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Thammaroj P, Chowchuen P, Foocharoen C. Clinical course and factors associated with progressive acro-osteolysis in early systemic sclerosis: a retrospective cohort study. Sci Rep 2024; 14:5129. [PMID: 38429484 PMCID: PMC10907566 DOI: 10.1038/s41598-024-55877-x] [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: 10/03/2023] [Accepted: 02/28/2024] [Indexed: 03/03/2024] Open
Abstract
To examine clinical course of early systemic sclerosis (SSc) and identify factors for progression of acro-osteolysis by a retrospective cohort study. Dual time-point hand radiography was performed at median interval (range 3.0 ± 0.4 years) in 64 recruited patients. Progressive acro-osteolysis was defined as the worsening of severity of acro-osteolysis according to rating scale (normal, mild, moderate, and severe). Incidence of the progression was determined. Cox regression was analyzed for the predictors. A total of 193.6 per 100 person-years, 19/64 patients had progressive acro-osteolysis with incidence of 9.8 per 100-person-years (95% CI 6.3-15.4). The median time of progressive acro-osteolysis was 3.5 years. Rate of progression increased from 1st to 3rd years follow-up with the progression rate at 1-, 2- and 3-years were 0, 2.0 and 18.3%, respectively. Patients with positive anti-topoisomerase I tended to have more progressive acro-osteolysis but no significant predictors on Cox regression. 44%, 18%, and 33% of who had no, mild, and moderate acro-osteolysis previously developed progression and 10 turned to be severe acro-osteolysis. In conclusion, the incidence of progressive acro-osteolysis was uncommon in early SSc but the rate of progression was pronouncedly increasing after three years follow-up. A half of the patients progressed to severe acro-osteolysis.
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Affiliation(s)
- Punthip Thammaroj
- Department of Radiology, Faculty of Medicine, Khon Kaen University, 123 Mittraphap Rd, Nai-Mueang, Mueang District, Khon Kaen, 40002, Thailand.
| | - Prathana Chowchuen
- Department of Radiology, Faculty of Medicine, Khon Kaen University, 123 Mittraphap Rd, Nai-Mueang, Mueang District, Khon Kaen, 40002, Thailand
| | - Chingching Foocharoen
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Lepri G, Airò P, Distler O, Andréasson K, Braun-Moscovici Y, Hachulla E, Balbir-Gurman A, De Langhe E, Rednic S, Ingegnoli F, Rosato E, Groseanu L, Ionescu R, Bellando-Randone S, Garzanova L, Beretta L, Bellocchi C, Moiseev S, Novikov P, Szabo I, Krasowska D, Codullo V, Walker UA, Manolaraki C, Guiducci S, Truchetet ME, Iannone F, Tofani L, Bruni C, Smith V, Cuomo G, Krusche M, Matucci-Cerinic M, Allanore Y. Systemic sclerosis and primary biliary cholangitis: Longitudinal data to determine the outcomes. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2023; 8:210-220. [PMID: 37744053 PMCID: PMC10515998 DOI: 10.1177/23971983231155948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/15/2022] [Indexed: 09/26/2023]
Abstract
Background Several studies described the cross-sectional characteristics of systemic sclerosis patients and coexisting primary biliary cholangitis, but longitudinal prognostic data are lacking. Aims To describe the systemic sclerosis-primary biliary cholangitis phenotype, including baseline characteristics and outcomes. Methods We performed a multicentre the European Scleroderma Trials and Research Group study of systemic sclerosis patients with primary biliary cholangitis or with primary biliary cholangitis-specific antibodies, matched with systemic sclerosis controls free from hepatobiliary involvement matched for disease duration and cutaneous subset. Data were recorded at baseline and at the last available visit. Results A total of 261 patients were enrolled (115 primary biliary cholangitis-systemic sclerosis, 161 systemic sclerosis). At baseline, systemic sclerosis-primary biliary cholangitis patients had a higher prevalence of anti-centromere antibodies (p = 0.0023) and a lower prevalence of complete absence of digital ulcers. The milder vascular involvement was confirmed at follow-up when crucial differences emerged in the percentage of patients experiencing digital ulcers; a significantly higher number of patients who never experienced digital ulcers were observed among primary biliary cholangitis-systemic sclerosis patients (p = 0.0015). Moreover, a greater incidence of pulmonary arterial hypertension (p < 0.001) and of conduction blocks (p = 0.0256) was observed in systemic sclerosis patients without primary biliary cholangitis. Patients with primary biliary cholangitis had higher levels of liver enzymes at baseline than systemic sclerosis patients; a significant decrease in liver enzymes was observed at follow-up. Out of 18 patients with cholangitis, one received a liver transplant at follow-up. Conclusion Our data show that systemic sclerosis-primary biliary cholangitis exhibit a mild systemic sclerosis and primary biliary cholangitis phenotype with outcomes being in general favourable.
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Affiliation(s)
- Gemma Lepri
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Paolo Airò
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Brescia, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Kristofer Andréasson
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Yolanda Braun-Moscovici
- Rheumatology Department, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Eric Hachulla
- Department of Internal Medicine, Hôpital Claude Huriez, Lille, France
| | - Alexandra Balbir-Gurman
- Rheumatology Department, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ellen De Langhe
- ERN ReCONNET, Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Simona Rednic
- Department of Rheumatology, Emergency County Teaching Hospital, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Francesca Ingegnoli
- Clinical Rheumatology Unit, ASST Pini-CTO, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Laura Groseanu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ruxandra Ionescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Silvia Bellando-Randone
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Liudmila Garzanova
- Laboratory of Microcirculation and Inflammation, VA Nasonova Institute of Rheumatology, Moscow, Russian Federation
| | - Lorenzo Beretta
- Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Chiara Bellocchi
- Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Sergey Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Pavel Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Iulia Szabo
- Department of Rheumatology, Emergency County Teaching Hospital, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Dorota Krasowska
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | | | - Ulrich A. Walker
- Department of Rheumatology, Universitätsspital Basel, Basel, Switzerland
| | | | - Serena Guiducci
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Florenzo Iannone
- Rheumatology Unit – DETO, School of Medicine, University of Bari, Bari, Italy
| | - Lorenzo Tofani
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Cosimo Bruni
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital and Department of Internal Medicine, Ghent University, Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Giovanna Cuomo
- Department of Precision of Medicine, University of Campania – L. Vanvitelli, Naples, Italy
| | - Martin Krusche
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Yannick Allanore
- Rheumatology, Cochin Hospital, APHP, Paris Cité University, Paris, France
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Lekieffre M, Gallay L, Landon-Cardinal O, Hot A. Joint and muscle inflammatory disease: A scoping review of the published evidence. Semin Arthritis Rheum 2023; 61:152227. [PMID: 37210805 DOI: 10.1016/j.semarthrit.2023.152227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 04/05/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVES Polyarthritis is commonly reported in idiopathic inflammatory myositis patients, but few studies have focused on the overlap of myositis with rheumatoid arthritis which is a difficult diagnosis in the absence of well-defined diagnostic criteria. The primary objective of this scoping review was to map the field of research to explore the potential diagnoses in patients presenting with both myositis and polyarthritis. METHODS Two electronic databases (MEDLINE/PubMed® and Web of Science®) were systematically searched using the terms (myositis OR 'inflammatory idiopathic myopathies') AND (polyarthritis OR 'rheumatoid arthritis') without any publication date limit. RESULTS Among individual records, 280 reports met inclusion criteria after full-text review. There was heterogeneity in the definition of overlap myositis as well as the characteristics of rheumatoid arthritis. In many studies, key data were lacking; rheumatoid factor status was reported in 56.8% (n=151), anti-citrullinated proteins antibodies status in 18.8% (n=50), and presence or absence of bone erosions in 45.1% (n=120) of the studies. Thirteen different diagnoses were found to associate myositis with polyarthritis: antisynthetase syndrome (29.6%, n=83), overlap myositis with rheumatoid arthritis (16.1%, n=45), drug-induced myositis (20.0%, n=56), rheumatoid myositis (7.5%, n=21), inclusion body myositis (1.8%, n=5), overlap with connective tissue disease (20.0%, n=56), and others (5.0%, n=14). CONCLUSION The spectrum of joint and muscle inflammatory diseases encompasses many diagnoses including primitive and secondary myositis associated with RA or arthritis mimicking RA. This review highlights the need for a consensual definition of OM with RA to better individualise this entity from the numerous differential diagnoses.
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Affiliation(s)
- Maud Lekieffre
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 place d'Arsonval, Lyon 69003, France.
| | - Laure Gallay
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 place d'Arsonval, Lyon 69003, France
| | - Océane Landon-Cardinal
- Division of Rheumatology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Arnaud Hot
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 place d'Arsonval, Lyon 69003, France
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Sawadpanich K, Promasen P, Mairiang P, Sukeepaisarnjareon W, Sangchan A, Suttichaimongkol T, Tangvoraphonkchai K, Foocharoen C. Incidence and Predictors of an Abnormal Liver Function Test Among 674 Systemic Sclerosis Patients: A Cohort Study. Open Access Rheumatol 2023; 15:81-92. [PMID: 37214354 PMCID: PMC10199701 DOI: 10.2147/oarrr.s410165] [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: 03/09/2023] [Accepted: 05/02/2023] [Indexed: 05/24/2023] Open
Abstract
Background Abnormal liver function tests (LFTs) can indicate cirrhosis or liver cancer leading to mortality among systemic sclerosis (SSc) patients. No recent studies have investigated the clinical predictors of an abnormal LFT in SSc. We aimed to determine the incidence of abnormal LFT (including from hepatitis and cholestasis) and to identify its clinical predictors in SSc patients. Methods An historical cohort was conducted on 674 adult SSc patients who attended the Scleroderma Clinic, Khon Kaen University, between January 2012 and November 2019 and who underwent routine screening for LFT. A Cox regression was used to analyze the clinical predictors of abnormal LFT. Results Four hundred and thirty cases, representing 4190 person-years, had abnormal LFTs (viz, from hepatitis, cholestasis, and cholestatic hepatitis) for an incidence rate of 10.2 per 100 person-years. The respective incidence of hepatitis, cholestasis, and cholestatic hepatitis was 20.5, 12.9, and 20.4 per 100 person-years. The respective median first-time detection of hepatitis, cholestasis, and cholestatic hepatitis was 3.0, 5.9, and 2.8 years, and none had signs or symptoms suggestive of liver disease. According to the Cox regression analysis, the predictors of an abnormal LFT in SSc were elderly onset of SSc (hazard ratio (HR) 1.02), alcoholic drinking (HR 1.74), high modified Rodnan Skin Score (mRSS) (HR 1.03), edematous skin (HR 2.94), Raynaud's phenomenon (HR 1.39), hyperCKaemia (HR 1.88), and methotrexate use (HR 1.55). In contrast, current sildenafil treatment (HR 0.63) and high serum albumin (HR 0.70) were protective factors. Conclusion Occult hepatitis, cholestasis, and cholestatic hepatitis can be detected in SSc patients using LFT screening, especially in cases of early disease onset. The long-term outcome is uncertain, and more longitudinal research is required.
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Affiliation(s)
- Kookwan Sawadpanich
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Palinee Promasen
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Pisaln Mairiang
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Wattana Sukeepaisarnjareon
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Apichat Sangchan
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Tanita Suttichaimongkol
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Kawin Tangvoraphonkchai
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Chingching Foocharoen
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
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Giannini M, Ellezam B, Leclair V, Lefebvre F, Troyanov Y, Hudson M, Senécal JL, Geny B, Landon-Cardinal O, Meyer A. Scleromyositis: A distinct novel entity within the systemic sclerosis and autoimmune myositis spectrum. Implications for care and pathogenesis. Front Immunol 2023; 13:974078. [PMID: 36776390 PMCID: PMC9910219 DOI: 10.3389/fimmu.2022.974078] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/19/2022] [Indexed: 01/27/2023] Open
Abstract
Systemic sclerosis and autoimmune myositis are both associated with decreased quality of life and increased mortality. Their prognosis and management largely depend on the disease subgroups. Indeed, systemic sclerosis is a heterogeneous disease, the two predominant forms of the disease being limited and diffuse scleroderma. Autoimmune myositis is also a heterogeneous group of myopathies that classically encompass necrotizing myopathy, antisynthetase syndrome, dermatomyositis and inclusion body myositis. Recent data revealed that an additional disease subset, denominated "scleromyositis", should be recognized within both the systemic sclerosis and the autoimmune myositis spectrum. We performed an in-depth review of the literature with the aim of better delineating scleromyositis. Our review highlights that this concept is supported by recent clinical, serological and histopathological findings that have important implications for patient management and understanding of the disease pathophysiology. As compared with other subsets of systemic sclerosis and autoimmune myositis, scleromyositis patients can present with a characteristic pattern of muscle involvement (i.e. distribution of muscle weakness) along with multisystemic involvement, and some of these extra-muscular complications are associated with poor prognosis. Several autoantibodies have been specifically associated with scleromyositis, but they are not currently integrated in diagnostic and classification criteria for systemic sclerosis and autoimmune myositis. Finally, striking vasculopathic lesions at muscle biopsy have been shown to be hallmarks of scleromyositis, providing a strong anatomopathological substratum for the concept of scleromyositis. These findings bring new insights into the pathogenesis of scleromyositis and help to diagnose this condition, in patients with subtle SSc features and/or no autoantibodies (i.e. "seronegative" scleromyositis). No guidelines are available for the management of these patients, but recent data are showing the way towards a new therapeutic approach dedicated to these patients.
