in the pathogenesis of SSc. METHODS FOXP3 expression in CD4+ T cells was measured by real-time quantitative reverse-itranscriptase polymerase chain reaction and western blot. Bisulfite sequencing was performed to determine the methylation status of the FOXP3 proximal promoter sequence. The percentage of Treg cells was estimated by flow cytometry. RESULTS Decreased FOXP3 expression was observed in CD4+ T cells from patients with SSc. The methylation levels of the FOXP3 regulatory sequences were elevated and inversely correlated with FOXP3 mRNA expression in patients with SSc. The number of Tregs was significantly reduced in patients with SSc. Treatment of SSc CD4+ T cells with a DNA methylation inhibitor, 5-azacytidine, reduced the mean methylation levels, and enhanced FOXP3 expression and Treg generation. The promoter methylation status and expression level of FOXP3 are significantly associated with disease activity. CONCLUSIONS The contribution of the hypermethylation of the FOXP3 promoter to decreased FOXP3 expression and the subsequent quantitative defects of Tregs may mediate the immune dysfunction in SSc.
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Affiliation(s)
- Y Y Wang
- Department of Dermatology, Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha, 410011, China
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Demir N, Şahin A, Küçükşahin O, Kayacan O, Dinçer İ, Sayın T, Karnak D, Turgay M. Pulmonary Arterial Hypertension and Systemic Sclerosis Relation: A Single Centre Experience. Heart Lung Circ 2014; 23:667-73. [DOI: 10.1016/j.hlc.2014.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/25/2014] [Accepted: 02/01/2014] [Indexed: 11/25/2022]
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Rimar D, Rosner I, Nov Y, Slobodin G, Rozenbaum M, Halasz K, Haj T, Jiries N, Kaly L, Boulman N, Daood R, Vadasz Z. Brief report: lysyl oxidase is a potential biomarker of fibrosis in systemic sclerosis. Arthritis Rheumatol 2014; 66:726-30. [PMID: 24574233 DOI: 10.1002/art.38277] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 11/07/2013] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Fibrosis is a major cause of morbidity and mortality in systemic sclerosis (SSc). Levels of lysyl oxidase (LOX), an extracellular enzyme that stabilizes collagen fibrils, have been found to be elevated in the skin of SSc patients, but have not been evaluated in the serum or correlated with the clinical parameters. We undertook this study to evaluate serum LOX levels in SSc patients and to correlate these levels with clinical parameters of SSc. METHODS SSc patients were evaluated for demographic features, clinical manifestations, routine laboratory tests, serum autoantibodies, serum LOX concentrations, and nailfold capillaroscopy patterns. They underwent pulmonary function testing, echocardiography, and high-resolution computed tomography scans of the lung, assessment of skin fibrosis by the modified Rodnan skin thickness score (MRSS), and assessment of disease severity and activity by the Medsger severity scale and the Valentini activity index. RESULTS Twenty-six SSc patients were evaluated and compared with 25 healthy controls and with 9 disease control patients with primary myelofibrosis. Almost 62% of the SSc patients (16 of 26) had limited cutaneous SSc (lcSSc), while 38% had diffuse cutaneous SSc (dcSSc) (10 of 26); 31% of the patients (8 of 26) had lung involvement. The LOX concentration in SSc patients was higher than that in healthy controls and similar to that in disease controls (P < 0.0001), and it was significantly higher in patients with dcSSc than in those with lcSSc (P = 0.006). The LOX concentration correlated with the MRSS in patients without lung fibrosis. CONCLUSION This study is the first to demonstrate high serum LOX levels in SSc patients that correlate specifically with skin fibrosis. These correlations suggest that LOX levels may serve as a novel biomarker of fibrosis. Future studies are warranted to determine whether LOX is a potential therapeutic target in SSc.
