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Masoumi M, Bodaghi AB, Khorramdelazad H, Ebadi E, Houshmandfar S, Saeedi-Boroujeni A, Karami J. Unraveling the immunometabolism puzzle: Deciphering systemic sclerosis pathogenesis. Heliyon 2024; 10:e35445. [PMID: 39170585 PMCID: PMC11336762 DOI: 10.1016/j.heliyon.2024.e35445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/26/2024] [Accepted: 07/29/2024] [Indexed: 08/23/2024] Open
Abstract
The article delves into the pathogenesis of systemic sclerosis (SSc) with an emphasis on immunometabolism dysfunctions. SSc is a complex autoimmune connective tissue disorder with skin and organ fibrosis manifestation, vasculopathy, and immune dysregulation. A growing amount of research indicates that immunometabolism plays a significant role in the pathogenesis of autoimmune diseases, including SSc. The review explores the intricate interplay between immune dysfunction and metabolic alterations, focusing on the metabolism of glucose, lipids, amino acids, the TCA (tricarboxylic acid) cycle, and oxidative stress in SSc disease. According to recent research, there are changes in various metabolic pathways that could trigger or perpetuate the SSc disease. Glycolysis and TCA pathways play a pivotal role in SSc pathogenesis through inducing fibrosis. Dysregulated fatty acid β-oxidation (FAO) and consequent lipid metabolism result in dysregulated extracellular matrix (ECM) breakdown and fibrosis induction. The altered metabolism of amino acids can significantly be involved in SSc pathogenesis through various mechanisms. Reactive oxygen species (ROS) production has a crucial role in tissue damage in SSc patients. Indeed, immunometabolism involvement in SSc is highlighted, which offers potential therapeutic avenues. The article underscores the need for comprehensive studies to unravel the multifaceted mechanisms driving SSc pathogenesis and progression.
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Affiliation(s)
- Maryam Masoumi
- Clinical Research Development Unit, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran
| | - Ali Bayat Bodaghi
- Student Research Committee, Khomein University of Medical Sciences, Khomein, Iran
| | - Hossein Khorramdelazad
- Department of Immunology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Erfan Ebadi
- Student Research Committee, Khomein University of Medical Sciences, Khomein, Iran
| | - Sheyda Houshmandfar
- Department of Basic Medical Sciences, Faculty of Medicine, Abadan University of Medical Sciences, Abadan, Iran
| | - Ali Saeedi-Boroujeni
- Department of Basic Medical Sciences, Faculty of Medicine, Abadan University of Medical Sciences, Abadan, Iran
| | - Jafar Karami
- Department of Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran
- Molecular and Medicine Research Center, Khomein University of Medical Sciences, Khomein, Iran
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Farhat MM, Guerreschi P, Morell-Dubois S, Deken V, Labreuche J, Sanges S, Sobanski V, Hachulla E, Cottencin O, Launay D. Perception of aesthetic impairment in patients with systemic sclerosis determined using a semi-quantitative scale and its association with disease characteristics. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2024; 9:124-133. [PMID: 38910601 PMCID: PMC11188849 DOI: 10.1177/23971983241231620] [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: 09/11/2023] [Accepted: 01/22/2024] [Indexed: 06/25/2024]
Abstract
Background Systemic sclerosis is a fibrotic disease. Body image assessments could be key in optimizing care; however, data are scarce. The main objective was to assess the perception of aesthetic impairment using a visual aesthetic evaluation scale in patients with systemic sclerosis compared with healthy subjects. The secondary objectives were to assess associations between the perception of aesthetic impairment and scores on standardized questionnaires for aesthetic impairment as well as clinical, psychological/quality of life, and functional parameters of patients with systemic sclerosis. Methods This study evaluated and compared the perception of aesthetic impairment in two populations: patients with systemic sclerosis from a referral center at Lille Hospital, France, and healthy controls. Results This study included 88 patients (69 (78.4%) women) with a median age of 52 years and 88 controls (49 (55.7%) women) with a median age of 45 years. The perception of aesthetic impairment assessed using the aesthetic evaluation scale was poorer in systemic sclerosis patients than in controls (3.7 ± 0.3 vs 2.8 ± 0.3, p = 0.028) and was statistically correlated with assessments using the adapted satisfaction with appearance, a specific aesthetic impact assessment questionnaire for patients with systemic sclerosis. Patients with anxiety or depressive symptoms had significantly higher aesthetic evaluation scale scores. Systemic sclerosis patients with facial involvement and pitting scars had a worse perception of aesthetic impairment. Compared with healthy controls, systemic sclerosis patients had a worse perception of aesthetic impairment, especially systemic sclerosis patients with anxiety or depression and those with facial and hand involvement. Conclusion The aesthetic evaluation scale appears to be an easy-to-use tool to evaluate body image. Correlations of the aesthetic evaluation scale score with psychological and quality of life parameters reflect the importance of these parameters for body image evaluation and its complex assessment. Trial registration Clinical Trial NCT03271320 (Registered 9 January 2017, https://www.clinicaltrials.gov/ct2/show/NCT03271320?term=NCT03271320&cntry=FR&draw=2&rank=1).