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Affiliation(s)
- Margherita Giannini
- Service de Physiologie et explorations fonctionnelles, University Hospital of Strasbourg, Strasbourg, France,Centre de Référence des Maladies Autoimmunes Rares, University Hospital of Strasbourg, Strasbourg, France,Unité de Recherche 3072 (UR3072), Centre de Recherche en Biomédecine, University of Strasbourg, Strasbourg, France
| | - Benjamin Ellezam
- Division of Pathology, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Department of Pathology and Cell Biology, Université de Montréal, Montréal, QC, Canada
| | - Valérie Leclair
- Division of Rheumatology, Jewish General Hospital, Department of Medicine, McGill University, Montréal, QC, Canada
| | - Frédéric Lefebvre
- Division of Rheumatology, Centre Hospitalier de l’Université de Montréal (CHUM), Autoimmunity Research Laboratory, CHUM Research Center, Montréal, QC, Canada,Department of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Yves Troyanov
- Division of Rheumatology, Hôpital du Sacré-Coeur, Department of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Marie Hudson
- Division of Rheumatology, Jewish General Hospital, Department of Medicine, McGill University, Montréal, QC, Canada
| | - Jean-Luc Senécal
- Division of Rheumatology, Centre Hospitalier de l’Université de Montréal (CHUM), Autoimmunity Research Laboratory, CHUM Research Center, Montréal, QC, Canada,Department of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Bernard Geny
- Service de Physiologie et explorations fonctionnelles, University Hospital of Strasbourg, Strasbourg, France,Unité de Recherche 3072 (UR3072), Centre de Recherche en Biomédecine, University of Strasbourg, Strasbourg, France
| | - Océane Landon-Cardinal
- Division of Rheumatology, Centre Hospitalier de l’Université de Montréal (CHUM), Autoimmunity Research Laboratory, CHUM Research Center, Montréal, QC, Canada,Department of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Alain Meyer
- Service de Physiologie et explorations fonctionnelles, University Hospital of Strasbourg, Strasbourg, France,Unité de Recherche 3072 (UR3072), Centre de Recherche en Biomédecine, University of Strasbourg, Strasbourg, France,Service de rhumatologie, Centre de Référence des Maladies Autoimmunes Rares, University Hospital of Strasbourg, Strasbourg, France,*Correspondence: Alain Meyer,
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Hughes M, Herrick AL. Diagnosis and management of systemic sclerosis-related calcinosis. Expert Rev Clin Immunol 2023; 19:45-54. [PMID: 36333952 DOI: 10.1080/1744666x.2023.2144835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Calcinosis is common in patients with systemic sclerosis (SSc) and refers to the sub-epidermal deposition of calcium salts in the skin. SSc-related calcinosis is associated with significant morbidity, including through cutaneous ulceration and predisposition to become infected. AREAS COVERED After briefly addressing aetiopathogenesis, we describe the clinical burden of SSc-associated calcinosis and provide a structured and practical clinical approach to diagnosis and assessment, including discussion of the role of different imaging modalities. The multi-faceted treatment of SSc-associated calcinosis is presented under three broad headings of 'general measures,' and 'medical treatment' and 'surgical treatment.' We adopted a narrative approach to identify relevant manuscripts to inform our review. EXPERT OPINION SSc-related calcinosis is an area of major unmet clinical need and for too long has been a neglected area of research. Safe and effective treatments are badly needed to improve patient quality of life and outcomes. To facilitate future clinical trials, we require increased understanding of pathogenesis (to inform selection of potential targeted therapies) and reliable outcome measures, including those which will measure the impact and severity of calcinosis from the patient perspective. International collaborative research is ongoing to develop outcome measures and treatments for this potentially devastating complication of SSc.
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Affiliation(s)
- Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, the University of Manchester, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Ariane L Herrick
- Division of Musculoskeletal and Dermatological Sciences, the University of Manchester, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, UK
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7
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Satoh M, Ceribelli A, Hasegawa T, Tanaka S. Clinical Significance of Antinucleolar Antibodies: Biomarkers for Autoimmune Diseases, Malignancies, and others. Clin Rev Allergy Immunol 2022; 63:210-239. [PMID: 35258843 DOI: 10.1007/s12016-022-08931-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2022] [Indexed: 01/13/2023]
Abstract
Nucleolar staining is one of the standard patterns in immunofluorescence antinuclear antibodies (ANA), seen in 5-9% of ANA in various conditions. Antinucleolar antibodies (ANoA) are classified into 3 patterns in the International Consensus on ANA Patterns (ICAP) classification; AC-8 homogeneous pattern, AC-9 clumpy pattern, and AC-10 punctate pattern. Specificities known to show AC-8 include anti-Th/To, -PM-Scl, -nucleophosmin/B23, -nucleolin/C23, -No55, and others. AC-9 is seen by anti-fibrillarin/U3RNP and AC-10 by anti-RNA polymerase I and hUBF/NOR-90. ANoA has been classically known to be associated with scleroderma (SSc) and the characterization of nucleolar antigens identified several autoantigens recognized by SSc autoantibodies. The clinical association of anti-Th/To, PM-Scl, fibrillarin/U3RNP, and RNA polymerase I with SSc or SSc-overlap syndrome is well established, and commercial assays are developed. Anti-hUBF/NOR90, nucleophosmin/B23, and nucleolin/C23 are known for decades and reported in systemic autoimmune rheumatic diseases (SARDs), malignancies, graft versus host disease (GVHD), and others; however, their clinical significance remains to be established.
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Affiliation(s)
- Minoru Satoh
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, 1-1 Isei-gaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan.
| | - Angela Ceribelli
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano (Milan), 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Via A. Manzoni 56, Pieve Emnuele (Milan), 20089, Italy
| | - Tomoko Hasegawa
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, 1-1 Isei-gaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan
| | - Shin Tanaka
- Department of Human, Information and Sciences, School of Health Sciences, University of Occupational and Environmental Health, 1-1 Isei-gaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan
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8
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Bobeica C, Niculet E, Craescu M, Parapiru EL, Musat CL, Dinu C, Chiscop I, Nechita L, Debita M, Stefanescu V, Stefanopol IA, Nechifor A, Pelin AM, Balan G, Chirobocea S, Vasile CI, Tatu AL. CREST Syndrome in Systemic Sclerosis Patients - Is Dystrophic Calcinosis a Key Element to a Positive Diagnosis? J Inflamm Res 2022; 15:3387-3394. [PMID: 35706527 PMCID: PMC9191197 DOI: 10.2147/jir.s361667] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/04/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction CREST syndrome is a clinical entity associated with systemic sclerosis, which meets at least three of the five clinical features: calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia. Three of these clinical features (Raynaud’s phenomenon, sclerodactyly and esophageal dysmotility) are often present in classical subsets of SSc: limited and diffuse, and their presence in association does not define CREST syndrome. Calcinosis seems to be less common in SSc and its association with other clinical features is characteristic of CREST syndrome. Therefore, it can be appreciated that calcinosis is the key element of CREST syndrome. Methods This study included a number of 37 candidates with SSc, diagnosed with the help of the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) 2013 criteria. Results and Discussions These three elements (calcinosis, Raynaud’s phenomenon, esophageal dysmotility) were recorded both in the limited subset of SSc, but especially in the subset of diffuse SSc, contrary to the data in the literature. Conclusion We appreciate that CREST syndrome is a clinical entity that can overlap with both subsets of SSc. Given the divergent views of the authors on the classification of CREST syndrome, future studies may contribute to a reassessment of SSc classification.
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Affiliation(s)
- Carmen Bobeica
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, Romania.,Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), 'Dunărea de Jos' University, Galați, Romania
| | - Mihaela Craescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, Romania
| | - Elena-Laura Parapiru
- Clinical Medical Department, Faculty of Medicine and Pharmacy, Dunărea de Jos University, Galați, Romania
| | - Carmina Liana Musat
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, Romania
| | - Ciprian Dinu
- Dental Department, Faculty of Medicine and Pharmacy, Dunărea de Jos University, Galați, Romania
| | - Iulia Chiscop
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, Romania
| | - Luiza Nechita
- Clinical Medical Department, Faculty of Medicine and Pharmacy, Dunărea de Jos University, Galați, Romania
| | - Mihaela Debita
- Medical Department, Faculty of Medicine and Pharmacy, Dunărea de Jos University, Galați, Romania
| | - Victorita Stefanescu
- Medical Department, Faculty of Medicine and Pharmacy, Dunărea de Jos University, Galați, Romania
| | - Ioana Anca Stefanopol
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, Romania.,Department of Pediatrics, Clinical Emergency Hospital for Children "Sf. Ioan", Galati, Romania
| | - Alexandru Nechifor
- Clinical Medical Department, Faculty of Medicine and Pharmacy, Dunărea de Jos University, Galați, Romania
| | - Ana Maria Pelin
- Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, Romania
| | - Gabriela Balan
- Clinical Medical Department, Faculty of Medicine and Pharmacy, Dunărea de Jos University, Galați, Romania.,Department of Gastroenterology, "Sf. Apostol Andrei" County Emergency Clinical Hospital, Galați, Romania.,Research Center in the Field of Medical and Pharmaceutical Sciences, "Dunărea de Jos" University, Galați, Romania
| | - Silvia Chirobocea
- Department of Neurology, Municipal Emergency Hospital, Moinești, Romania
| | - Claudiu Ionut Vasile
- Clinical Medical Department, Faculty of Medicine and Pharmacy, Dunărea de Jos University, Galați, Romania
| | - Alin Laurentiu Tatu
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), 'Dunărea de Jos' University, Galați, Romania.,Clinical Medical Department, Faculty of Medicine and Pharmacy, Dunărea de Jos University, Galați, Romania.,Dermatology Department, "Sf. Cuvioasa Parascheva" Clinical Hospital of Infectious Diseases, Galați, Romania
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9
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Bobeica C, Niculet E, Musat CL, Craescu M, Stefanescu BI, Dinu C, Chiscop I, Chirobocea S, Nechita L, Iancu AV, Stefanescu V, Balan G, Stefanopol IA, Pelin AM, Tatu AL. Paraclinical Aspects in Systemic Sclerosis. Int J Gen Med 2022; 15:4391-4398. [PMID: 35502184 PMCID: PMC9056056 DOI: 10.2147/ijgm.s355662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Abstract
Systemic sclerosis (SSc) is a chronic inflammatory disease with an autoimmune substrate that affects the skin and a large number of internal organs. The chronic inflammatory process is sustained by a wide range of cytokines and chemokines, which are discharged by inflammatory cells, with fibrosis and nail bed vascular changes (disorganized vasculature architecture with microhemorrhages, megacapillaries and areas without capillaries). Confocal microscopy contributes to the understanding of the molecular mechanism involved in chronic inflammation and mainly targets the field of research. Coherent optical tomography, capillaroscopy, and skin biopsy are useful for the differential diagnosis of SSc with other sclerodermoid syndromes. The immunological profile is a classification criterion for SSc and directs the diagnosis to the two subsets of the disease. Multisystemic damage requires evaluation with the help of a set of investigations specific to each affected organ, such as: diffusing capacity for carbon monoxide, forced vital capacity, 6-minute walk test, high-resolution computed tomography standard and reduced sequential, cardiac ultrasound and right cardiac catheterization. The current possibilities of diagnosis, treatment and monitoring are permanently adapting to new medical discoveries.
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Affiliation(s)
- Carmen Bobeica
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galați, Galati, 800008, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galați, Galati, 800008, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galați, 800008, Romania
- Correspondence: Elena Niculet; Carmina Liana Musat, Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galați, 35 Alexandru Ioan Cuza Street, Galați, 800008, Romania, Tel +40741398895; +40723338438, Email ;
| | - Carmina Liana Musat
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galați, Galati, 800008, Romania
| | - Mihaela Craescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galați, Galati, 800008, Romania
| | - Bogdan Ioan Stefanescu
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania
| | - Ciprian Dinu
- Dental Department, Faculty of Medicine and Pharmacy, Dunărea de Jos University, Galați, Romania
| | - Iulia Chiscop
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania
| | - Silvia Chirobocea
- Department of Neurology, Municipal Emergency Hospital, Moinești, Romania
| | - Luiza Nechita
- Clinical Medical Department, Faculty of Medicine and Pharmacy, Dunărea de Jos University, Galați, Romania
| | - Alina Viorica Iancu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galați, Galati, 800008, Romania
| | - Victorita Stefanescu
- Medical Department, Faculty of Medicine and Pharmacy, Dunărea de Jos University, Galați, Romania
| | - Gabriela Balan
- Clinical Medical Department, Faculty of Medicine and Pharmacy, Dunărea de Jos University, Galați, Romania
- Department of Gastroenterology, “Sf. Apostol Andrei” County Emergency Clinical Hospital, Galați, Romania
- Research Center in the Field of Medical and Pharmaceutical Sciences, “Dunărea de Jos” University, Galați, Romania
| | - Ioana Anca Stefanopol
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galați, Galati, 800008, Romania
- Department of Pediatrics, Clinical Emergency Hospital for Children “Sf. Ioan”, Galati, Romania
| | - Ana Maria Pelin
- Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania
| | - Alin Laurentiu Tatu
- Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galați, 800008, Romania
- Clinical Medical Department, Faculty of Medicine and Pharmacy, Dunărea de Jos University, Galați, Romania
- Dermatology Department, “Sf. Cuvioasa Parascheva” Clinical Hospital of Infectious Diseases, Galați, Romania
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10
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Bobeica C, Niculet E, Halip AI, Gheuca-Solovastru L, Draganescu ML, Popescu IA, Onisor C, Chirobocea S, Lungu M, Craescu M. Predictive value of immunological markers in systemic sclerosis. Exp Ther Med 2021; 22:994. [PMID: 34345276 PMCID: PMC8311248 DOI: 10.3892/etm.2021.10426] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/04/2021] [Indexed: 12/20/2022] Open
Abstract
Systemic sclerosis (SSc) is a collagenosis characterized by excessive deposition of collagen in the skin and viscera, in a background of immune disorder. The immunological profile of SSc often shows elevated levels of antinuclear antibodies (ANAs). However, many authors have identified cases of SSc having normal ANA levels, framed as paraneoplastic SSc. Among patients with negative ANAs in our group, we did not identify any neoplastic process that could support this hypothesis. The extended detection of autoantibodies is extremely useful in establishing the subset of SSc. Thus, anti-Scl70 antibodies are specific for the diffuse subset of SSc, while anticentromere antibodies (ACAs) have specificity for a limited subset. However, studies have shown the existence of cases of diffuse SSc having high titers of ACAs and cases of limited SSc with high titers of anti-Scl70 antibodies. This indicates an inconsistent association between the disease subset and the autoantibodies specific to each subset. Our study found a more balanced consistency between disease subsets and autoantibodies specific for each subset. Therefore, the percentages of patients having an immunological profile inconsistent with the subset of SSc, are lower than those found by other authors. This observation opens the perspective of larger studies on the immunological profile in SSc.