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Rockwood MR, MacDonald E, Sutton E, Rockwood K, Baron M. Frailty index to measure health status in people with systemic sclerosis. J Rheumatol 2014; 41:698-705. [PMID: 24584923 DOI: 10.3899/jrheum.130182] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To develop and validate, as a measure of overall health status, a Frailty Index (FI) for patients (n=1372) in the Canadian Scleroderma Research Group (CSRG) Registry. METHODS Forty-four items were selected from the CSRG database as health deficits and recoded using FI criteria. To test construct validity, we compared measurement properties of the CSRG-FI to other FI, and related it to measures of damage, age, and time since diagnosis. To test criterion validity, we compared the baseline FI to that at last recorded visit and to mortality. RESULTS The mean CSRG-FI was 0.33 with a sub-maximal limit of 0.67. In patients with diffuse disease, the mean was 0.38(SD 0.14); in patients with limited disease, the mean was 0.31(SD 0.13). The CSRG-FI was weakly (but significantly) correlated with the Rodnan Skin Score (r=0.28 in people with diffuse disease; 0.18 with limited) and moderately with the Physician Assessment of Damage (r=0.51 for both limited and diffuse). The risk of death increased with higher FI scores and with higher physician ratings of damage. The area under the receiver operating characteristic curve for the baseline FI in relation to death was 0.75, higher than for other measures (range: 0.57-0.67). CONCLUSION The FI quantifies overall health status in people with scleroderma and predicts mortality. Whether the FI might help with decisions about who might best be served by more aggressive treatment, such as bone marrow transplantation, needs to be evaluated.
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Affiliation(s)
- Michael R Rockwood
- From Geriatric Medicine Research; Division of Rheumatology; Division of Geriatric Medicine, Department of Medicine, Dalhousie University and Capital District Health Authority, Halifax, Nova Scotia; and Division of Rheumatology, Department of Medicine, McGill University and SMBD-Jewish General Hospital, Montreal, Quebec, Canada
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Serum galectin-3 level in systemic sclerosis. Clin Rheumatol 2013; 33:215-20. [DOI: 10.1007/s10067-013-2346-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 07/08/2013] [Accepted: 07/16/2013] [Indexed: 01/13/2023]
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Wang Y, Yang Y, Luo Y, Yin Y, Wang Q, Li Y, Kanekura T, Wang J, Liang G, Zhao M, Lu Q, Xiao R. Aberrant histone modification in peripheral blood B cells from patients with systemic sclerosis. Clin Immunol 2013; 149:46-54. [PMID: 23891737 DOI: 10.1016/j.clim.2013.06.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/10/2013] [Accepted: 06/12/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate alterations in histone modifications in B cells and their role in the pathogenesis of systemic sclerosis (SSc). METHODS Global histone H3/H4 acetylation and H3K4/H3K9 methylation in B cells of SSc were tested by EpiQuik™ assay kits. Related histone modifier enzymes were measured by RT-PCR and Western blot. RESULTS Global histone H4 hyperacetylation and global histone H3K9 hypomethylation were observed in SSc B cells compared with controls. Expression of JHDM2A was significantly increased but HDAC2, HDAC7, and, SUV39H2 were significantly down-regulated in SSc B cells relative to controls. Global histone H4 acetylation and the expression of HDAC2 were negatively correlated. Global histone H3K9 methylation and the expression of SUV39H2 protein were positively correlated. Global H4 acetylation was positively correlated with disease activity and expression of HDAC2 protein was negatively correlated with skin thickness. CONCLUSIONS Histone modifications were altered in B cells in SSc correlating with skin thickness and disease activity.
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Affiliation(s)
- YaoYao Wang
- Department of Dermatology, Second Xiangya Hospital, Central South University, 139 Ren-Min Road, Changsha 410011, China
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Almeida I, Faria R, Vita P, Vasconcelos C. Systemic sclerosis refractory disease: from the skin to the heart. Autoimmun Rev 2011; 10:693-701. [PMID: 21575745 DOI: 10.1016/j.autrev.2011.04.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Systemic sclerosis or scleroderma (SSc) is an heterogeneous disease involving the connective tissue and the microvasculature with fibrosis and vascular occlusion. It is difficult to define refractory SSc once it is itself a paradigm of a refractory condition: there is no evidence of when to act to stop the progression to fibrosis and irreversible microvascular damage. There is no definition of refractory disease in SSc and to propose a definition we used mainly the Medsger severity index and the EULAR 2009 treatment recommendations from the skin to the heart through peripheral vascular, musculoskeletal, gastrointestinal, renal, pulmonary hypertension and interstitial lung disease. We used some clinical setting reflecting the different reasoning when there is probable refractory disease and finally we briefly pointed out some available treatment options to refractory disease. With this reflection, we would like to open paths to a broader discussion.