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Affiliation(s)
- Méryem-Maud Farhat
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- Inserm, Lille, France
- Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Pierre Guerreschi
- Plastic Surgery Department, University Hospital of Lille, Lille, France
- Competence Center for Clefts and CranioFacial Malformations, Lille, France
| | - Sandrine Morell-Dubois
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- Inserm, Lille, France
- Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Valérie Deken
- Univ. Lille, CHU Lille, EA2694—Santé publique: épidémiologie et qualité des soins, Lille, France
| | - Julien Labreuche
- Univ. Lille, CHU Lille, EA2694—Santé publique: épidémiologie et qualité des soins, Lille, France
| | - Sebastien Sanges
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- Inserm, Lille, France
- Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Vincent Sobanski
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- Inserm, Lille, France
- Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Eric Hachulla
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- Inserm, Lille, France
- Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Olivier Cottencin
- INSERM U-1172. Univ Lille. LiNC. PSY team, CHU Lille Department of Psychiatry and Addiction Medicine, Lille, France
| | - David Launay
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, Lille, France
- Inserm, Lille, France
- Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
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Chaigne B, Mouthon L. [Update on targeted biopharmaceuticals in systemic sclerosis!]. Rev Med Interne 2024; 45:109-113. [PMID: 37980267 DOI: 10.1016/j.revmed.2023.11.002] [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: 09/08/2023] [Revised: 10/24/2023] [Accepted: 11/04/2023] [Indexed: 11/20/2023]
Abstract
Systemic sclerosis (SSc) is a rare connective tissue disease characterized by inflammation, fibrosis, and autoimmunity. Despite few clinical trials when compared to other autoimmune diseases, SSc has benefited from renewed interest over the past ten years and a large number of clinical trials have been performed or are underway. We present here the results of the trials published in the last 5 years in ScS according to the chosen endpoint criteria and describe the trials in progress or expected in the years to come.
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Affiliation(s)
- B Chaigne
- Service de médecine interne, centre de référence maladies autoimmunes systémiques Rares d'Ile de France, hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; AP-HP-CUP, Université Paris Cité, Hôpital Cochin, 75014 Paris, France.
| | - L Mouthon
- Service de médecine interne, centre de référence maladies autoimmunes systémiques Rares d'Ile de France, hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; AP-HP-CUP, Université Paris Cité, Hôpital Cochin, 75014 Paris, France
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Emil NS, Vondenberg JA, Waters YM, Muruganandam M, Ariza-Hutchinson A, Patel RA, Nunez SE, Gibb JI, McElwee MK, Poole JL, O'Sullivan FX, Fields RA, Sibbitt WL. Systemic sclerosis in Native Americans of the American Southwest. Int J Rheum Dis 2022; 25:916-925. [PMID: 35699136 DOI: 10.1111/1756-185x.14367] [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: 02/21/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Many indigenous non-Caucasian populations, including Native Americans, have been reported to have higher rates, distinct clinical phenotypes, increased complications, and greater severity of systemic sclerosis (SSc). However, little is known of SSc specifically in Native Americans of the American Southwest. This study compared the clinical and serologic manifestations and outcomes of SSc in Native Americans and non-Native Americans (non-Natives) of this region. METHODS This cross-sectional retrospective study included 137 SSc patients (109 [80%] were non-Native and 28 [20%] were Native Americans) followed over a mean of 11.5 ± 7.6 years. Participants were repetitively evaluated with medical history, physical examination, echocardiography, chest imaging, and serologic testing. Disease characteristics and outcomes were statistically compared between Native Americans and non-Native patients. RESULTS The estimated prevalence of SSc in Native Americans was 40.0 cases/100 000 vs 17.1 cases/100 000 for non-Natives (odds ratio 2.34, 95% confidence interval [CI] 1.55-3.55, P < .001). The cohorts were similar in terms age, age of onset, limited vs diffuse cutaneous SSc, telangiectasias, gastroesophageal reflux disease, Raynaud phenomenon, serologies, interstitial lung disease, pulmonary arterial hypertension, scleroderma renal crisis, cancer prevalence, and overall mortality (all P > .05). However, for Native Americans, mortality specifically from fatal infections was 3.94-fold that of non-Natives (hazard ratio 6.88, 95% CI 1.37-34.64; P < .001). CONCLUSION In Native Americans of the American Southwest, SSc is increased in prevalence but is phenotypically similar to SSc in non-Natives. However, mortality due specifically to infection is increased in Native Americans with SSc.