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Affiliation(s)
- Carmen Bobeica
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, ‘Dunărea de Jos’ University of Galați, 800216 Galați, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, ‘Dunărea de Jos’ University of Galați, 800216 Galați, Romania
| | - Alina Ioana Halip
- Department of Dermato-Venereology, Doctoral School of ‘Gr. T. Popa’ University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Laura Gheuca-Solovastru
- Department of Clinical Dermato-Venereology, Faculty of Medicine and Pharmacy, ‘Gr. T. Popa’ University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Miruna Luminita Draganescu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunărea de Jos’ University of Galați, 800216 Galați, Romania
| | - Ioana Adriana Popescu
- Department of Dermato-Venereology, Doctoral School of ‘Gr. T. Popa’ University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Cristian Onisor
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, ‘Dunărea de Jos’ University of Galați, 800216 Galați, Romania
| | - Silvia Chirobocea
- Department of Neurology, Municipal Emergency Hospital, 605400 Moinești, Romania
| | - Mihaela Lungu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunărea de Jos’ University of Galați, 800216 Galați, Romania
| | - Mihaela Craescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, ‘Dunărea de Jos’ University of Galați, 800216 Galați, Romania
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11
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Qiu M, Nian X, Pang L, Yu P, Zou S. Prevalence and risk factors of systemic sclerosis-associated interstitial lung disease in East Asia: A systematic review and meta-analysis. Int J Rheum Dis 2021; 24:1449-1459. [PMID: 34418313 PMCID: PMC9292335 DOI: 10.1111/1756-185x.14206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
Objective Interstitial lung disease (ILD) is a common and potentially life‐threatening complication for individuals with systemic sclerosis (SSc). The purpose of this study was to complete a systematic review and meta‐analysis on prevalence and risk factors of SSc‐ILD in East Asia. Methods Medline, EMBASE, and Cochrane Library were searched up to January 22, 2021. The Reporting of Observational Studies in Epidemiology (STROBE) statement was applied to access the methodological quality of the eligible studies. Study characteristics and magnitude of effect sizes were extracted. Then, we calculated the pooled prevalence, weighted mean differences (WMDs), pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs), and performed subgroup analysis, sensitivity analysis, and publication bias with Egger's test. Results Twenty‐seven of 1584 articles were eligible and a total of 5250 patients with SSc were selected in the meta‐analysis. The pooled prevalence of SSc‐ILD in East Asia was 56% (95% CI 49%‐63%). The SSc‐ILD prevalence was higher in China (72%) than in Japan (46%) and Korea (51%). Longer disease duration (WMD = 1.97, 95% CI 0.55‐3.38), diffuse SSc (OR = 2.84, 95% CI 1.91‐4.21), positive anti‐topoisomerase I antibody (ATA) (OR = 4.92, 95% CI 2.74‐8.84), positive anti‐centromere body antibody (ACA) (OR = 0.14, 95% CI 0.08‐0.25), positive anti‐U3 ribonucleoprotein (RNP) antibody (OR = 0.17, 95% CI 0.04‐0.66), and higher erythrocyte sedimentation rate (ESR) (WMD = 6.62, 95% CI 1.19‐12.05) were associated with SSc‐ILD in East Asia. Conclusion Through this systematic review and meta‐analysis, we found that ILD occurs in up to approximately 56% of patients with SSc in East Asia. Longer disease duration, diffuse SSc, positive ATA, negative ACA, negative anti‐U3 RNP antibody, and higher ESR were risk factors for SSc‐ILD.
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Affiliation(s)
- Meihua Qiu
- Department of Respiratory and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated with the Medical College of Qingdao, Yantai, China
| | - Xueyuan Nian
- Department of Gastroenterology, Yantai Yuhuangding Hospital, Affiliated with the Medical College of Qingdao, Yantai, China
| | - Lingling Pang
- Department of Respiratory and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated with the Medical College of Qingdao, Yantai, China
| | - Pengfei Yu
- Department of Respiratory and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated with the Medical College of Qingdao, Yantai, China
| | - Shenchun Zou
- Department of Respiratory and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated with the Medical College of Qingdao, Yantai, China
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12
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Hesselstrand R, Distler JHW, Riemekasten G, Wuttge DM, Törngren M, Nyhlén HC, Andersson F, Eriksson H, Sparre B, Tuvesson H, Distler O. An open-label study to evaluate biomarkers and safety in systemic sclerosis patients treated with paquinimod. Arthritis Res Ther 2021; 23:204. [PMID: 34330322 PMCID: PMC8325221 DOI: 10.1186/s13075-021-02573-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 07/06/2021] [Indexed: 12/30/2022] Open
Abstract
Objectives To evaluate the changes in disease-related biomarkers and safety of paquinimod, an oral immunomodulatory compound, in patients with systemic sclerosis (SSc). Methods In this open-label, single-arm, multicenter study, SSc patients with a rapidly progressive disease received paquinimod for 8 weeks. Blood and skin biopsies were collected at baseline, during treatment, and at follow-up for the analyses of type I interferon (IFN) activity, chemokine (C-C motif) ligand 2 (CCL2), and the number of myofibroblasts. The safety of paquinimod was evaluated throughout the study. Results Nine SSc patients were enrolled and completed the study treatment with paquinimod at 3 mg/day for 8 weeks. After the treatment, a reduction of type I IFN activity in the plasma from one patient with elevated baseline IFN activity was recorded. A trend towards reduced IFN activity in the skin after treatment was also observed in patients. The serum level of CCL2 was reduced in 7 of 9 patients after paquinimod treatment. There was a median reduction of 10% of the number of myofibroblasts in skin biopsies at week 8 compared to baseline. No change in modified Rodnan skin score and quality of life was detected in the study. Reported adverse events (AEs) were mild to moderate and expected with the most common being arthralgia (n = 3) and headache (n = 3), and C-reactive protein (CRP) increase. Conclusions Analysis of biomarkers before and after treatment suggest reduced type I IFN activity and reduced number of myofibroblasts in lesional skin. Paquinimod was overall well tolerated with mild to moderate and expected AEs. Trial registration ClinicalTrials.gov, NCT01487551. Registered on 7 September 2011 Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02573-0.
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Affiliation(s)
- Roger Hesselstrand
- Department of Rheumatology, Skåne University Hospital and Lund University, Lund, Sweden.
| | | | | | - Dirk M Wuttge
- Department of Rheumatology, Skåne University Hospital and Lund University, Lund, Sweden
| | | | | | | | | | | | | | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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13
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Bobeica C, Niculet E, Craescu M, Onisor C, Bujoreanu F, Draganescu ML, Halip IA, Gheuca-Solovastru L. Epidemiological profile of systemic sclerosis in the southeast region of Romania. Exp Ther Med 2020; 21:77. [PMID: 33363588 PMCID: PMC7725015 DOI: 10.3892/etm.2020.9509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/20/2020] [Indexed: 12/11/2022] Open
Abstract
Systemic sclerosis (SSc) is a collagenosis, in which the microvasculature of the skin and internal organs becomes affected, followed by excessive deposition of connective tissue. It has been included in the group of rare diseases, and it seems to have had an increasing incidence over the last two decades. Statistics show, not only an increase in the incidence of SSc, but that of autoimmune diseases as a whole. The present study aimed to outline the epidemiological profile of SSc in the southeast region of Romania and to identify similarities and differences concerning the epidemiology of this disease in other countries. The current observational study was carried out on a group of 22 patients who were diagnosed with SSc and who were hospitalized at a university clinic in Bucharest. Our research revealed a higher prevalence of women suffering from SSc, with higher numbers suffering from the diffuse subset of this disease. In addition, we found that the majority of patients came from urban areas. SSc has an important impact on the quality of life of patients, thus opening the opportunity for studies to be carried out on larger populations of patients in order to identify epidemiological similarities and differences in various countries, as well as finding new experimental models useful for future research.
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Affiliation(s)
- Carmen Bobeica
- Department of Dermato‑Venereology, 'Gr. T. Popa' Doctoral School University of Medicine and Pharmacy, Iași 700115, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University, Galați 800216, Romania
| | - Mihaela Craescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University, Galați 800216, Romania
| | - Cristian Onisor
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University, Galați 800216, Romania
| | - Florin Bujoreanu
- Department of Clinical Dermato‑Venereology, 'Sf. Cuvioasă Parascheva' Infectious Diseases Clinical Hospital, Galați 800179, Romania
| | - Miruna Luminita Draganescu
- Department of Clinical Infectious Diseases, 'Dunărea de Jos' University, Faculty of Medicine and Pharmacy, Galați 800216, Romania
| | - Ioana Alina Halip
- Department of Dermato‑Venereology, 'Gr. T. Popa' Doctoral School University of Medicine and Pharmacy, Iași 700115, Romania
| | - Laura Gheuca-Solovastru
- Department of Clinical Dermato-Venereology, 'Gr. T. Popa' University of Medicine and Pharmacy, Faculty of Medicine and Pharmacy, Iași 700115, Romania
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14
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Krikeerati T, Pussadhamma B, Mahakkanukrauh A, Suwannaroj S, Nanagara R, Foocharoen C. Associated factors of early-onset pulmonary hypertension and clinical difference between early- and late-onset pulmonary hypertension in Thai systemic sclerosis. Mod Rheumatol 2020; 31:649-656. [PMID: 32924684 DOI: 10.1080/14397595.2020.1823067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Pulmonary hypertension (PH) is a major cause of death in systemic sclerosis (SSc). Detection of early-onset PH and its associated factors would be helpful for improving patient care. Our aims were to determine the factors associated with early-onset PH and to define the differences between early- and late-onset PH among SSc patients. METHODS A cohort study was conducted of 409 adult SSc patients who had followed-up between January 2014 and December 2016. Early-PH is defined when the onset of PH is diagnosed within 5 years of the disease. Logistic regression analysis was applied to determine the factors associated with early-PH. RESULTS In 3409 person-years, we diagnosed 50 cases with PH confirmation by right heart catheterization, of whom 26 were early-PH (incidence 0.7 per 100 person-years; 95%CI:0.5-1.1). Among SSc with early-PH, 69.2% had the diffuse cutaneous SSc subset and the most common PH classification was PH due to interstitial lung disease (18 cases;69.2%). According to a logistic regression analysis, early-PH was associated with a WHO functional class (WHO-FC) II and higher, cardiomegaly according to chest radiography, and tricuspid regurgitation jet maximum velocity (TRVmax)>2.8 m/s with the respective OR of 20.12 (95%CI:1.59-255.35), 7.42 (95%CI:1.35-40.88), and 8.20 (95%CI:1.17-57.64). To contrast, early-PH had a negative association with gastrointestinal involvement (OR 0.08; 95%CI:0.01-0.56). CONCLUSIONS Early-PH is prevalent among SSc patients and the most common cause is interstitial lung disease. A poor WHO-FC, cardiomegaly, and a high TRVmax are associated with early-PH. Gastrointestinal involvement is a protective factor for early-PH in SSc.
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Affiliation(s)
- Thanachit Krikeerati
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Burabha Pussadhamma
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ajanee Mahakkanukrauh
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Siraphop Suwannaroj
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ratanavadee Nanagara
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chingching Foocharoen
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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15
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Miyake M, Matsushita T, Takehara K, Hamaguchi Y. Clinical features of Japanese systemic sclerosis (SSc) patients negative for SSc-related autoantibodies: A single-center retrospective study. Int J Rheum Dis 2020; 23:1219-1225. [PMID: 32662135 DOI: 10.1111/1756-185x.13908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the clinical features of systemic sclerosis (SSc) patients negative for SSc-related autoantibodies (autoAbs). METHODS Serum samples were collected from 546 SSc patients. The presence of antinuclear antibody (ANA) was screened by indirect immunofluorescence (IIF) staining using HEp-2 cells. SSc-related autoantibodies were identified by specific IIF staining, enzyme-linked immunosorbent assay, or immunoprecipitation assay. Clinical features were analyzed among patients negative for ANA/SSc-related autoAbs, anticentromere Abs (ACA), anti-topoisomerase I (anti-topo I) Abs, and anti-RNA polymerase (anti-RNAP) Abs. RESULTS Of the 546 SSc patients, 26 (4.8%) were negative for ANA and 29 (5.3%) were ANA-positive but negative for SSc-related autoAbs. Regarding clinical features, patients negative for ANA/SSc-related autoAbs (n = 55) had a significantly shorter disease duration, higher proportion of the diffuse type, contracture of phalanges, diffuse pigmentation, higher modified Rodnan total skin thickness score (mRSS), and lower incidence of telangiectasia than those with ACA (n = 224). On the other hand, younger disease onset, lower mRSS, and lower incidence of scleroderma renal crisis were observed in patients negative for ANA/SSc-related autoAbs than in those with anti-RNAP Abs (n = 52). Although pitting scars were less common in patients negative for ANA/SSc-related autoAbs than in those with anti-topo I Abs (n = 144), their clinical features were similar. CONCLUSION Patients negative for ANA/SSc-related autoAbs form a clinically distinct subset among SSc patients.
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Affiliation(s)
- Miho Miyake
- Department of Molecular Pathology of Skin, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Takashi Matsushita
- Department of Molecular Pathology of Skin, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Kazuhiko Takehara
- Department of Molecular Pathology of Skin, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Yasuhito Hamaguchi
- Department of Molecular Pathology of Skin, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
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16
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Duffus K, López-Isac E, Teruel M, Simeón CP, Carreria P, Ortego-Centeno N, Vicente E, Worthington J, Herrick AL, Martin J. Association of TNFSF4 (OX40L) polymorphisms with systemic sclerosis-related calcinosis. Rheumatology (Oxford) 2020; 58:1299-1301. [PMID: 30789234 DOI: 10.1093/rheumatology/kez015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kate Duffus
- Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Elena López-Isac
- Institute of Parasitology and Biomedicine López-Neyra, IPBLN-CSIC, PTS Granada, Granada, Spain
| | - Maria Teruel
- Center for Genomics and Oncological Research Pfizer/University of Granada/Andalusian Government, GENYO, PTS Granada, Granada, Spain
| | | | - Patricia Carreria
- Department of Rheumatology, 12 de Octubre University Hospital, Madrid, Spain
| | | | - Esther Vicente
- Department of Rheumatology, La Princesa Hospital, Madrid, Spain
| | - Jane Worthington
- Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ariane L Herrick
- Centre for Musculoskeletal Research, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Javier Martin
- Institute of Parasitology and Biomedicine López-Neyra, IPBLN-CSIC, PTS Granada, Granada, Spain
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17
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Florin L, Rubben K, Vanhaecke A, Devreese K, De Keyser F, Smith V, Bonroy C. Evaluation of the primary biliary cholangitis-related serologic profile in a large cohort of Belgian systemic sclerosis patients. ACTA ACUST UNITED AC 2019; 58:416-423. [DOI: 10.1515/cclm-2019-0655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/21/2019] [Indexed: 01/27/2023]
Abstract
Abstract
Background
Systemic sclerosis (SSc) and primary biliary cholangitis (PBC) are autoimmune diseases that may occur concomitantly and are both strongly associated with disease-specific autoantibodies. This study investigated the prevalence and fine specificity of PBC-specific serology (PBC-Ab) and associations with the SSc-subtypes and SSc-specific antibodies as well as the association with cholestatic liver enzymes. Furthermore, three different techniques for the detection of PBC-Ab were compared.