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Affiliation(s)
- Isabel Almeida
- Unidade de Imunologia Clínica, Hospital de Santo António, Centro Hospitalar do Porto, Portugal.
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Suppiah R, Mukhtyar C, Flossmann O, Alberici F, Baslund B, Batra R, Brown D, Holle J, Hruskova Z, Jayne DRW, Judge A, Little MA, Palmisano A, Stegeman C, Tesar V, Vaglio A, Westman K, Luqmani R. A cross-sectional study of the Birmingham Vasculitis Activity Score version 3 in systemic vasculitis. Rheumatology (Oxford) 2010; 50:899-905. [DOI: 10.1093/rheumatology/keq400] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kallen MA, Mayes MD, Kriseman YL, de Achaval SB, Cox VL, Suarez-Almazor ME. The symptom burden index: development and initial findings from use with patients with systemic sclerosis. J Rheumatol 2010; 37:1692-8. [PMID: 20516027 DOI: 10.3899/jrheum.090504] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our study had 3 aims: (1) to evaluate the functioning of the Symptom Burden Index (SBI) in patients with systemic sclerosis (SSc); (2) to determine the amount of burden per problem experienced by patients as well as the number of patients experiencing each measured problem area, and the number of SSc problems per patient; and (3) to characterize the burden profiles of problem area-specific subgroups of patients. METHODS We developed the SBI to determine the effect of problems in 8 major symptomatic areas of importance to patients (skin, hand mobility, calcinosis, shortness of breath, eating, bowel, sleep, and pain). RESULTS Sixty-two patients with SSc completed questionnaires on current disease-related problems, physical functioning, and health status. On average, patients were 53.4 years old and had had SSc for 8 years. Patients were mainly women (87%), English-speaking (87%), with diffuse SSc (63%), white (69%), married (61%), and lived with 1 or more additional household members (84%). Only 26% were employed full-time. The 3 most widely reported problem areas were pain, hand, and skin, experienced by 92%, 89%, and 88%, respectively. About one-third reported experiencing 0-5 problems and one-third 7-8 problems; individual patients experienced, on average, 5.7 problems. CONCLUSION Psychometric evaluation determined that (1) summarizing SBI problem area item sets to report burden scores per problem measured is justified; (2) the 8 proposed problem areas are independent and deserve separate evaluation; and (3) burden scores correlate as expected with the Health Assessment Questionnaire-Disability Index and the Medical Outcomes Study Short-Form 36 questionnaire. The number of problems experienced and the degree of problem-associated burden that patients with SSc bear are substantial. Use of the SBI's patient-focused measurements may aid physicians in resolving problems most directly affecting patients' quality of life. This approach to measuring symptomatic burden in patients with chronic disease could be extended to other conditions.
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Affiliation(s)
- Michael A Kallen
- University of Texas MD Anderson Cancer Center and The University of Texas Health Science Center, Houston, Texas 77230-1402, USA.
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Minier T, Nagy Z, Balint Z, Farkas H, Radics J, Kumanovics G, Czompoly T, Simon D, Varju C, Nemeth P, Czirjak L. Construct validity evaluation of the European Scleroderma Study Group activity index, and investigation of possible new disease activity markers in systemic sclerosis. Rheumatology (Oxford) 2010; 49:1133-45. [DOI: 10.1093/rheumatology/keq022] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Systemic sclerosis is an autoimmune inflammatory disorder of unknown etiologycharacterized b y pronounced fibroproliferative alterations in the microvasculature, and frequent cellular and humoral immunity abnormalities, culminating in a severe and often progressive fibrotic process. Numerous biomarkers reflecting the three main pathogenetic mechanisms in systemic sclerosis have been described; however, aside from several disease-specific autoantibodies, other biomarkers have not been thoroughly validated and require further study. Thus, there is an unmet need for validated biomarkers for diagnosis, disease classification, and evaluation of organ involvement and therapeutic response in systemic sclerosis.