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Affiliation(s)
- N Suzanne Emil
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Jaime A Vondenberg
- Department of Medicine, Rheumatology/Immunology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Yvonne M Waters
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Maheswari Muruganandam
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Angie Ariza-Hutchinson
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Rosemina A Patel
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Sharon E Nunez
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - James I Gibb
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Matthew K McElwee
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Janet L Poole
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Frank X O'Sullivan
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Roderick A Fields
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Wilmer L Sibbitt
- Division of Rheumatology and School of Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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Westerlind H, Bairkdar M, Gunnarsson K, Moshtaghi-Svensson J, Sysojev AÖ, Hesselstrand R, Holmqvist M. Incidence and prevalence of systemic sclerosis in Sweden, 2004-2015, a register-based study. Semin Arthritis Rheum 2022; 53:151978. [PMID: 35189452 DOI: 10.1016/j.semarthrit.2022.151978] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES we aim to present an in-depth report of the incidence and prevalence of systemic sclerosis (SSc) in Sweden in a nation-wide register-based study covering the entire Swedish population METHODS: each individual residing in Sweden is given a unique personal identity number. We linked the National Patient Register and the Total Population Register to identify 1) patients with prevalent SSc on 2015-12-31 and 2) patients with incident SSc during the time period 2004-2015 based on ICD-10 codes. We estimated prevalence and incidence overall and stratified on age, sex, and county. RESULTS we identified 1774 prevalent cases, median age was 65 years (IQR 19.2) and 84% were women. The point prevalence estimate was 22.7 per 100,000 (95%CI 13.3-32.0). 1139 individuals were newly diagnosed with SSc during 2004-2015 with a median age of 60 years (IQR 20.6) and 80% were women. The mean standardized incidence was 11.9 per 1,000,000 person-years (95%CI 5.1-18.7). The annual incidence remained stable over the study period. Women had five times higher incidence and prevalence than men. The highest prevalence stratified by age strata was observed in the group aged 70-79. CONCLUSION SSc incidence and prevalence in Sweden are comparable to estimates from southern Europe, as opposed to the previous assumption of lower occurrence in northern Europe. We further observe that SSc incidence has been rather constant throughout recent years in Sweden with no obvious increase.
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Affiliation(s)
- Helga Westerlind
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Sweden
| | - Majd Bairkdar
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Sweden.
| | - Karin Gunnarsson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Sweden; Rheumatology Division, Department of medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - John Moshtaghi-Svensson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Sweden
| | - Anton Öberg Sysojev
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Sweden
| | - Roger Hesselstrand
- Rheumatology, Department of Clinical Sciences, Lund, Lund University, Sweden
| | - Marie Holmqvist
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Sweden; Rheumatology Division, Department of medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Allanore Y, Constans J, Godard D, de Pouvourville G, Bouee S, Jeanbat V, Teissier C, Le Lay K, Chollet J, Hachulla E. Quality of life in SSc-ILD patients: Understanding the impact of the ILD and the needs of the SSc-ILD patients and their need for caregivers in France. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2022; 7:49-56. [PMID: 35386942 PMCID: PMC8922678 DOI: 10.1177/23971983211013979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/03/2021] [Indexed: 02/03/2023]
Abstract