Methods
Serum of 184 Belgian SSc patients with a known SSc-antibody profile, was analyzed for PBC-Ab (antimitochondrial antibodies [AMA], anti-Gp210, anti-Sp100 and anti-PML) using indirect immunofluorescence (IIF) analysis on human epithelioma-2000 (HEp-2000) cells (ANA-IIF, Immunoconcepts) and liver-kidney-stomach tissue sections (IIF-LKS) (Menarini), and a line immunoblot (LB) (EuroImmun). Alkaline phosphatase/γ-glutamyl transferase (ALP/GGT) were evaluated at time of first sampling (t0) and after 3 years of follow-up (t3).
Results
PBC-Ab were present in 13% of patients and significantly correlated with centromere antibodies (anti-CENP-B), but not correlated with the limited cutaneous SSc subgroup (lcSSc). The most frequent reactivities were AMA (11%, with 9% AMA-M2) and Sp-100 antibodies (5%), showing a major overlap. There was no relevant association between the presence of PBC-Ab and ALP or GGT elevation at t0 nor at t3. Detection of AMA with IIF-LKS is comparable to LB. ANA-IIF screening was less sensitive compared to LB.
Conclusions
A wide range of PBC-Ab is detectable in SSc in the absence of cholestatic liver enzyme elevations, even after 3 years of follow-up. However, as these antibodies may precede PBC-disease up to 10 years further prospective follow-up of our cohort will be necessary.
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Affiliation(s)
- Lisa Florin
- Department of Laboratory Medicine , Ghent University Hospital , Ghent , Belgium
| | - Kaat Rubben
- Department of Laboratory Medicine , Ghent University Hospital , Ghent , Belgium
| | - Amber Vanhaecke
- Department of Rheumatology , Ghent University Hospital , Ghent , Belgium
- Department of Internal Medicine , Ghent University , Ghent , Belgium
| | - Katrien Devreese
- Department of Laboratory Medicine , Ghent University Hospital , Ghent , Belgium
- Department of Diagnostic Sciences , Ghent University , Ghent , Belgium
| | - Filip De Keyser
- Department of Rheumatology , Ghent University Hospital , Ghent , Belgium
- Praktijk 10A , Maldegem , Belgium
| | - Vanessa Smith
- Department of Rheumatology , Ghent University Hospital , Ghent , Belgium
- Department of Internal Medicine , Ghent University , Ghent , Belgium
- Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC) , Ghent , Belgium
| | - Carolien Bonroy
- Department of Diagnostic Sciences , Ghent University , Ghent , Belgium
- Department of Laboratory Medicine , Ghent University Hospital , Corneel Heymanslaan 10 , 9000 Ghent , Belgium
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18
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Hamaguchi Y, Takehara K. Anti-nuclear autoantibodies in systemic sclerosis : News and perspectives. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2018; 3:201-213. [PMID: 35382013 PMCID: PMC8922602 DOI: 10.1177/2397198318783930] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/20/2018] [Indexed: 02/01/2024]
Abstract
Systemic sclerosis is a connective tissue disorder characterized by microvascular damage and excessive fibrosis of the skin and internal organs. One hallmark of the immunological abnormalities in systemic sclerosis is the presence of anti-nuclear antibodies, which are detected in more than 90% of patients with systemic sclerosis. Anti-centromere antibodies, anti-DNA topoisomerase I antibodies, and anti-RNA polymerase III antibodies are the predominant anti-nuclear antibodies found in systemic sclerosis patients. Other systemic sclerosis-related anti-nuclear antibodies include those targeted against U3 ribonucleoprotein, Th/To, U11/U12 ribonucleoprotein, and eukaryotic initiation factor 2B. Anti-U1 ribonucleoprotein, anti-Ku antibodies, anti-PM-Scl, and anti-RuvBL1/2 antibodies are associated with systemic sclerosis overlap syndrome. Anti-human upstream binding factor, anti-Ro52/TRIM21, anti-B23, and anti-centriole antibodies do not have specificity to systemic sclerosis, but are sometimes detected in sera from patients with systemic sclerosis. Identification of each systemic sclerosis-related antibody is useful to diagnose and predict organ involvement, since the particular type of systemic sclerosis-related antibodies is often predictive of clinical features, severity, and prognosis. The clinical phenotypes are largely influenced by ethnicity. Currently, an immunoprecipitation assay is necessary to detect most systemic sclerosis-related antibodies; therefore, the establishment of an easy, reliable, and simple screening system is warranted.
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Affiliation(s)
- Yasuhito Hamaguchi
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Japan
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19
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Hepatobiliary involvement in systemic sclerosis and the cutaneous subsets: Characteristics and survival of patients from the Spanish RESCLE Registry. Semin Arthritis Rheum 2017; 47:849-857. [PMID: 29246416 DOI: 10.1016/j.semarthrit.2017.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/26/2017] [Accepted: 10/02/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the prevalence and causes of hepatobiliary involvement (HBI) in systemic sclerosis (SSc), to investigate the clinical characteristics and prognosis of SSc patients with HBI (SSc-HBI) and without HBI (SSc-non-HBI), and to compare both groups according to the cutaneous SSc subsets. METHODS In all, 1572 SSc patients were collected in the RESCLE registry up to January 2015, and all hepatobiliary disturbances were recorded. We investigated the HBI-related characteristics and survival from the entire SSc cohort and according to the following cutaneous subsets: diffuse cutaneous SSc (dcSSc), limited cutaneous SSc (lcSSc), and SSc sine scleroderma (ssSSc). RESULTS Out of 1572, 118 (7.5%) patients had HBI. Primary biliary cholangitis (PBC) was largely the main cause (n = 67, 4.3%), followed by autoimmune hepatitis (n = 19, 1.2%), and anti-mitochondrial negative PBC (n = 6, 0.4%). Other causes of HBI were as follows: secondary liver diseases (n = 11, 0.7%), SSc-related HBI (n = 7, 0.4%), nodular regenerative hyperplasia (n = 3, 0.2%), liver cirrhosis (n = 3, 0.2%), and HBI of unknown origin (n = 2, 0.1%). In multivariate analysis, HBI was independently associated to lesser risk of dcSSc (5.1% vs. 24.4%), and higher frequency of calcinosis (26% vs. 18%), left ventricular diastolic dysfunction (46% vs. 27%), sicca syndrome (51% vs. 29%), and anti-centromere antibodies (ACA, 73% vs. 44%). According to the cutaneous subsets, HBI was associated (1) in lcSSc, to longer time from SSc onset to diagnosis (10.8 ± 12.5 vs. 7.2 ± 9.3 years), sicca syndrome (54% vs. 33%), and ACA (80% vs. 56%); (2) in ssSSc, to sicca syndrome (44% vs. 19%), and (3) in dcSSc, no associations were found. HBI was the cause of death in 2.3% patients but the cumulative survival according to the presence or absence of HBI showed no differences. CONCLUSIONS HBI prevalence in SSc is 7.5% and dcSSc is the least involved subset. PBC is the main cause of HBI. Patients with SSc-HBI exhibited specific clinical and immunologic profile. Survival is similar for SSc patients with HBI.
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20
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Mejia Otero C, Assassi S, Hudson M, Mayes MD, Estrada-Y-Martin R, Pedroza C, Mills TW, Walker J, Baron M, Stevens W, Proudman SM, Nikpour M, Mehra S, Wang M, Fritzler MJ. Antifibrillarin Antibodies Are Associated with Native North American Ethnicity and Poorer Survival in Systemic Sclerosis. J Rheumatol 2017; 44:799-805. [PMID: 28365584 DOI: 10.3899/jrheum.160574] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the clinical correlates and survival in patients with antifibrillarin antibodies (AFA) in a large international study population consisting of well-characterized systemic sclerosis (SSc) cohorts from Canada, Australia, and the United States. METHODS Baseline clinical data from the prospective cohorts (Canadian Scleroderma Research Group, the Australian Scleroderma Cohort Study, and the American Genetics versus Environment in Scleroderma Outcome Study) were investigated. Clinical variables were harmonized and sera were tested for AFA using a commercially available SSc profile line immunoassay, regardless of the immunofluorescence staining pattern. Association of demographic and clinical features with AFA was investigated by logistic or linear regression. Further, a survival analysis was performed by Cox regression analysis. RESULTS A total of 1506 patients with SSc with complete serological profiles were included in the study. Fifty-two patients (3.5%) had antibodies detected against fibrillarin. Patients of African descent and Native North American ethnicity were more likely to be AFA-positive compared with other ethnicities. After adjustment for demographic factors, diffuse involvement, and intestinal bacterial overgrowth requiring antibiotics, gastrointestinal reflux disease showed a trend for association with AFA. Further, AFA positivity was associated with shorter survival independently of demographic factors and disease type (HR 1.76, 95% CI 1.11-2.79, p = 0.016). CONCLUSION In this large multinational SSc cohort, AFA was associated with Native American ethnicity and was an independent predictor of mortality.
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21
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Tall F, Dechomet M, Riviere S, Cottin V, Ballot E, Tiev KP, Montin R, Morin C, Chantran Y, Grange C, Jullien D, Ninet J, Chretien P, Cabane J, Fabien N, Johanet C. The Clinical Relevance of Antifibrillarin (anti-U3-RNP) Autoantibodies in Systemic Sclerosis. Scand J Immunol 2017; 85:73-79. [PMID: 27864990 DOI: 10.1111/sji.12510] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/10/2016] [Indexed: 11/28/2022]
Abstract
Systemic sclerosis (SSc) is a heterogeneous autoimmune disease associated with several antinuclear autoantibodies useful to diagnosis and prognosis. The aim of the present multicentric study was to determine the clinical relevance of antifibrillarin autoantibodies (AFA) in patients with SSc. The clinical features of 37 patients with SSc positive for AFA (AFA+) and 139 SSc patients without AFA (AFA-) were collected retrospectively from medical records to enable a comparison between AFA- and AFA+ patients. Antifibrillarin autoantibodies were screened by an indirect immunofluorescence technique using HEp2 cells and identified by an in-house Western blot technique and/or an EliA test. Comparing AFA+ and AFA- patients, AFA+ patients were significantly younger at disease onset (36.9 versus 42.9; P = 0.02), more frequently male (P = 0.02) and of Afro-Caribbean descent (65% versus 7.7%; P < 0.001). At diagnosis, the Rodnan skin score evaluating the cutaneous manifestations was higher (13.3 versus 8.7; P = 0.01) and myositis was also more common in the AFA+ group (31.4% versus 12.2%; P < 0.01). Patients with AFA+ were not associated with diffuse cutaneous SSc or with lung involvement and no difference in survival was observed. Antifibrillarin autoantibodies are associated with patients of Afro-Caribbean origin and can identify patients with SSc who are younger at disease onset and display a higher prevalence of myositis.
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Affiliation(s)
- F Tall
- Immunology Department, AP-HP Saint-Antoine Hospital, Paris, France
| | - M Dechomet
- Immunology Department, Lyon-Sud Hospital, Hospices Civils de Lyon; Claude Bernard, Pierre-Benite, France
| | - S Riviere
- Internal Medicine Department, AP-HP Saint-Antoine Hospital, Paris, France
| | - V Cottin
- Respiratory Diseases Department, Louis Pradel Hospital, Bron, France
| | - E Ballot
- Immunology Department, AP-HP Saint-Antoine Hospital, Paris, France
| | - K P Tiev
- Internal Medicine Department, AP-HP Saint-Antoine Hospital, Paris, France
| | - R Montin
- Immunology Department, AP-HP Saint-Antoine Hospital, Paris, France
| | - C Morin
- Internal Medicine Department, AP-HP Saint-Antoine Hospital, Paris, France
| | - Y Chantran
- Immunology Department, AP-HP Saint-Antoine Hospital, Paris, France
| | - C Grange
- Internal Medicine Department, Lyon-Sud Hospital, Pierre-Bénite, France
| | - D Jullien
- Dermatology Department, Edouard Herriot Hospital, Lyon, France
| | - J Ninet
- Internal Medicine Department, Edouard Herriot Hospital, Lyon, France
| | - P Chretien
- Immunology Department, AP-HP Bicêtre Hospital, Kremlin Bicêtre, France
| | - J Cabane
- Internal Medicine Department, AP-HP Saint-Antoine Hospital, Paris, France
| | - N Fabien
- Immunology Department, Lyon-Sud Hospital, Hospices Civils de Lyon; Claude Bernard, Pierre-Benite, France.,University Lyon I, University of Lyon, Pierre-Bénite, France
| | - C Johanet
- Immunology Department, AP-HP Saint-Antoine Hospital, Paris, France.,UFR 967, Faculte de medecine, University Pierre et Marie Curie, Paris6, France
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22
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Foocharoen C, Watcharenwong P, Netwijitpan S, Mahakkanukrauh A, Suwannaroj S, Nanagara R. Relevance of clinical and autoantibody profiles in systemic sclerosis among Thais. Int J Rheum Dis 2017; 20:1572-1581. [PMID: 28296274 DOI: 10.1111/1756-185x.13060] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Autoantibody profiles in systemic sclerosis (SSc) and their relative clinical association vary between studies. The rate for being anti-topoisomerase-I (ATA) positive and the association with diffuse cutaneous the SSc subset (dcSSc) is higher among Thais than among Caucasians. The objective was to evaluate the relevance of clinical presentation, namely being positive for one or more autoantibodies among Thai SSc patients. METHOD A retrospective, cohort study was performed among SSc patients over 18 years of age at Srinagarind Hospital, Khon Kaen University, Thailand, during January 2006 to December 2013. Autoantibodies comprising 13 SSc-specific antigens were evaluated using the EUROIMMUN AG (Lübeck, Germany) in order to define their clinical association(s). RESULTS Two hundred and eighty-five scleroderma patients (200 female; 85 male) were included. The majority (66.7%) were dcSSc subset. ATA was the most common antibody profile in our patients (231 cases; 81.1%), followed by anti-Ro 52 (87 cases; 30.5%). Eleven of our patients (3.9%) were negative for all antibody profiles and 44 cases (15.4%) were negative for ATA and anti-centromere antibody (anti-CENP). Almost 40% (112 cases) were positive for at least two autoantibodies. There was an association between the presence of ATA and hand deformity (odds ratio [OR] 3.94; 95% CI 1.12-13.84), anti-CENP and hand deformity (OR 0.20; 95% CI 0.02-0.90), anti-Ku and scleroderma-polymyositis overlap syndrome (OR 6.58; 95% CI 2.16-19.39) and the absence of both ATA and anti-CENP with female sex (OR 2.90; 95% CI 1.12-7.51), limited cutaneous SSc subset (OR 2.70; 95% CI 1.30-5.55) and scleroderma-polymyositis overlap syndrome (OR 2.53; 95% CI 1.04-6.16). Neither ATA nor anti-CENP were associated with the SSc subset. CONCLUSIONS ATA and anti-CENP were not helpful in differentiating the SSc subset in Thai SSc patients, albeit they were good for predicting hand function. Coexisting ATA and anti-CENP negativity were associated with less extensive skin tightness and SSc overlap syndrome.