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Affiliation(s)
- Susan V Castro
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA 19107-15541, USA.
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Slobodin G, Ahmad MS, Rosner I, Peri R, Rozenbaum M, Kessel A, Toubi E, Odeh M. Regulatory T cells (CD4(+)CD25(bright)FoxP3(+)) expansion in systemic sclerosis correlates with disease activity and severity. Cell Immunol 2010; 261:77-80. [PMID: 20096404 DOI: 10.1016/j.cellimm.2009.12.009] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 12/21/2009] [Accepted: 12/23/2009] [Indexed: 01/01/2023]
Abstract
BACKGROUND The role and function of T regulatory (Treg) cells have not been fully investigated in patients with systemic sclerosis (SSc). METHODS Ten patients with SSc donated 20ml of peripheral blood. Activity (Valentini) and severity (Medsger) scores for SSc were calculated for all patients. Healthy volunteers (controls) were matched to each patient by gender and age. CD4(+) cells were separated using the MACS system. The numbers of Treg cells were estimated by flow cytometry after staining for CD4, CD25, and FoxP3 and calculated as patient-to-control ratio separately for each experiment. Correlations with activity and severity indices of the disease were performed. Twenty-four-hour production of TGF-beta and IL-10 by activated CD4(+) cells was measured by ELISA in culture supernatants. RESULTS The numbers of Treg cells, expressed as patient-to-control ratio, correlated significantly with both activity and severity indices (r=0.71, p=0.034 and r=0.67, p=0.044, respectively). ELISA-measured production of TGF-beta and IL-10 by CD4(+) cells was similar in patients and controls. CONCLUSIONS Increased numbers of Treg cells are present in patients with SSc, correlating with activity and severity of the disease. This expansion of Treg cells was not accompanied, however, by heightened TGF-beta or IL-10 production. Further studies to elaborate the causes and functional significance of Treg cell expansion in SSc are needed.
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Affiliation(s)
- Gleb Slobodin
- Department of Internal Medicine A, Bnai Zion Medical Center and Ruth & Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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Zuber-Jerger I, Müller A, Kullmann F, Gelbmann CM, Endlicher E, Müller-Ladner U, Fleck M. Gastrointestinal manifestation of systemic sclerosis--thickening of the upper gastrointestinal wall detected by endoscopic ultrasound is a valid sign. Rheumatology (Oxford) 2009; 49:368-72. [PMID: 20008473 DOI: 10.1093/rheumatology/kep381] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Gastrointestinal (GI) tract involvement has been observed in the majority of patients with SSc. This has been attributed to an accumulation of extracellular matrix within the GI walls. We visualized the walls of the oesophagus, stomach and duodenum with its layers and measured the thickness in SSc patients and control patients utilizing endoscopic ultrasound (EUS). METHODS Twenty-five SSc patients and 25 controls were evaluated. In addition to analysis of clinical symptoms, endoscopy and EUS (20-MHz miniprobe) were performed. The thickness of the complete wall was measured, and the mucosa, submucosa and muscularis were evaluated separately. RESULTS Clinical symptoms of SSc patients were dysphagia (14/25) and heartburn (19/25). Endoscopic findings were hiatal hernia (16/25), oesophagitis (6/25), amotility (19/25) and a dehiscent pylorus (15/25). In comparison with controls, SSc patients had significantly thicker oesophageal [SSc 1.619 (0.454) mm, control 1.392 (0.333) mm; P = 0.025], antral [SSc 1.876 (0.635) mm, control 1.599 (0.291) mm; P = 0.029] and duodenal [SSc 1.730 (0.522) mm, control 1.525 (0.222) mm; P = 0.039] walls. Predominantly, submucosa and muscularis were significantly thicker in SSc patients. The presence of dysphagia or amotility was significantly associated with the thickening of the GI walls. CONCLUSIONS The EUS revealed a significant thickening of the walls of the upper GI tract in SSc patients. Predominantly, the submucosa and muscularis are enlarged. These results strengthen the hypothesis that increased matrix deposition is an important aspect in the pathogenesis of GI involvement in SSc.