Objectives The objectives of this study were to describe the impact of systemic sclerosis associated interstitial lung disease, on quality of life, to estimate the correlation between quality of life and severity of lung disease and to assess the impact of interstitial lung disease on caregivers. Methods Seven investigators included systemic sclerosis associated interstitial lung disease patients from December 2019 to April 2020. Sociodemographics and clinical data were collected. Patients reported outcomes and questionnaires were used with 1 generic patients reported outcome (EQ-5D-5L), 1 specific PRO (Brief Interstitial Lung Disease) and 2 self-reported questionnaires on impact of SSc complications and impact on caregivers. The correlation between forced vital capacity and EQ-5D-5L score was estimated with a multivariate linear regression model adjusted on several covariates. Results In all, 89 patients were included. 26.4% were males, mean age was 58.2 ± 14.5 years. Mean EQ-5D-5L score = 0.79 ± 0.22 (median = 0.85). Mean EQ-5D-5L visual analog scale score = 60.8 ± 20.4 (median = 61.5). Mean King's Brief Interstitial Lung Disease score = 58.4 ± 12.7 (median = 58.0). After adjustment on covariates, a significant correlation between forced vital capacity and EQ-5D-5L score was found with an increase of 0.003 of the EQ-5D-5L score for a 1% increase of FVC (p = 0.0096). No significant correlation between forced vital capacity and the EQ-VAS and King's Brief Interstitial Lung Disease score were found. The impact of SSc on other organs was significantly correlated with EQ- 5D-5L score, respectively, for the impact scores on the lung system (p = 0.0003), heart system (p = 0.0182), Raynaud's syndrome (p = 0.0015), digestive system (p = 0.0032), joints/muscles (p = 0.0003), skin (p < 0.0001), kidney (p = 0.0052) and gastro-oesophageal reflux (p = 0.0063). Significant correlations between King's Brief Interstitial Lung Disease score and lung system (p < 0.0001), heart system (p < 0.0001), digital ulcers (p = 0.058), digestive system (p < 0.0001), kidney (p = 0.0004), skin (p = 0.0499) and gastro-oesophageal reflux (p = 0.0033) scores were found 68.5% of patients reported their need for a caregiver to help them in their daily life activities. Conclusion Our study highlighted the strong burden of systemic sclerosis associated interstitial lung disease` for patients, especially with an impact on quality of life, on other organs manifestations and need for caregivers in their daily life.
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Affiliation(s)
- Yannick Allanore
- Rheumatology, Cochin Hospital, Université de Paris, Paris, France
| | | | | | | | | | | | | | | | | | - Eric Hachulla
- Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286–INFINITE–Institute for Translational Research in Inflammation, Lille, France
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Chen Y, Wu L, J Hernández-Muñoz J, J Miller M, Pope M, Huyan Y, Zhong L. The economic burden of systemic sclerosis-A systematic review. Int J Rheum Dis 2021; 25:110-120. [PMID: 34970861 DOI: 10.1111/1756-185x.14270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 11/27/2022]
Abstract
AIM Systemic sclerosis (SSc) is a rare, chronic autoimmune disease associated with a substantial economic burden. This study aimed to assess the costs associated with SSc and to identify major cost drivers. METHODS A systematic search was conducted in MEDLINE and Embase to identify relevant studies. Two independent reviewers evaluated studies based on inclusion/exclusion criteria and performed data extraction. Costs were converted into 2017 US dollars by purchasing power parity. The review was conducted following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guideline. RESULTS The original literature search identified 113 potentially relevant citations, of which 10 articles met all the inclusion/exclusion criteria and were included in the data extraction and analysis. The identified studies evaluated costs associated with SSc in 11 countries from North America, Europe, and Australia published between 2009 and 2018. Eight studies reported direct costs and seven studies reported indirect costs. Direct costs varied from $3356 (Hungary) to $27 032 (Germany) with hospitalization and medication being two of the biggest components of direct medical costs in most studies. The indirect costs for lost productivity varied from $2433 (Italy) to $20 663 (UK), accounting for a significant portion of the total economic burden. CONCLUSIONS Large variations existed in annual costs of SSc, but all studies found that SSc imposed a substantial economic burden on patients and their families. The identified studies were mostly from high-income countries and there is still a knowledge gap regarding the cost of SSc in other parts of the world.