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Affiliation(s)
- Chingching Foocharoen
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Sittichai Netwijitpan
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ajanee Mahakkanukrauh
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Siraphop Suwannaroj
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ratanvadee Nanagara
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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23
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Hoffmann-Vold AM, Midtvedt Ø, Tennøe AH, Garen T, Lund MB, Aaløkken TM, Andreassen AK, Elhage F, Brunborg C, Taraldsrud E, Molberg Ø. Cardiopulmonary Disease Development in Anti-RNA Polymerase III-positive Systemic Sclerosis: Comparative Analyses from an Unselected, Prospective Patient Cohort. J Rheumatol 2017; 44:459-465. [PMID: 28089974 DOI: 10.3899/jrheum.160867] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Extensive skin disease and renal crisis are hallmarks of anti-RNA polymerase III (RNAP)-positive systemic sclerosis (SSc), while lung and heart involvement data are conflicting. Here, the aims were to perform time-course analyses of interstitial lung disease (ILD) and pulmonary hypertension (PH) in the RNAP subset of a prospective unselected SSc cohort and to use the other autoantibody subsets as comparators. METHODS The study cohort included 279 patients with SSc from the observational Oslo University Hospital cohort with complete data on (1) SSc-related autoantibodies, (2) paired, serial analyses of lung function and fibrosis by computed tomography, and (3) PH verified by right heart catheterization. RESULTS RNAP was positive in 33 patients (12%), 79% of which had diffuse cutaneous SSc. Pulmonary findings were heterogeneous; 49% had no signs of fibrosis while 18% had > 20% fibrosis at followup. Forced vital capacity at followup was < 80% in 39% of the RNAP subset, comparable to the antitopoisomerase subset (ATA; 47%), but higher than anticentromere (ACA; 13%). Accumulated frequency of PH in the RNAP subset (12%) was lower than in ACA (18%). At 93% and 78%, the 5- and 10-year survival rates in RNAP were comparable to the ATA and ACA subsets. CONCLUSION In this cohort, the RNAP subset was marked by cardiopulmonary heterogeneity, ranging from mild ILD to development of severe ILD in 18%, and PH development in 12%. These data indicate that cardiopulmonary risk stratification early in the disease course is particularly important in RNAP-positive SSc.
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Affiliation(s)
- Anna-Maria Hoffmann-Vold
- From the Department of Rheumatology, the Department of Respiratory Medicine, the Department of Radiology and Nuclear Medicine, and the Department of Cardiology, Oslo University Hospital - Rikshospitalet; Institute of Clinical Medicine, University of Oslo; Institutes of Immunology, Oslo University Hospital; Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway. .,A.M. Hoffmann-Vold, MD, PhD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; Ø. Midtvedt, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; A.H. Tennøe, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; T. Garen, MS, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; M.B. Lund, MD, PhD, Professor, Institute of Clinical Medicine, University of Oslo, and Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; T.M. Aaløkken, PhD, Department of Radiology and Nuclear Medicine, Oslo University Hospital - Rikshospitalet; A.K. Andreassen, PhD, Department of Cardiology, Oslo University Hospital - Rikshospitalet; F. Elhage, MD, Institutes of Immunology, Oslo University Hospital; C. Brunborg, MS, Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital; E. Taraldsrud, MD, Professor, Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; Ø. Molberg, MD, PhD, Professor, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo.
| | - Øyvind Midtvedt
- From the Department of Rheumatology, the Department of Respiratory Medicine, the Department of Radiology and Nuclear Medicine, and the Department of Cardiology, Oslo University Hospital - Rikshospitalet; Institute of Clinical Medicine, University of Oslo; Institutes of Immunology, Oslo University Hospital; Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.,A.M. Hoffmann-Vold, MD, PhD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; Ø. Midtvedt, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; A.H. Tennøe, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; T. Garen, MS, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; M.B. Lund, MD, PhD, Professor, Institute of Clinical Medicine, University of Oslo, and Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; T.M. Aaløkken, PhD, Department of Radiology and Nuclear Medicine, Oslo University Hospital - Rikshospitalet; A.K. Andreassen, PhD, Department of Cardiology, Oslo University Hospital - Rikshospitalet; F. Elhage, MD, Institutes of Immunology, Oslo University Hospital; C. Brunborg, MS, Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital; E. Taraldsrud, MD, Professor, Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; Ø. Molberg, MD, PhD, Professor, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo
| | - Anders H Tennøe
- From the Department of Rheumatology, the Department of Respiratory Medicine, the Department of Radiology and Nuclear Medicine, and the Department of Cardiology, Oslo University Hospital - Rikshospitalet; Institute of Clinical Medicine, University of Oslo; Institutes of Immunology, Oslo University Hospital; Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.,A.M. Hoffmann-Vold, MD, PhD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; Ø. Midtvedt, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; A.H. Tennøe, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; T. Garen, MS, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; M.B. Lund, MD, PhD, Professor, Institute of Clinical Medicine, University of Oslo, and Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; T.M. Aaløkken, PhD, Department of Radiology and Nuclear Medicine, Oslo University Hospital - Rikshospitalet; A.K. Andreassen, PhD, Department of Cardiology, Oslo University Hospital - Rikshospitalet; F. Elhage, MD, Institutes of Immunology, Oslo University Hospital; C. Brunborg, MS, Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital; E. Taraldsrud, MD, Professor, Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; Ø. Molberg, MD, PhD, Professor, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo
| | - Torhild Garen
- From the Department of Rheumatology, the Department of Respiratory Medicine, the Department of Radiology and Nuclear Medicine, and the Department of Cardiology, Oslo University Hospital - Rikshospitalet; Institute of Clinical Medicine, University of Oslo; Institutes of Immunology, Oslo University Hospital; Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.,A.M. Hoffmann-Vold, MD, PhD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; Ø. Midtvedt, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; A.H. Tennøe, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; T. Garen, MS, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; M.B. Lund, MD, PhD, Professor, Institute of Clinical Medicine, University of Oslo, and Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; T.M. Aaløkken, PhD, Department of Radiology and Nuclear Medicine, Oslo University Hospital - Rikshospitalet; A.K. Andreassen, PhD, Department of Cardiology, Oslo University Hospital - Rikshospitalet; F. Elhage, MD, Institutes of Immunology, Oslo University Hospital; C. Brunborg, MS, Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital; E. Taraldsrud, MD, Professor, Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; Ø. Molberg, MD, PhD, Professor, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo
| | - May Brit Lund
- From the Department of Rheumatology, the Department of Respiratory Medicine, the Department of Radiology and Nuclear Medicine, and the Department of Cardiology, Oslo University Hospital - Rikshospitalet; Institute of Clinical Medicine, University of Oslo; Institutes of Immunology, Oslo University Hospital; Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.,A.M. Hoffmann-Vold, MD, PhD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; Ø. Midtvedt, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; A.H. Tennøe, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; T. Garen, MS, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; M.B. Lund, MD, PhD, Professor, Institute of Clinical Medicine, University of Oslo, and Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; T.M. Aaløkken, PhD, Department of Radiology and Nuclear Medicine, Oslo University Hospital - Rikshospitalet; A.K. Andreassen, PhD, Department of Cardiology, Oslo University Hospital - Rikshospitalet; F. Elhage, MD, Institutes of Immunology, Oslo University Hospital; C. Brunborg, MS, Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital; E. Taraldsrud, MD, Professor, Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; Ø. Molberg, MD, PhD, Professor, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo
| | - Trond M Aaløkken
- From the Department of Rheumatology, the Department of Respiratory Medicine, the Department of Radiology and Nuclear Medicine, and the Department of Cardiology, Oslo University Hospital - Rikshospitalet; Institute of Clinical Medicine, University of Oslo; Institutes of Immunology, Oslo University Hospital; Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.,A.M. Hoffmann-Vold, MD, PhD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; Ø. Midtvedt, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; A.H. Tennøe, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; T. Garen, MS, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; M.B. Lund, MD, PhD, Professor, Institute of Clinical Medicine, University of Oslo, and Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; T.M. Aaløkken, PhD, Department of Radiology and Nuclear Medicine, Oslo University Hospital - Rikshospitalet; A.K. Andreassen, PhD, Department of Cardiology, Oslo University Hospital - Rikshospitalet; F. Elhage, MD, Institutes of Immunology, Oslo University Hospital; C. Brunborg, MS, Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital; E. Taraldsrud, MD, Professor, Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; Ø. Molberg, MD, PhD, Professor, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo
| | - Arne K Andreassen
- From the Department of Rheumatology, the Department of Respiratory Medicine, the Department of Radiology and Nuclear Medicine, and the Department of Cardiology, Oslo University Hospital - Rikshospitalet; Institute of Clinical Medicine, University of Oslo; Institutes of Immunology, Oslo University Hospital; Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.,A.M. Hoffmann-Vold, MD, PhD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; Ø. Midtvedt, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; A.H. Tennøe, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; T. Garen, MS, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; M.B. Lund, MD, PhD, Professor, Institute of Clinical Medicine, University of Oslo, and Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; T.M. Aaløkken, PhD, Department of Radiology and Nuclear Medicine, Oslo University Hospital - Rikshospitalet; A.K. Andreassen, PhD, Department of Cardiology, Oslo University Hospital - Rikshospitalet; F. Elhage, MD, Institutes of Immunology, Oslo University Hospital; C. Brunborg, MS, Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital; E. Taraldsrud, MD, Professor, Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; Ø. Molberg, MD, PhD, Professor, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo
| | - Fadi Elhage
- From the Department of Rheumatology, the Department of Respiratory Medicine, the Department of Radiology and Nuclear Medicine, and the Department of Cardiology, Oslo University Hospital - Rikshospitalet; Institute of Clinical Medicine, University of Oslo; Institutes of Immunology, Oslo University Hospital; Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.,A.M. Hoffmann-Vold, MD, PhD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; Ø. Midtvedt, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; A.H. Tennøe, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; T. Garen, MS, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; M.B. Lund, MD, PhD, Professor, Institute of Clinical Medicine, University of Oslo, and Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; T.M. Aaløkken, PhD, Department of Radiology and Nuclear Medicine, Oslo University Hospital - Rikshospitalet; A.K. Andreassen, PhD, Department of Cardiology, Oslo University Hospital - Rikshospitalet; F. Elhage, MD, Institutes of Immunology, Oslo University Hospital; C. Brunborg, MS, Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital; E. Taraldsrud, MD, Professor, Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; Ø. Molberg, MD, PhD, Professor, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo
| | - Cathrine Brunborg
- From the Department of Rheumatology, the Department of Respiratory Medicine, the Department of Radiology and Nuclear Medicine, and the Department of Cardiology, Oslo University Hospital - Rikshospitalet; Institute of Clinical Medicine, University of Oslo; Institutes of Immunology, Oslo University Hospital; Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.,A.M. Hoffmann-Vold, MD, PhD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; Ø. Midtvedt, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; A.H. Tennøe, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; T. Garen, MS, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; M.B. Lund, MD, PhD, Professor, Institute of Clinical Medicine, University of Oslo, and Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; T.M. Aaløkken, PhD, Department of Radiology and Nuclear Medicine, Oslo University Hospital - Rikshospitalet; A.K. Andreassen, PhD, Department of Cardiology, Oslo University Hospital - Rikshospitalet; F. Elhage, MD, Institutes of Immunology, Oslo University Hospital; C. Brunborg, MS, Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital; E. Taraldsrud, MD, Professor, Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; Ø. Molberg, MD, PhD, Professor, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo
| | - Eli Taraldsrud
- From the Department of Rheumatology, the Department of Respiratory Medicine, the Department of Radiology and Nuclear Medicine, and the Department of Cardiology, Oslo University Hospital - Rikshospitalet; Institute of Clinical Medicine, University of Oslo; Institutes of Immunology, Oslo University Hospital; Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.,A.M. Hoffmann-Vold, MD, PhD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; Ø. Midtvedt, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; A.H. Tennøe, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; T. Garen, MS, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; M.B. Lund, MD, PhD, Professor, Institute of Clinical Medicine, University of Oslo, and Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; T.M. Aaløkken, PhD, Department of Radiology and Nuclear Medicine, Oslo University Hospital - Rikshospitalet; A.K. Andreassen, PhD, Department of Cardiology, Oslo University Hospital - Rikshospitalet; F. Elhage, MD, Institutes of Immunology, Oslo University Hospital; C. Brunborg, MS, Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital; E. Taraldsrud, MD, Professor, Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; Ø. Molberg, MD, PhD, Professor, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo
| | - Øyvind Molberg
- From the Department of Rheumatology, the Department of Respiratory Medicine, the Department of Radiology and Nuclear Medicine, and the Department of Cardiology, Oslo University Hospital - Rikshospitalet; Institute of Clinical Medicine, University of Oslo; Institutes of Immunology, Oslo University Hospital; Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.,A.M. Hoffmann-Vold, MD, PhD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; Ø. Midtvedt, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; A.H. Tennøe, MD, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo; T. Garen, MS, Department of Rheumatology, Oslo University Hospital - Rikshospitalet; M.B. Lund, MD, PhD, Professor, Institute of Clinical Medicine, University of Oslo, and Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; T.M. Aaløkken, PhD, Department of Radiology and Nuclear Medicine, Oslo University Hospital - Rikshospitalet; A.K. Andreassen, PhD, Department of Cardiology, Oslo University Hospital - Rikshospitalet; F. Elhage, MD, Institutes of Immunology, Oslo University Hospital; C. Brunborg, MS, Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital; E. Taraldsrud, MD, Professor, Department of Respiratory Medicine, Oslo University Hospital - Rikshospitalet; Ø. Molberg, MD, PhD, Professor, Department of Rheumatology, Oslo University Hospital - Rikshospitalet, and Institute of Clinical Medicine, University of Oslo
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Bissell LA, Md Yusof MY, Buch MH. Primary myocardial disease in scleroderma—a comprehensive review of the literature to inform the UK Systemic Sclerosis Study Group cardiac working group. Rheumatology (Oxford) 2016; 56:882-895. [DOI: 10.1093/rheumatology/kew364] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Indexed: 02/04/2023] Open
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Nandiwada SL, Peterson LK, Mayes MD, Jaskowski TD, Malmberg E, Assassi S, Satoh M, Tebo AE. Ethnic Differences in Autoantibody Diversity and Hierarchy: More Clues from a US Cohort of Patients with Systemic Sclerosis. J Rheumatol 2016; 43:1816-1824. [PMID: 27481902 DOI: 10.3899/jrheum.160106] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine the autoantibody repertoire and clinical associations in a multiethnic cohort of American patients with systemic sclerosis (SSc). METHODS There were 1000 patients with SSc (196 Hispanic, 228 African American, 555 white, and 21 other) who were screened for antinuclear antibodies (ANA), including anticentromere antibodies (ACA) by indirect immunofluorescence assay, antitopoisomerase-1 (topo-1/Scl-70) by immunodiffusion, and anti-RNA polymerase III (RNAP III) by ELISA. Sera from 160 patients with mainly nucleolar and/or speckled ANA pattern, but negative for ACA, Scl-70, and RNAP III, were further characterized by immunoprecipitation for SSc-specific antibodies. RESULTS The prevalence of antibodies against RNAP III, Th/To, and PM/Scl did not differ significantly among the ethnic groups. The frequency of anti-Scl-70 was lowest in whites (18.0%) compared with 24.0% and 26.8% in Hispanics and African Americans (p = 0.01), respectively. Compared with African American patients, Hispanic and white subjects had a higher frequency of ACA (p < 0.0001) and lower frequency of U3-RNP (p < 0.0001). U3-RNP antibodies were uniquely higher in African American patients, independent of clinical subset, while Th/To autoantibodies were associated with limited cutaneous SSc in white subjects. Overall, Hispanic and African American patients had an earlier age of onset and a predominance of diffuse cutaneous SSc compared with their white counterparts. CONCLUSION SSc-specific antibodies may predict disease subset; however, the hierarchy of their prevalence differs across ethnic groups. This study provides the most extensive analysis to date on the relevance of autoantibodies in the diagnosis and clinical manifestations of SSc in Hispanic American patients.