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Affiliation(s)
- Ina Zuber-Jerger
- Department of Internal Medicine I, University Medical Center Regensburg, 93042 Regensburg, Germany.
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Fan X, Pope J, Baron M. What is the relationship between disease activity, severity and damage in a large Canadian systemic sclerosis cohort? Results from the Canadian Scleroderma Research Group (CSRG). Rheumatol Int 2009; 30:1205-10. [DOI: 10.1007/s00296-009-1129-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 09/13/2009] [Indexed: 11/28/2022]
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Mercado U, Acosta H, Diaz-Molina R. Antibody response to pneumococcal polysaccharide vaccine in systemic sclerosis. J Rheumatol 2009; 36:1549-50. [PMID: 19567636 DOI: 10.3899/jrheum.081227] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Mosca M, Giuliano T, Cuomo G, Doveri M, Tani C, Curcio M, Abignano G, De Feo F, Bazzichi L, Della Rossa A, Valentini G, Bombardieri S. Cell-free DNA in the plasma of patients with systemic sclerosis. Clin Rheumatol 2009; 28:1437-40. [PMID: 19669854 DOI: 10.1007/s10067-009-1245-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 07/13/2009] [Accepted: 07/23/2009] [Indexed: 11/28/2022]
Abstract
The aim of the present study was to evaluate the concentration of cell-free DNA (cf-DNA) in the plasma of patients with systemic sclerosis (SSc) and to examine the correlation of cf-DNA with clinical variables of the disease. The study population consisted of 122 SSc patients and 16 healthy controls. Epidemiological and clinical data were collected by direct assessment. The beta-globin gene was used to determine the total amount of DNA in the plasma by real-time quantitative PCR analysis. cf-DNA was found in all patients (mean concentration 1,420.7 copies/ml) and controls (mean concentration 1,462.5), with no significant difference. In SSc patients, no correlation was found between cf-DNA and the type of organ involvement, but patients with active disease presented significantly higher cf-DNA concentrations than those with inactive disease (p < 0.05). Our data suggest that cf-DNA could provide a useful biomarker for the assessment of disease activity in SSc patients.
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Affiliation(s)
- Marta Mosca
- Rheumatology Unit, Department of Internal Medicine, University of Pisa, Via Roma no. 67, 56126 Pisa, Italy.
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Mokkink LB, Terwee CB, Stratford PW, Alonso J, Patrick DL, Riphagen I, Knol DL, Bouter LM, de Vet HCW. Evaluation of the methodological quality of systematic reviews of health status measurement instruments. Qual Life Res 2009; 18:313-33. [PMID: 19238586 DOI: 10.1007/s11136-009-9451-9] [Citation(s) in RCA: 126] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 01/29/2009] [Indexed: 12/13/2022]
Abstract
A systematic review of measurement properties of health-status instruments is a tool for evaluating the quality of instruments. Our aim was to appraise the quality of the review process, to describe how authors assess the methodological quality of primary studies of measurement properties, and to describe how authors evaluate results of the studies. Literature searches were performed in three databases. One hundred and forty-eight reviews were included. The purpose of included reviews was to identify health status instruments used in an evaluative application and to report on the measurement properties of these instruments. Two independent reviewers selected the articles and extracted the data. Reviews were often of low quality: 22% of the reviews used one database, the search strategy was often poorly described, and in many cases it was not reported whether article selection (75%) and data extraction (71%) was done by two independent reviewers. In 11 reviews the methodological quality of the primary studies was evaluated for all measurement properties, and of these 11 reviews only 7 evaluated the results. Methods to evaluate the quality of the primary studies and the results differed widely. The poor quality of reviews hampers evidence-based selection of instruments. Guidelines for conducting and reporting systematic reviews of measurement properties should be developed.