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Affiliation(s)
- Yongcong Chen
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Lin Wu
- Health Sciences Library, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | | | - Michael J Miller
- Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA
| | - Melinda Pope
- College of Pharmacy, Texas A&M University College Station, College Station, Texas, USA
| | - Yidan Huyan
- School of Public Health, Texas A&M University College Station, College Station, Texas, USA
| | - Lixian Zhong
- College of Pharmacy, Texas A&M University College Station, College Station, Texas, USA.,Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, California, USA.,Houston Methodist Academic Institute, Houston, TX, USA
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Garnier R, Médernach C, Laborde-Castérot H, Langrand J. Sclérodermie et exposition professionnelle aux solvants organiques. Revue de la littérature et méta-analyse. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2021. [DOI: 10.1016/j.toxac.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bairkdar M, Rossides M, Westerlind H, Hesselstrand R, Arkema EV, Holmqvist M. Incidence and prevalence of systemic sclerosis globally: a comprehensive systematic review and meta-analysis. Rheumatology (Oxford) 2021; 60:3121-3133. [PMID: 33630060 PMCID: PMC8516513 DOI: 10.1093/rheumatology/keab190] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/14/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We aimed to conduct a systematic review and meta-analysis on the incidence and prevalence of SSc covering the entire literature. METHODS This study followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement of 2009. We conducted a systematic search in MEDLINE, Web of Science and Embase to identify articles reporting incidence and/or prevalence of SSc. Two authors conducted the search, reviewed articles for inclusion and extracted relevant data. We used random-effects models to estimate the pooled prevalence and incidence of SSc and performed subgroup analyses by sex, case definition and region to investigate heterogeneity. We explored the association between calendar period and reported estimates using meta-regression. RESULTS Among 6983 unique records identified, we included 61 studies of prevalence and 39 studies of incidence in the systematic review. The overall pooled prevalence of SSc was 17.6 (95% CI 15.1, 20.5) per 100 000 and the overall pooled incidence rate of SSc was 1.4 (95% CI 1.1, 1.9) per 100 000 person-years. We observed significant regional variations in reported estimates; studies conducted in North America reported considerably higher estimates than other regions. The pooled incidence and prevalence in women were five times higher than in men. More recent studies reported higher estimates than older ones. CONCLUSION In this comprehensive review of the incidence and prevalence of SSc across the world, there was large heterogeneity among estimates, which should be taken into consideration when interpreting the results.
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Affiliation(s)
- Majd Bairkdar
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Marios Rossides
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Helga Westerlind
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Roger Hesselstrand
- Section for Rheumatology, Department of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund
| | - Elizabeth V Arkema
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Marie Holmqvist
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Pauling JD, McGrogan A, Snowball J, McHugh NJ. Epidemiology of systemic sclerosis in the UK: an analysis of the Clinical Practice Research Datalink. Rheumatology (Oxford) 2021; 60:2688-2696. [PMID: 33212504 DOI: 10.1093/rheumatology/keaa680] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/07/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES We developed and tested a robust case ascertainment strategy within the Clinical Practice Research Datalink (CPRD), with the aim of assessing the incidence, prevalence, mortality and delay in diagnosis of SSc in the UK. METHODS A two-stage case ascertainment strategy was devised and tested to establish a valid cohort of SSc cases within the CPRD. Incidence, prevalence and mortality statistics were analysed, alongside evaluation of the relationship between primary care codes for RP and SSc to examine diagnostic delay. RESULTS SSc Read codes were identified in 3123 patients (from a study cohort of >10.1 million individuals). Of these, 1757 cases of SSc were identified using our case ascertainment approach. The overall incidence rate of SSc over the period between 1999 and 2017 was 10.7/million/year (95% CI: 9.9-11.4), being higher in females [17.69/million/year (95% CI: 16.32-19.07)] than in males [3.59/million/year (95% CI: 2.97-4.21)]. The overall prevalence of SSc in adults was 235.5/million (95% CI: 207.2-245.7). The mean rate of mortality was 32/1000 person-years, with an overall standardized mortality ratio of 3.51 (95% CI: 3.19-3.84). Of those with an initial code of RP prior to a Read code of SSc, 191/854 (22.4%) had a lag period of >10 years. CONCLUSION We have developed and tested a robust case ascertainment strategy to examine the incidence, prevalence, mortality and diagnostic delay of SSc using primary care records of over 10 million UK residents. A significant lag between coding of RP and SSc in many patients suggests diagnostic delay in SSc remains an important unmet need.