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Affiliation(s)
- Sarada L Nandiwada
- From the Department of Pathology, University of Utah; ARUP Laboratories, Salt Lake City, Utah; Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center, Houston, Texas; Department of Medicine, University of Florida, Gainesville, Florida, USA; Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan.S.L. Nandiwada, PhD, Assistant Professor of Pediatrics, Department of Pathology, University of Utah, and Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; L.K. Peterson, PhD, Clinical Immunology Fellow, Department of Pathology, University of Utah; M.D. Mayes, MD, Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; T.D. Jaskowski, BS, R&D Scientist, ARUP Laboratories; E. Malmberg, MS, Outcomes Analyst, ARUP Laboratories; S. Assassi, MD, Associate Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; M. Satoh, MD, PhD, Professor, Department of Clinical Nursing, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Department of Medicine, University of Florida; A.E. Tebo, PhD, Associate Professor of Pathology, Department of Pathology, University of Utah, and ARUP Laboratories. Dr. Nandiwada and Dr. Peterson contributed equally to this manuscript.
| | - Lisa K Peterson
- From the Department of Pathology, University of Utah; ARUP Laboratories, Salt Lake City, Utah; Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center, Houston, Texas; Department of Medicine, University of Florida, Gainesville, Florida, USA; Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan.S.L. Nandiwada, PhD, Assistant Professor of Pediatrics, Department of Pathology, University of Utah, and Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; L.K. Peterson, PhD, Clinical Immunology Fellow, Department of Pathology, University of Utah; M.D. Mayes, MD, Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; T.D. Jaskowski, BS, R&D Scientist, ARUP Laboratories; E. Malmberg, MS, Outcomes Analyst, ARUP Laboratories; S. Assassi, MD, Associate Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; M. Satoh, MD, PhD, Professor, Department of Clinical Nursing, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Department of Medicine, University of Florida; A.E. Tebo, PhD, Associate Professor of Pathology, Department of Pathology, University of Utah, and ARUP Laboratories. Dr. Nandiwada and Dr. Peterson contributed equally to this manuscript
| | - Maureen D Mayes
- From the Department of Pathology, University of Utah; ARUP Laboratories, Salt Lake City, Utah; Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center, Houston, Texas; Department of Medicine, University of Florida, Gainesville, Florida, USA; Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan.S.L. Nandiwada, PhD, Assistant Professor of Pediatrics, Department of Pathology, University of Utah, and Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; L.K. Peterson, PhD, Clinical Immunology Fellow, Department of Pathology, University of Utah; M.D. Mayes, MD, Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; T.D. Jaskowski, BS, R&D Scientist, ARUP Laboratories; E. Malmberg, MS, Outcomes Analyst, ARUP Laboratories; S. Assassi, MD, Associate Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; M. Satoh, MD, PhD, Professor, Department of Clinical Nursing, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Department of Medicine, University of Florida; A.E. Tebo, PhD, Associate Professor of Pathology, Department of Pathology, University of Utah, and ARUP Laboratories. Dr. Nandiwada and Dr. Peterson contributed equally to this manuscript
| | - Troy D Jaskowski
- From the Department of Pathology, University of Utah; ARUP Laboratories, Salt Lake City, Utah; Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center, Houston, Texas; Department of Medicine, University of Florida, Gainesville, Florida, USA; Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan.S.L. Nandiwada, PhD, Assistant Professor of Pediatrics, Department of Pathology, University of Utah, and Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; L.K. Peterson, PhD, Clinical Immunology Fellow, Department of Pathology, University of Utah; M.D. Mayes, MD, Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; T.D. Jaskowski, BS, R&D Scientist, ARUP Laboratories; E. Malmberg, MS, Outcomes Analyst, ARUP Laboratories; S. Assassi, MD, Associate Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; M. Satoh, MD, PhD, Professor, Department of Clinical Nursing, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Department of Medicine, University of Florida; A.E. Tebo, PhD, Associate Professor of Pathology, Department of Pathology, University of Utah, and ARUP Laboratories. Dr. Nandiwada and Dr. Peterson contributed equally to this manuscript
| | - Elisabeth Malmberg
- From the Department of Pathology, University of Utah; ARUP Laboratories, Salt Lake City, Utah; Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center, Houston, Texas; Department of Medicine, University of Florida, Gainesville, Florida, USA; Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan.S.L. Nandiwada, PhD, Assistant Professor of Pediatrics, Department of Pathology, University of Utah, and Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; L.K. Peterson, PhD, Clinical Immunology Fellow, Department of Pathology, University of Utah; M.D. Mayes, MD, Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; T.D. Jaskowski, BS, R&D Scientist, ARUP Laboratories; E. Malmberg, MS, Outcomes Analyst, ARUP Laboratories; S. Assassi, MD, Associate Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; M. Satoh, MD, PhD, Professor, Department of Clinical Nursing, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Department of Medicine, University of Florida; A.E. Tebo, PhD, Associate Professor of Pathology, Department of Pathology, University of Utah, and ARUP Laboratories. Dr. Nandiwada and Dr. Peterson contributed equally to this manuscript
| | - Shervin Assassi
- From the Department of Pathology, University of Utah; ARUP Laboratories, Salt Lake City, Utah; Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center, Houston, Texas; Department of Medicine, University of Florida, Gainesville, Florida, USA; Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan.S.L. Nandiwada, PhD, Assistant Professor of Pediatrics, Department of Pathology, University of Utah, and Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; L.K. Peterson, PhD, Clinical Immunology Fellow, Department of Pathology, University of Utah; M.D. Mayes, MD, Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; T.D. Jaskowski, BS, R&D Scientist, ARUP Laboratories; E. Malmberg, MS, Outcomes Analyst, ARUP Laboratories; S. Assassi, MD, Associate Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; M. Satoh, MD, PhD, Professor, Department of Clinical Nursing, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Department of Medicine, University of Florida; A.E. Tebo, PhD, Associate Professor of Pathology, Department of Pathology, University of Utah, and ARUP Laboratories. Dr. Nandiwada and Dr. Peterson contributed equally to this manuscript
| | - Minoru Satoh
- From the Department of Pathology, University of Utah; ARUP Laboratories, Salt Lake City, Utah; Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center, Houston, Texas; Department of Medicine, University of Florida, Gainesville, Florida, USA; Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan.S.L. Nandiwada, PhD, Assistant Professor of Pediatrics, Department of Pathology, University of Utah, and Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; L.K. Peterson, PhD, Clinical Immunology Fellow, Department of Pathology, University of Utah; M.D. Mayes, MD, Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; T.D. Jaskowski, BS, R&D Scientist, ARUP Laboratories; E. Malmberg, MS, Outcomes Analyst, ARUP Laboratories; S. Assassi, MD, Associate Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; M. Satoh, MD, PhD, Professor, Department of Clinical Nursing, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Department of Medicine, University of Florida; A.E. Tebo, PhD, Associate Professor of Pathology, Department of Pathology, University of Utah, and ARUP Laboratories. Dr. Nandiwada and Dr. Peterson contributed equally to this manuscript
| | - Anne E Tebo
- From the Department of Pathology, University of Utah; ARUP Laboratories, Salt Lake City, Utah; Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center, Houston, Texas; Department of Medicine, University of Florida, Gainesville, Florida, USA; Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan.S.L. Nandiwada, PhD, Assistant Professor of Pediatrics, Department of Pathology, University of Utah, and Section of Allergy, Immunology and Rheumatology, Baylor College of Medicine; L.K. Peterson, PhD, Clinical Immunology Fellow, Department of Pathology, University of Utah; M.D. Mayes, MD, Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; T.D. Jaskowski, BS, R&D Scientist, ARUP Laboratories; E. Malmberg, MS, Outcomes Analyst, ARUP Laboratories; S. Assassi, MD, Associate Professor of Rheumatology and Clinical Immunogenetics, Department of Internal Medicine, Division of Rheumatology and Clinical Immunogenetics, University of Texas Health Science Center; M. Satoh, MD, PhD, Professor, Department of Clinical Nursing, Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, and Department of Medicine, University of Florida; A.E. Tebo, PhD, Associate Professor of Pathology, Department of Pathology, University of Utah, and ARUP Laboratories. Dr. Nandiwada and Dr. Peterson contributed equally to this manuscript
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Abstract
Purpose To provide an update on the clinical burden of calcinosis (subcutaneous or intracutaneous deposition of calcium salts) in patients with systemic sclerosis (SSc), and discuss advances in our understanding of pathogenesis, associates, and measurement techniques, as well as an overview of the current approach to management. Methods Four case scenarios are presented, to illustrate the clinical spectrum of calcinosis. Epidemiology (including associates), pathogenesis, imaging and measurement, and treatment are reviewed. Results Calcinosis represents a major clinical problem in patients with SSc. Up to 40% of patients are affected, the proportion depending in part on how carefully calcinosis is looked for. Associates of calcinosis include longer disease duration, anticentromere antibody, and digital ulceration. When severe, calcinosis causes pain, disability, and disfigurement. Pathogenesis is unknown, but tissue ischaemia, microtrauma, and loss of balance between calcification stimulants and inhibitors are likely contributors. Calcinosis deposits are mainly composed of hydroxyapatite. They are very visible on plain radiographs, and radiographic scoring systems are being developed, and other imaging modalities (including computed tomography and ultrasound) are being explored. Despite a number of proposed treatments, currently there is no effective ‘disease-modifying’ therapy for calcinosis and the main aspects of management are antibiotics, analgesics, multidisciplinary team input, and surgical debulking. Conclusions Up until recently, SSc-related calcinosis has received very little attention in terms of research into pathogenesis, measurement, and treatment. This imbalance is now being redressed and although we still do not have an effective treatment, progress is being made.
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Perosa F, Prete M, Di Lernia G, Ostuni C, Favoino E, Valentini G. Anti-centromere protein A antibodies in systemic sclerosis: Significance and origin. Autoimmun Rev 2015; 15:102-9. [PMID: 26455561 DOI: 10.1016/j.autrev.2015.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/04/2015] [Indexed: 02/03/2023]
Abstract
Systemic sclerosis (SSc) is systemic, autoimmune, connective tissue disorder characterized by vascular abnormalities, collagen deposition (fibrosis), and the production of autoantibodies to nuclear proteins. About 20%-40% of patients have antibodies to centromere protein (CENP)-A or -B. Despite the known association of anti-CENP antibodies with certain clinical features of SSc, the role of these antibodies in SSc physiopathology is still poorly understood. To better understand the clinical significance and origin of these antibodies, we and others have been studying the epitopic motifs (amino acid contact sites) on CENP-A with the aim of determining whether other proteins can prime or be targeted by them. Here, we review published and ongoing studies aimed at defining the fine specificity and origin of anti-CENP-A antibodies. We describe progress made in identifying the CENP-A epitopic motif amino acids, and the discovery of one of these motifs in forkhead box protein E3 (FOXE-3), a transcription factor previously studied only for its role in the development of lens fiber cells. Moreover, we discuss preliminary evidence for a possible role of FOXE-3 in SSc pathogenesis and for the association of different subsets of anti-CENP-A antibodies, heterogeneously expressed among SSc patients, with some clinical correlates.
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Affiliation(s)
- Federico Perosa
- Department of Biomedical Sciences and Human Oncology (DIMO), Section of Systemic Rheumatic and Autoimmune Diseases, University of Bari Medical School, Bari, Italy.
| | - Marcella Prete
- Department of Biomedical Sciences and Human Oncology (DIMO), Section of Internal Medicine, University of Bari Medical School, Bari, Italy
| | - Giuseppe Di Lernia
- Department of Biomedical Sciences and Human Oncology (DIMO), Section of Systemic Rheumatic and Autoimmune Diseases, University of Bari Medical School, Bari, Italy
| | - Carmela Ostuni
- Department of Biomedical Sciences and Human Oncology (DIMO), Section of Clinical Oncology, University of Bari Medical School, Bari, Italy
| | - Elvira Favoino
- Department of Biomedical Sciences and Human Oncology (DIMO), Section of Systemic Rheumatic and Autoimmune Diseases, University of Bari Medical School, Bari, Italy
| | - Gabriele Valentini
- Department of Clinical and Experimental Internal Medicine "F. Magrassi, A. Lanzara", Rheumatology Section, Second University of Naples, Naples, Italy
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Gastrointestinal Manifestations, Malnutrition, and Role of Enteral and Parenteral Nutrition in Patients With Scleroderma. J Clin Gastroenterol 2015; 49:559-64. [PMID: 25992813 DOI: 10.1097/mcg.0000000000000334] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Scleroderma (systemic sclerosis) is an autoimmune disease that can affect multiple organ systems. Gastrointestinal (GI) involvement is the most common organ system involved in scleroderma. Complications of GI involvement including gastroesophageal reflux disease, small intestinal bacterial overgrowth, and chronic intestinal pseudoobstruction secondary to extensive fibrosis may lead to nutritional deficiencies in these patients. Here, we discuss pathophysiology, progression of GI manifestations, and malnutrition secondary to scleroderma, and the use of enteral and parenteral nutrition to reverse severe nutritional deficiencies. Increased mortality in patients with concurrent malnutrition in systemic sclerosis, as well as the refractory nature of this malnutrition to pharmacologic therapies compels clinicians to provide novel and more invasive interventions in reversing these nutritional deficiencies. Enteral and parenteral nutrition have important implications for patients who are severely malnourished or have compromised GI function as they are relatively safe and have substantial retrospective evidence of success. Increased awareness of these therapeutic options is important when treating scleroderma-associated malnutrition.