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Affiliation(s)
- Lidwine B Mokkink
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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Qi Q, Guo Q, Tan G, Mao Y, Tang H, Zhou C, Zeng F. Predictors of the scleroderma phenotype in fibroblasts from systemic sclerosis patients. J Eur Acad Dermatol Venereol 2008; 23:160-8. [PMID: 19054252 DOI: 10.1111/j.1468-3083.2008.03016.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fibroblasts from skin lesions generally exhibit the scleroderma phenotype in the early stage of in vitro culture, and act as one of the most important samples to investigate systemic sclerosis. However, not all cell lines from patients show the scleroderma phenotype, and little prospective evidence can be relied on to predict the phenotype of fibroblasts from systemic sclerosis patients. OBJECTIVE This study aims to find the predictive factors related to fibroblast phenotypes. METHODS Fibroblast lines from 15 patients with systemic sclerosis were established through explant culture, with their scleroderma phenotypes being determined by real-time reverse transcription-polymerase chain reaction (RT-PCR) of procollagen transcription. Logistic regression analysis was used to analyse the clinical data of these patients. Haematoxylin-eosin staining was performed to observe histopathological differences. Expression of methylation-related factors was detected by real-time reverse transcription-polymerase chain reaction. RESULTS Eight of the 15 fibroblast cell lines from patients with systemic sclerosis exhibited the scleroderma phenotype. Logistic regression analysis yielded an equation (Y = -9.718 + 2.525X1) in which X1 significantly represents the Valentini Disease Activity Index. Histopathology results demonstrated that the scleroderma phenotype was positively correlated with leucocyte infiltration. Further laboratory observations showed increased expression of Dnmt1 in the positive phenotype fibroblasts and a positive correlation between elevations of Dnmt1 and the maintenance period of the scleroderma phenotype. CONCLUSIONS The results of this study suggest that the Valentini Disease Activity Index and expression of Dnmt1 may act as indicators of the scleroderma phenotype in fibroblasts. Additionally, these data also imply that epigenetic factors, such as Dnmt1, may be involved in the maintenance of the scleroderma phenotype. Our analyses may be beneficial to the research in systemic sclerosis.
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Affiliation(s)
- Q Qi
- Department of Dermatology, Second Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Della Rossa A, Bombardieri S, Valentini G. Comment on: Disease Activity Criteria in Scleroderma. Semin Arthritis Rheum 2008; 37:271-2; author reply 272. [PMID: 17889262 DOI: 10.1016/j.semarthrit.2007.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Accepted: 07/17/2007] [Indexed: 10/22/2022]
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Hudson M, Steele R, Baron M. Reply. Semin Arthritis Rheum 2008. [DOI: 10.1016/j.semarthrit.2007.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Beretta L, Santaniello A, Cappiello F, Barili M, Scorza R. No evidence for a role of the proximal IL-6 G/C -174 single nucleotide polymorphism in Italian patients with systemic sclerosis. J Cell Mol Med 2007; 11:896-8; author reply 898-9. [PMID: 17760849 PMCID: PMC3823266 DOI: 10.1111/j.1582-4934.2007.00070_1.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Indexed: 11/29/2022] Open
Affiliation(s)
- Lorenzo Beretta
- Referral Centre for Systemic Autoimmune Diseases, IRCCS Fondazione Policlinico-Mangiagalli-Regina Elena and University of Milan, Milan, Italy
| | - Alessandro Santaniello
- Referral Centre for Systemic Autoimmune Diseases, IRCCS Fondazione Policlinico-Mangiagalli-Regina Elena and University of Milan, Milan, Italy
| | - Francesca Cappiello
- Referral Centre for Systemic Autoimmune Diseases, IRCCS Fondazione Policlinico-Mangiagalli-Regina Elena and University of Milan, Milan, Italy
| | - Morena Barili
- Referral Centre for Systemic Autoimmune Diseases, IRCCS Fondazione Policlinico-Mangiagalli-Regina Elena and University of Milan, Milan, Italy
| | - Raffaella Scorza
- Referral Centre for Systemic Autoimmune Diseases, IRCCS Fondazione Policlinico-Mangiagalli-Regina Elena and University of Milan, Milan, Italy
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