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Affiliation(s)
- John D Pauling
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.,Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust, Bath, UK
| | - Anita McGrogan
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Julia Snowball
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Neil J McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
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Vitton V, Bazin C, Luciano L, Granel B, Alessandrini M, Harle JR. Oesophageal motor disorders and oesophageal endoscopic involvement in patients with systemic sclerosis: a systematic association? Scand J Gastroenterol 2021; 56:508-513. [PMID: 33689560 DOI: 10.1080/00365521.2021.1881813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Although oesophageal motor disorders (OMDs) are frequent in systemic sclerosis (SSc), the frequency of associated endoscopic lesions is unknown. We aimed at assessing the presence of endoscopic lesions in SSc patients with OMD. The secondary objective was to identify the clinical and serological profile of such patients. METHODS This retrospective study included SSc patients suffering from OMD diagnosed by oesophageal high-resolution manometry (OHRM) and with recent upper gastro-intestinal endoscopy (UGIE). Clinical data collected were age, gender, body mass index, SSc disease duration, tobacco, SSc cutaneous type, non-digestive SSc visceral disorders, oesophageal symptoms, serological profile (autoantibodies), proton pump inhibitor use, time between SSc diagnosis and UGIE. RESULTS 53 selected patients from 210 SSc patients investigated by OHRM in our department were included. Among these patients, 25 (47.2%) had endoscopic lesions: 18 (34.6%) had oesophagitis and 7 (13.5%) had Barrett's oesophagus. The only two parameters significantly associated with endoscopic lesions were a shorter disease duration (6 vs. 11 years; p = .002) and a shorter delay between SSc diagnosis and UGIE (3 vs. 8.5 years; p = .002). No other clinical or biological parameters could help identify the patients at risk of endoscopic lesion. CONCLUSION In our study, only a shorter disease duration and a shorter delay between SSc diagnosis and UGIE were significantly associated with the presence of endoscopic lesions in patients with OMD, but no other parameters were identified. This study highlights the need to perform UGIE in SSc patients with OMD whatever their clinical symptoms.
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Affiliation(s)
- Véronique Vitton
- Department of Gastroenterology, North Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Camille Bazin
- Department of Gastroenterology, North Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Laure Luciano
- Department of Gastroenterology, Instruction Hospital of French Army Laveran, Marseille, France
| | - Brigitte Granel
- Internal Medicine Department, CHU Nord, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, Vascular Research Center of Marseille, INSERM UMRS-1076, Aix-Marseille University, Marseille, France
| | - Marine Alessandrini
- EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille University, Marseille, France
| | - Jean-Robert Harle
- Internal Medicine Department, CHU La Timone, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, Marseille, France
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12
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Ciaffi J, Morabito MF, Ruscitti P, D'Angelo S, Mancarella L, Brusi V, Abignano G, Pucino V, Giacomelli R, Meliconi R, Ursini F. Incidence, prevalence and mortality of systemic sclerosis in Italy: a nationwide population-based study using administrative health data. Rheumatol Int 2020; 41:129-137. [PMID: 33052445 DOI: 10.1007/s00296-020-04720-3] [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: 08/02/2020] [Accepted: 10/01/2020] [Indexed: 02/06/2023]
Abstract
To study incidence, prevalence and mortality of systemic sclerosis (SSc) in Italy, assessing epidemiological differences between men and women and in distinct age groups. We performed a nationwide population-based study using administrative health data from regional co-payment exemption registries. Patients entitled with SSc-specific co-payment exemption were included. Fourteen of the 20 Italian regions contributed data covering a population of over 45 million individuals. Crude annual incidence rate, annual prevalence, crude annual mortality rate and standardised mortality ratio (SMR) were calculated. In 2016, the overall crude incidence rate of SSc was 18.5 (95% CI 16.9-20.2) per million per year. Incidence rate was 31.0 (95% CI 28.1-34.1) per million in women, and 4.3 (95% CI 3.2-5.6) per million in men. Peak incidence was observed in the age range 55-69 years. Overall annual prevalence was 306.1 (95% CI 301.1-311.2) per million. Prevalence was 530.8 (95% CI 521.5-540.2) per million in women and 67.8 (95% CI 64.4-71.3) per million in men, with a female to male ratio of 7.8:1. Highest prevalence was observed in the range 70-84 years. Crude annual mortality rate was 27.9 (95% CI 24.9-31.1) per 1000 patients. Overall SMR in patients with SSc was 2.8 (95% CI 1.9-3.8). SMR was 3.8 (95% CI 2.9-5.1) in men and 2.6 (95% CI 1.8-3.6) in women. We provided updated estimates on epidemiology of SSc in Italy. Our findings on incidence, prevalence and mortality of SSc are consistent with previously published literature.