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Abstract
PURPOSE OF REVIEW The gastrointestinal tract is the most common extra-cutaneous organ system involved with systemic sclerosis (SSc) affecting approximately 90% of patients. This review summarizes the recent advances in the evaluation and management of gastrointestinal manifestations of SSc. RECENT FINDINGS There is a growing body of evidence that uncontrolled GERD can play a significant role in the pathogenesis of SSc-associated interstitial lung disease. Newer forms of management of Barrett esophagus are showing significant promise as potentially curative therapy. Gastric antral vascular ectasias have strongly been associated with the presence of RNA polymerase III antibody. Newer technologies have advanced the assessment of gastrointestinal dysmotility in SSc. Evidence of probiotic use for the treatment of gastrointestinal complications is emerging. The UCLA SCTC GIT 2.0 questionnaire is being increasingly accepted by the SSc experts as a validated instrument for evaluation of patient-reported outcomes involving the gastrointestinal tract. SUMMARY Our knowledge of the complex pathogenesis of gastrointestinal manifestations of SSc has expanded substantially in the last few decades. There has also been considerable technological progress in the evaluation of these manifestations. Patient care is being optimized by close collaboration of rheumatologists and gastroenterologists, leading to a more coordinated approach in the management of these complications.
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Silva I, Almeida J, Vasconcelos C. A PRISMA-driven systematic review for predictive risk factors of digital ulcers in systemic sclerosis patients. Autoimmun Rev 2014; 14:140-52. [PMID: 25449678 DOI: 10.1016/j.autrev.2014.10.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/04/2014] [Indexed: 01/20/2023]
Abstract
Vasculopathy has a major role in the pathogenesis and tissue injury in systemic sclerosis (SSc). Raynaud's phenomenon (RP) is frequently the first clinical manifestation of SSc preceding by years other clinical manifestations. RP in SSc patients is frequent, often very severe and long lasting. The repeated bouts of RP lead to prolonged digital ischemia that may progress to digital ulceration or in extreme to critical digital ischemia with gangrene. Digital ulcers (DU) are a true burden for all patients. They are very painful, with a long and slow healing course, have high risk of infection and are extremely disabling. In adults, up to 40-50% of patients will experience at least one DU in the course of the disease and of these 31-71% will have recurrent ulcers. In order to try to identify predictive risk factors for DU in SSc patients, an extensive literature review was conducted, according to the guidelines proposed at the PRISMA statement. MEDLINE database (PubMed) and Thomson Reuters Web of Knowledge platform were searched for articles published in peer-reviewed journals since 1990 with the last search run on June 2014 and published in English language. The keyword search terms included: digital ulcer/s, systemic sclerosis, scleroderma, digital scars, ischemic complications, autoantibodies, biomarkers, endothelium dysfunction, endothelin-1, vascular endothelial growth factor (VEGF), endostatin, ADMA, endoglin, angiostatin, and capillaroscopy. The following criteria were included: (1) cohorts of SSc patients including patients with DU, (2) endothelium dysfunction and angiogenesis biomarkers compared with a healthy control group, (3) autoantibodies, capillary morphology and distribution, endothelium dysfunction and angiogenesis biomarkers compared between patients with and without digital ulcers, (4) detailed description of the statistical methods used to conclude for predictive factors, and (5) English language. Our search provided a total of 376 citations. Of these, 297 studies were discarded for not meeting the criteria proposed.
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Affiliation(s)
- I Silva
- Angiology and Vascular Surgery and Clinical Imunology Unit, Hospital Santo António, Centro Hospitalar do Porto, Portugal.
| | - J Almeida
- Internal Medicine Service, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - C Vasconcelos
- Clinical Imunology Unit, Hospital Santo António, Centro Hospitalar do Porto, Portugal; UMIB, ICBAS, Universidade do Porto, Portugal
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Foocharoen C, Suwannachat P, Netwijitpan S, Mahakkanukrauh A, Suwannaroj S, Nanagara R. Clinical differences between Thai systemic sclerosis patients with positive versus negative anti-topoisomerase I. Int J Rheum Dis 2014; 19:312-20. [PMID: 25293362 DOI: 10.1111/1756-185x.12492] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anti-topoisomerase I antibody (ATA) carries an increased risk of systemic sclerosis (SSc) internal organ involvement. There have been no published comparisons of the clinical characteristics of patients positive and negative for ATA in Thailand, where the positive rate for ATA is higher than among Caucasians. OBJECTIVE To define the clinical differences between SSc, positive versus negative, for ATA. METHODS A retrospective cohort study was performed among SSc patients over 18 at Srinagarind Hospital, Khon Kaen University, Thailand, during January 2006-December 2013. SSc-overlap syndrome was excluded. RESULTS Two hundred and ninety-four SSc patients were included (female : male 2.5 : 1). The majority (68.6%) were the diffuse cutaneous SSc subset (dcSSc). ATA was positive in 252 patients (85.7%), among whom 71.7% had dcSSc and 28.2% limited cutaneous SSc (lcSSc). Using a multivariate analysis, hand deformity had a significantly positive association with ATA (odds ratio [OR] 7.01; 95% CI 1.02-48.69), whereas being anti-centromere (ACA) positive had a negative association (OR 0.17; 95% CI 0.03-0.92). After doing a subgroup analysis of the SSc subset, the median duration of disease at time of pulmonary fibrosis detection among ATA positive dcSSc was significantly shorter than the ATA negative group (1.05 vs. 6.77 years, P = 0.01). Raynaud's phenomenon (RP) at onset was significantly more frequent in lcSSc sufferers who were ATA negative than those who were ATA positive (90.5% vs. 56.9%, P = 0.005). CONCLUSIONS A high prevalence of ATA positivity was found among Thai SSc patients and this was associated with a high frequency of hand deformity, ACA negativity, a short duration of pulmonary fibrosis in dcSSc and a lower frequency of RP in lcSSc.
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Affiliation(s)
- Chingching Foocharoen
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Sittichai Netwijitpan
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ajanee Mahakkanukrauh
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Siraphop Suwannaroj
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ratanavadee Nanagara
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Systemic sclerosis at the crossroad of polyautoimmunity. Autoimmun Rev 2013; 12:1052-7. [DOI: 10.1016/j.autrev.2013.05.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 05/20/2013] [Indexed: 12/30/2022]
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Song G, Hu C, Zhu H, Wang L, Zhang F, Li Y, Wu L. New centromere autoantigens identified in systemic sclerosis using centromere protein microarrays. J Rheumatol 2013; 40:461-8. [PMID: 23418382 DOI: 10.3899/jrheum.120264] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To identify novel centromere protein (CENP) targets of anticentromere antibodies (ACA), and to investigate their association with clinical manifestations of systemic sclerosis (SSc). METHODS A CENP-focused protein microarray was fabricated by spotting 14 purified CENP. These microarrays were individually incubated with 35 ACA-positive SSc sera and 20 ACA-negative healthy control samples. Newly identified CENP autoantigens with high sensitivities were selected for validation and characterization. RESULTS Statistical analysis revealed 11 CENP are potential target antigens of ACA in patients with SSc. Of them, 5 [CENP-P, CENP-Q, CENP-M (isoform I), CENP-J, and CENP-T] are novel, among which CENP-P and CENP-Q showed high sensitivities in ACA-positive SSc sera of 34.3% and 28.6%, respectively. Subsequently, 186 SSc sera (35 ACA-positives and 151 negatives), 69 ACA-positive sera from other various autoimmune diseases (primary Sjögren syndrome, systemic lupus erythematosus, rheumatoid arthritis, and primary biliary cirrhosis), and 31 healthy sera were assayed for the presence of anti-CENP-P and -Q autoantibodies by ELISA followed by Western blotting analysis. CENP-P and -Q autoantibodies were detected in ACA-positive sera of various disease groups; among them, SSc showed the highest detection rate. Anti-CENP-P was also found in 9 of the 151 ACA-negative sera. Analyses of the correlation with clinical information showed anti-CENP-P-positive patients had higher levels of IgG, IgA, and erythrocyte sedimentation rate among the ACA-positive cohort and were more vulnerable to renal disease in the ACA-negative patients with SSc. Regardless of ACA status, anti-CENP-P or Q-negative patients seem to be predominantly affected by interstitial lung disease. CONCLUSION CENP-P and CENP-Q were identified as novel ACA autoantigens by CENP microarray assays followed by validation of ELISA and Western blotting. Both of them have prognostic utility for interstitial lung disease. CENP-P was associated with renal disease in an ACA-negative cohort.
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Affiliation(s)
- Guang Song
- Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, PR China
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Mehra S, Walker J, Patterson K, Fritzler MJ. Autoantibodies in systemic sclerosis. Autoimmun Rev 2013; 12:340-54. [DOI: 10.1016/j.autrev.2012.05.011] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 05/15/2012] [Indexed: 01/06/2023]
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Imura-Kumada S, Hasegawa M, Matsushita T, Hamaguchi Y, Encabo S, Shums Z, Norman GL, Takehara K, Fujimoto M. High prevalence of primary biliary cirrhosis and disease-associated autoantibodies in Japanese patients with systemic sclerosis. Mod Rheumatol 2012; 22:892-8. [PMID: 22327744 DOI: 10.1007/s10165-012-0607-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 01/25/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the prevalence of primary biliary cirrhosis (PBC) and PBC-associated autoantibodies in Japanese systemic sclerosis (SSc) patients. METHODS Clinical data from 225 Japanese SSc patients were retrospectively obtained. Serum samples from these patients were examined for PBC-associated autoantibodies, anti-mitochondrial M2 antibodies (AMA), anti-sp100 antibodies (anti-sp100), and anti-gp210 antibodies (anti-gp210) by enzyme-linked immunosorbent assay. RESULTS Of 225 patients, 37 (16.4%) had AMA, 13 (5.8%) had anti-sp100, and 3 (1.3%) had anti-gp210. Three patients were positive for both AMA and anti-sp100, and 2 were positive for both AMA and anti-gp210. PBC was found in 22 (9.8%) patients positive for AMA with or without anti-sp100 or anti-gp210, but not in those with anti-sp100 or anti-gp210 without AMA. Furthermore, 13 patients lacking these three antibodies were diagnosed with or suspected of PBC by liver biopsy and/or their clinical manifestation. Multivariable analysis revealed that AMA and anti-centromere antibodies were independently associated with PBC in SSc patients, while anti-sp100 and anti-gp210 were not. CONCLUSIONS This study has demonstrated even higher prevalence of both PBC-associated autoantibodies and PBC in the Japanese SSc population than in the Caucasian SSc population. AMA and anti-centromere antibodies are likely to indicate increasing risk of PBC in SSc patients.
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Affiliation(s)
- Sayako Imura-Kumada
- Department of Dermatology, Kanazawa University Graduate School of Medical Science, Ishikawa, Japan
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Optimization and diagnostic performance of a single multiparameter lineblot in the serological workup of systemic sclerosis. J Immunol Methods 2012; 379:53-60. [DOI: 10.1016/j.jim.2012.03.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 03/01/2012] [Accepted: 03/01/2012] [Indexed: 11/17/2022]
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Imura-Kumada S, Hasegawa M, Matsushita T, Hamaguchi Y, Encabo S, Shums Z, Norman GL, Takehara K, Fujimoto M. High prevalence of primary biliary cirrhosis and disease-associated autoantibodies in Japanese patients with systemic sclerosis. Mod Rheumatol 2012. [PMID: 22327744 DOI: 10.3109/s10165-012-0607-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the prevalence of primary biliary cirrhosis (PBC) and PBC-associated autoantibodies in Japanese systemic sclerosis (SSc) patients. METHODS Clinical data from 225 Japanese SSc patients were retrospectively obtained. Serum samples from these patients were examined for PBC-associated autoantibodies, anti-mitochondrial M2 antibodies (AMA), anti-sp100 antibodies (anti-sp100), and anti-gp210 antibodies (anti-gp210) by enzyme-linked immunosorbent assay. RESULTS Of 225 patients, 37 (16.4%) had AMA, 13 (5.8%) had anti-sp100, and 3 (1.3%) had anti-gp210. Three patients were positive for both AMA and anti-sp100, and 2 were positive for both AMA and anti-gp210. PBC was found in 22 (9.8%) patients positive for AMA with or without anti-sp100 or anti-gp210, but not in those with anti-sp100 or anti-gp210 without AMA. Furthermore, 13 patients lacking these three antibodies were diagnosed with or suspected of PBC by liver biopsy and/or their clinical manifestation. Multivariable analysis revealed that AMA and anti-centromere antibodies were independently associated with PBC in SSc patients, while anti-sp100 and anti-gp210 were not. CONCLUSIONS This study has demonstrated even higher prevalence of both PBC-associated autoantibodies and PBC in the Japanese SSc population than in the Caucasian SSc population. AMA and anti-centromere antibodies are likely to indicate increasing risk of PBC in SSc patients.
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Affiliation(s)
- Sayako Imura-Kumada
- Department of Dermatology, Kanazawa University Graduate School of Medical Science, Ishikawa, Japan
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Cappelli S, Bellando Randone S, Martinović D, Tamas MM, Pasalić K, Allanore Y, Mosca M, Talarico R, Opris D, Kiss CG, Tausche AK, Cardarelli S, Riccieri V, Koneva O, Cuomo G, Becker MO, Sulli A, Guiducci S, Radić M, Bombardieri S, Aringer M, Cozzi F, Valesini G, Ananyeva L, Valentini G, Riemekasten G, Cutolo M, Ionescu R, Czirják L, Damjanov N, Rednic S, Matucci Cerinic M. “To Be or Not To Be,” Ten Years After: Evidence for Mixed Connective Tissue Disease as a Distinct Entity. Semin Arthritis Rheum 2012; 41:589-98. [DOI: 10.1016/j.semarthrit.2011.07.010] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Revised: 07/27/2011] [Accepted: 07/28/2011] [Indexed: 11/29/2022]
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Clements PJ, Allanore Y, Khanna D, Singh M, Furst DE. Arthritis in systemic sclerosis: systematic review of the literature and suggestions for the performance of future clinical trials in systemic sclerosis arthritis. Semin Arthritis Rheum 2011; 41:801-14. [PMID: 22177105 DOI: 10.1016/j.semarthrit.2011.10.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 08/22/2011] [Accepted: 10/04/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Musculoskeletal (MSK) pain is a frequent (between 40-80%) complaint of patients with systemic sclerosis (SSc). Unfortunately, there are virtually no systematic studies of the causes or the management of MSK involvement in SSc and with few exceptions there have been no controlled trials to determine what are and should be the best strategies for managing MSK pain and synovitis in patients with SSc. METHODS A literature search was conducted for published reports that have addressed the clinical assessment of "arthritis" and "musculoskeletal" involvement in SSc. The literature search was a prelude to developing recommendations/suggestions for performing clinical trials (preferably randomized) in the future in SSc-related arthritis. RESULTS The search netted a number of articles that reported clinical assessments of arthritis in SSc, but very few reported results of controlled clinical trials. Nevertheless, a prevalence of clinical arthritis and tools used to assess the involvement (clinical examination, functional assessments and assessments of quality of life, and radiographic imaging) was found. CONCLUSIONS Most of the tools used to assess arthritis in SSc patients have not been validated and additional work is needed to develop a "core set" of variables for assessment of arthritis in SSc and its response to treatment. This report furnishes the background information that can help provide the building blocks for the development of a "core set" that can be used to chart the efficacy of new treatments for SSc-related arthritis in the future.