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Affiliation(s)
- Jacopo Ciaffi
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), Via Pupilli 1, 40136, Bologna, Italy.
| | - Maria Francesca Morabito
- Department of Economics, Statistics and Finance "Giovanni Anania", University of Calabria, Cosenza, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Salvatore D'Angelo
- Rheumatology Department of Lucania, Rheumatology Institute of Lucania (IReL), San Carlo Hospital of Potenza, Madonna Delle Grazie Hospital of Matera, Potenza, Italy
| | - Luana Mancarella
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), Via Pupilli 1, 40136, Bologna, Italy
| | - Veronica Brusi
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), Via Pupilli 1, 40136, Bologna, Italy
| | - Giuseppina Abignano
- Rheumatology Department of Lucania, Rheumatology Institute of Lucania (IReL), San Carlo Hospital of Potenza, Madonna Delle Grazie Hospital of Matera, Potenza, Italy
| | - Valentina Pucino
- Rheumatology Research Group, Institute for Inflammation and Ageing, College of Medical and Dental Sciences, Queen Elizabeth Hospital, University of Birmingham, Birmingham, UK
| | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Riccardo Meliconi
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), Via Pupilli 1, 40136, Bologna, Italy.,Section of Rheumatology, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Francesco Ursini
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli (IOR), Via Pupilli 1, 40136, Bologna, Italy.,Section of Rheumatology, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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13
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Chairta P, Psarelis S, Michailidou K, Demetriou C, Symeonidou S, Nicolaou P, Christodoulou K. Genetic Susceptibility to Systemic Sclerosis in the Greek-Cypriot Population: A Pilot Study. Genet Test Mol Biomarkers 2020; 24:309-317. [PMID: 32315557 PMCID: PMC7232649 DOI: 10.1089/gtmb.2019.0255] [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] [Indexed: 11/13/2022] Open
Abstract
Background: Systemic Sclerosis (SSc), also known as scleroderma, is an autoimmune rheumatic disease, which is clinically subdivided into two major subgroups; limited (lcSSc) and diffuse cutaneous scleroderma (dcSSc). Even though the SSc etiologies remains unclear, some HLA and non-HLA genetic variants have been associated with the disease. Aim: This study was designed to evaluate the associations between several HLA-related genetic variants and SSc in the Greek-Cypriot population. Methods: Forty-one SSc patients and 164 controls were genotyped at 18 selected single nucleotide polymorphisms (SNPs) using restriction fragment length polymorphism analyses, Sanger sequencing, and a multiplex SNaPshot minisequencing assay. Logistic regression analysis under the log-additive model was used to evaluate all possible associations between these SNPs and SSc; nominal statistical significance was assumed at p < 0.05. Results: Associations of SSc with SNPs rs3117230, rs3128930, and rs3128965 within the HLA-DPB1 and HLA-DPB2 regions were observed in the Greek-Cypriot population at the level of p < 0.05. However, none of these associations survived a Bonferroni correction. The direction of the effect is consistent with the direction reported in previous studies. In addition, allele frequencies of the majority of the selected SNPs in the Greek-Cypriot population are similar to those reported in the European population. Conclusion: This study initiates the genetic investigation of SSc in the Greek-Cypriot population, a relatively small newly investigated population. Further investigation with a larger sample size and/or additional SSc susceptibility loci may confirm the association of some of these variants with SSc in the Greek-Cypriot population that could potentially be used for predictive testing.
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Affiliation(s)
- Paraskevi Chairta
- Neurogenetics Department, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Savvas Psarelis
- Rheumatology Department, Nicosia General Hospital, Nicosia, Cyprus.,Medical School, University of Cyprus, Nicosia, Cyprus
| | - Kyriaki Michailidou
- Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,Biostatistics Unit, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | | | - Sofia Symeonidou
- Rheumatology Department, Nicosia General Hospital, Nicosia, Cyprus
| | - Paschalis Nicolaou
- Neurogenetics Department, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Kyproula Christodoulou
- Neurogenetics Department, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
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14
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Bergamasco A, Hartmann N, Wallace L, Verpillat P. Epidemiology of systemic sclerosis and systemic sclerosis-associated interstitial lung disease. Clin Epidemiol 2019; 11:257-273. [PMID: 31114386 PMCID: PMC6497473 DOI: 10.2147/clep.s191418] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/21/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Interstitial lung disease (ILD) is one of the leading causes of mortality in patients with systemic sclerosis (SSc). To further understand this patient population, we present the first systematic review on the epidemiology of SSc and SSc-associated ILD (SSc-ILD). Methods: Bibliographic databases and web sources were searched for studies including patients with SSc and SSc-ILD in Europe and North America (United States and Canada). The systematic review was limited to publications in English, German, French, Spanish, Italian, and Portuguese, published between January 1, 2000 and February 29, 2016. For all publications included in the review, the methodologic quality was assessed. For each dimension and region, data availability in terms of quantity and consistency of reported findings was evaluated. Results: Fifty publications reporting epidemiologic data (prevalence, incidence, demographic profile, and survival and mortality) were included; 39 included patients with SSc and 16 included patients with SSc-ILD. The reported prevalence of SSc was 7.2–33.9 and 13.5–44.3 per 100,000 individuals in Europe and North America, respectively. Annual incidence estimates were 0.6–2.3 and 1.4–5.6 per 100,000 individuals in Europe and North America, respectively. Associated ILD was present in ~35% of the patients in Europe and ~52% of the patients in North America. In Europe, a study estimated the prevalence and annual incidence of SSc-ILD at 1.7–4.2 and 0.1–0.4 per 100,000 individuals, respectively. In both Europe and North America, SSc-ILD was diagnosed at a slightly older age than SSc, with both presentations of the disease affecting 2–3 times more women than men. Ten-year survival in patients with SSc was reported at 65–73% in Europe and 54–82% in North America, with cardiorespiratory manifestations (including ILD) associated with poor prognosis. Conclusion: This systematic review confirms that SSc and SSc-ILD are rare, with geographic variation in prevalence and incidence.