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Affiliation(s)
- Philip J Clements
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-1670, USA.
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Mierau R, Moinzadeh P, Riemekasten G, Melchers I, Meurer M, Reichenberger F, Buslau M, Worm M, Blank N, Hein R, Müller-Ladner U, Kuhn A, Sunderkötter C, Juche A, Pfeiffer C, Fiehn C, Sticherling M, Lehmann P, Stadler R, Schulze-Lohoff E, Seitz C, Foeldvari I, Krieg T, Genth E, Hunzelmann N. Frequency of disease-associated and other nuclear autoantibodies in patients of the German Network for Systemic Scleroderma: correlation with characteristic clinical features. Arthritis Res Ther 2011; 13:R172. [PMID: 22018289 PMCID: PMC3308107 DOI: 10.1186/ar3495] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 08/23/2011] [Accepted: 10/21/2011] [Indexed: 02/01/2023] Open
Abstract
Introduction In the present study, we analysed in detail nuclear autoantibodies and their associations in systemic sclerosis (SSc) patients included in the German Network for Systemic Scleroderma Registry. Methods Sera of 863 patients were analysed according to a standardised protocol including immunofluorescence, immunoprecipitation, line immunoassay and immunodiffusion. Results Antinuclear antibodies (ANA) were detected in 94.2% of patients. In 81.6%, at least one of the autoantibodies highly associated with SSc or with overlap syndromes with scleroderma features was detected, that is, anti-centromere (35.9%) or anti-topoisomerase I (30.1%), followed in markedly lower frequency by antibodies to PM-Scl (4.9%), U1-ribonucleoprotein (U1-RNP) (4.8%), RNA polymerases (RNAPs) (3.8%), fibrillarin (1.4%), Ku (1.2%), aminoacyl-transfer RNA synthetases (0.5%), To (0.2%) and U11-RNP (0.1%). We found that the simultaneous presence of SSc-associated autoantibodies was rare (1.6%). Furthermore, additional autoantibodies were detected in 55.4% of the patients with SSc, of which anti-Ro/anti-La, anti-mitochondrial and anti-p25/p23 antibodies were most frequent. The coexistence of SSc-associated and other autoantibodies was common (43% of patients). SSc-associated autoantibodies disclosed characteristic associations with clinical features of patients, some of which were previously not acknowledged. Conclusions This study shows that five autoantigens (that is, centromere, topoisomerase I, PM-Scl, U1-RNP and RNAP) detected more than 95% of the known SSc-associated antibody responses in ANA-positive SSc patients and characterise around 79% of all SSc patients in a central European cohort. These data confirm and extend previous data underlining the central role of the determination of ANAs in defining the diagnosis, subset allocation and prognosis of SSc patients.
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Affiliation(s)
- Rudolf Mierau
- Laboratory at Rheumaklinik Aachen, Hauptstrasse 21, Aachen, D-52066, Germany.
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Low-dose naltrexone for pruritus in systemic sclerosis. Int J Rheumatol 2011; 2011:804296. [PMID: 21918649 PMCID: PMC3171757 DOI: 10.1155/2011/804296] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 07/14/2011] [Indexed: 12/20/2022] Open
Abstract
Pruritus is a common symptom in systemic sclerosis (SSc), an autoimmune disease which causes fibrosis and vasculopathy in skin, lung, and gastrointestinal tract (GIT). Unfortunately, pruritus has limited treatment options in this disease. Pilot trials of low-dose naltrexone hydrochloride (LDN) for pruritus, pain, and quality of life (QOL) in other GIT diseases have been successful. In this case series we report three patients that had significant improvement in pruritus and total GIT symptoms as measured by the 10-point faces scale and the University of California Los Angeles Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 (UCLA SCTC GIT 2.0) questionnaire. This small case series suggests LDN may be an effective, highly tolerable, and inexpensive treatment for pruritus and GIT symptoms in SSc.
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Morozzi G, Bellisai F, Fineschi I, Scaccia F, Pucci G, Simpatico A, Tampoia M, Chialà A, Lapadula G, Galeazzi M. Prevalence of anti-histone antibodies, their clinical significance and correlation with other autoantibodies in a cohort of Italian scleroderma patients. AUTOIMMUNITY HIGHLIGHTS 2011; 2:29-33. [PMID: 26000117 PMCID: PMC4389072 DOI: 10.1007/s13317-011-0015-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 01/13/2011] [Indexed: 11/30/2022]
Abstract
Purpose The aim of our study was to determine the prevalence, clinical significance of antibodies to individual histone components and to evaluate their correlation with other autoantibody specificities in a cohort of Italian SSc patients. Some authors, demonstrated high prevalence of anti-histone antibodies in Italian SSc patients, associated with cardiac and renal involvement, suggesting a prognostic value of these autoantibodies; however, these data need to be confirmed. Methods Serum from 112 adult SSc patients, classified as diffuse (dc) and limited cutaneous (lc) SSc subsets were analyzed for autoantibodies by indirect immunofluorescence, fluoroenzyme immunoassay and enzyme immunoassay. Results AHA were found in 13 patients (11.6%), nine with lcSSc and four with dcSSc. Among them, five patients were anti-Scl70+ and four were anti-CENP B+. The presence of AHA was not associated with multi-organ involvement or with diffuse subset, as already described. Anti-Scl70 was detected in 43% of patients, anti-CENP B in 32% and anti-RNA polymerase III in 7.1%. We confirmed the association between anti-Scl70 antibodies and pulmonary fibrosis (OR 15.75, p < 0.0001). Conclusion In our experience, the very low prevalence of AHA in Italian SSc patients and the lack of association with clinical manifestations suggest that this test is of little clinical use; however, it would be worthwhile extending the study to a larger population of patients.
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Affiliation(s)
- Gabriella Morozzi
- Sezione di Reumatologia, Dipartimento di Medicina Clinica e Scienze Immunologiche, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy
| | - Francesca Bellisai
- Sezione di Reumatologia, Dipartimento di Medicina Clinica e Scienze Immunologiche, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy
| | - Irene Fineschi
- Sezione di Reumatologia, Dipartimento di Medicina Clinica e Scienze Immunologiche, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy
| | - Francesca Scaccia
- Sezione di Reumatologia, Dipartimento di Medicina Clinica e Scienze Immunologiche, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy
| | - Gabriella Pucci
- Sezione di Reumatologia, Dipartimento di Medicina Clinica e Scienze Immunologiche, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy
| | - Antonella Simpatico
- Sezione di Reumatologia, Dipartimento di Medicina Clinica e Scienze Immunologiche, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy
| | | | | | - Giovanni Lapadula
- Sezione di Reumatologia, Dipartimento di Medicina Interna e Medicina Pubblica (DiMIMP), Bari, Italy
| | - Mauro Galeazzi
- Sezione di Reumatologia, Dipartimento di Medicina Clinica e Scienze Immunologiche, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy
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Abstract
Chronic liver disease is associated with several cutaneous manifestations. Although many of these changes are nonspecific, some are associated with distinct liver diseases and correlate with the severity of hepatic pathology. Often the first clue to a liver disease is manifested through skin. Although cirrhosis is associated with spider nevi and palmar erythema, disorders can result in noncirrhotic cutaneous manifestations. It is important for physicians to be familiar with the spectrum of these manifestations, to recognize, help detect, and treat the underlying hepatic disease. This article reviews the medical literature and discusses the spectrum of dermatologic manifestations of liver disorders and their pathogenesis, significance, and treatment.
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HAMAGUCHI Y. Autoantibody profiles in systemic sclerosis: Predictive value for clinical evaluation and prognosis. J Dermatol 2010; 37:42-53. [DOI: 10.1111/j.1346-8138.2009.00762.x] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Razykov I, Thombs BD, Hudson M, Bassel M, Baron M. Prevalence and clinical correlates of pruritus in patients with systemic sclerosis. ACTA ACUST UNITED AC 2009; 61:1765-70. [DOI: 10.1002/art.25010] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Assassi S, Fritzler MJ, Arnett FC, Norman GL, Shah KR, Gourh P, Manek N, Perry M, Ganesh D, Rahbar MH, Mayes MD. Primary biliary cirrhosis (PBC), PBC autoantibodies, and hepatic parameter abnormalities in a large population of systemic sclerosis patients. J Rheumatol 2009; 36:2250-6. [PMID: 19723904 PMCID: PMC2885441 DOI: 10.3899/jrheum.090340] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To investigate the diagnostic accuracy of antimitochondrial antibodies (AMA), sp100, and gp210 antibodies for primary biliary cirrhosis (PBC) in a large population of patients with systemic sclerosis (SSc); to examine concordance of these antibodies with subsets of SSc. Further, to assess the association of SSc-related antibodies with hepatic parameter abnormalities. METHODS We obtained medical records to verify the diagnoses of SSc and PBC. Sera from all participants were examined for the presence of SSc- and PBC-related antibodies, as well as for abnormalities in hepatic parameters. RESULTS We examined 817 patients with SSc, of whom 16 (2%) had confirmed PBC. The sensitivity and specificity of AMA by a MIT3 ELISA for PBC were 81.3% and 94.6%, respectively. Sp100 had a sensitivity and specificity of 31.3% and 97.4%, respectively, while gp210 had an even lower sensitivity. We were able to detect all PBC cases using AMA(MIT3) and sp100 as a combined marker, resulting in a significantly improved sensitivity of 100% (p = 0.042) with an incremental decrease in specificity to 92.6%. Independent of AMA or sp100 status, there was an association of anticentromere B (CENP-B) and anti-topoisomerase antibodies (ATA) with higher alkaline phosphatase levels (p = 0.051 and p = 0.003, respectively) while anti-RNA polymerase III (anti-RNAP) was associated with lower alkaline phosphatase levels (p = 0.019) among the patients with SSc. CONCLUSION Utilization of AMA(MIT3) and sp100 antibodies as a combined diagnostic marker leads to an improved detection of PBC in patients with SSc. CENP-B and ATA are associated with alkaline phosphatase elevation.
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Affiliation(s)
- Shervin Assassi
- The University of Texas-Health Science Center at Houston, 6431 Fannin, MSB 5.232, Houston, TX 77030, USA.
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Takada K, Suzuki K, Matsumoto M, Okada M, Nakanishi T, Horikoshi H, Higuchi T, Ohsuzu F. Clinical characteristics of patients with both anti-U1RNP and anti-centromere antibodies. Scand J Rheumatol 2008; 37:360-4. [PMID: 18686191 DOI: 10.1080/03009740802116190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To clarify the clinical characteristics of patients having both anti-U1RNP antibodies (anti-U1RNP) and anti-centromere antibodies (ACA) in comparison to subjects having either anti-U1RNP or ACA alone. SUBJECTS AND METHODS One hundred and fifty-six subjects who had anti-U1RNP and/or ACA were enrolled. They were classified into three groups: anti-U1RNP alone group (n = 64); ACA alone group (n = 82); and anti-U1RNP+ACA group (n = 10). The anti-U1RNP alone and ACA alone groups were also divided into the low-titre and the high-titre subgroups, respectively. The frequencies of the specific clinical findings and laboratory data were compared among the groups or subgroups. RESULTS The frequencies of persistent proteinuria or lupus nephritis (LN, 50.0%) and primary biliary cirrhosis (PBC, 30.0%) in the anti-U1RNP+ACA group were higher than that in the anti-U1RNP alone group (17.2%, p<0.01; 3.1%, p = 0.075; respectively). The frequencies of systemic lupus erythematosus (SLE, 60.0%), persistent proteinuria or LN (50.0%), anti-Ro (70.0%), and anti-La (30.0%) in the anti-U1RNP+ACA group were higher than those in the ACA alone group (11.0%, p<0.01; 4.9%, p<0.001; 23.2%, p<0.01; and 6.1%, p = 0.085; respectively). The frequency of systemic sclerosis (SSc) in the high-titre subgroup (30.0%) was higher than that in the low-titre subgroup (11.8%) in the anti-U1RNP alone group, without significance (p = 0.072). The frequency of interstitial pneumonia in the high-titre subgroup (26.8%) was higher than that in the low-titre subgroup (2.4%) in the ACA alone group (p<0.01). CONCLUSIONS The clinical characteristics of patients with anti-U1RNP+ACA were clarified in comparison to subjects having either anti-U1RNP or ACA alone.
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Affiliation(s)
- K Takada
- Department of Internal Medicine, Division of Rheumatology, National Defence Medical College, Tokorozawa, Saitama, Japan.
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Koenig M, Dieudé M, Senécal JL. Predictive value of antinuclear autoantibodies: The lessons of the systemic sclerosis autoantibodies. Autoimmun Rev 2008; 7:588-93. [DOI: 10.1016/j.autrev.2008.06.010] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Woodhead F, Wells AU, Desai SR. Pulmonary complications of connective tissue diseases. Clin Chest Med 2008; 29:149-64, vii. [PMID: 18267189 DOI: 10.1016/j.ccm.2007.11.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Lung involvement is common in patients who have complications of connective tissue disease (CTDs) and causes considerable morbidity and mortality. High resolution CT (HRCT) has a pivotal role in the detection of lung fibrosis. In patients who have coexistent pathologic processes, HRCT often allows the predominant process to be identified. HRCT has an important role in detecting possible complications such as opportunistic infection or the development of malignancy. However, the limitations of HRCT should not be overlooked. In many cases, HRCT appearances are nonspecific and may or may not be related to an underlying CTD. Thus, radiologic findings should never be interpreted without knowledge of the clinical picture.
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Affiliation(s)
- Felix Woodhead
- Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
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