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Affiliation(s)
| | - Nadine Hartmann
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Laura Wallace
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CO, USA
| | - Patrice Verpillat
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
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15
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Al-Sheikh H, Ahmad Z, Johnson SR. Ethnic Variations in Systemic Sclerosis Disease Manifestations, Internal Organ Involvement, and Mortality. J Rheumatol 2019; 46:1103-1108. [DOI: 10.3899/jrheum.180042] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2018] [Indexed: 11/22/2022]
Abstract
Objective.A multiethnic systemic sclerosis (SSc) cohort study to evaluate ethnic variations in disease manifestations, internal organ involvement, and survival.Methods.Adults who fulfilled the American College of Rheumatology/European League Against Rheumatism classification criteria for SSc between 1970 and 2017 were included. Self-reported ethnicity was categorized as European-descent white, Afro-Caribbean, Hispanic, Arab, East Asian, South Asian, First Nations, or Persian. The primary outcome was the time from diagnosis to death from all causes. Survival probabilities and median survival times were determined using Kaplan-Meier survival curves.Results.There were 1005 subjects evaluated, the majority of whom were European-descent white (n = 745, 74%), Afro-Caribbean (n = 58, 6%), South Asian (n = 70, 7%), and East Asian (n = 80, 8%). Compared to European-descent white subjects, East Asians less frequently had calcinosis (29% vs 9%, p = 0.002) and esophageal dysmotility (88% vs 69%, p = 0.002); Afro-Caribbeans more frequently had interstitial lung disease (31% vs 53%, p = 0.007); and First Nations subjects more frequently had diffuse cutaneous disease (35% vs 56%, p = 0.02) and diabetes (5% vs 33%, p = 0.03). We found no difference in the short-term survival across ethnicities. Hispanic subjects have better longterm survival (81.3%, 95% CI 63–100) compared to European-descent white subjects (55%, 95% CI 51–60). East Asians appear to have the longest median survival time (43.3 yrs) and Arabs the shortest median survival time (15 yrs). There was no significant difference in median survival times between Afro-Caribbean and European-descent white subjects (22.2 vs 22.6 yrs).Conclusion.Ethnic variations in some SSc disease manifestations are observed. However, this does not result in significant differences in short-term survival but may affect longterm survival.
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16
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Radtke T, Hua-Huy T, Dressel H, Dinh-Xuan AT. Of the need to reconcile discrepancies between two different reference equations for combined single-breath D LNO- D LCO in systemic sclerosis. Eur Respir J 2019; 53:13993003.02109-2018. [PMID: 30655283 DOI: 10.1183/13993003.02109-2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/08/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Thomas Radtke
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | | | - Holger Dressel
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich and University Hospital Zurich, Zurich, Switzerland
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17
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Parat K, Radić M, Borić K, Perković D, Biočina Lukenda D, Martinović Kaliterna D. Association of low socioeconomic status and physician assessment of disease severity with oral health-related quality of life in patients with systemic sclerosis: a pilot study from Croatia, a country in transition. J Int Med Res 2018; 46:5127-5136. [PMID: 30213219 PMCID: PMC6300935 DOI: 10.1177/0300060518791089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective This study was performed to identify a possible association of the clinical parameters of systemic sclerosis (SSc) and the socioeconomic status (SES) with oral health-related quality of life (OHrQoL) as measured by the Oral Health Impact Profile 49 (OHIP 49), taking into account the effect of educational level (as a proxy of SES) on oral health. Methods Subjects were recruited from the Croatian SSc Center of Excellence cohort. Detailed dental and clinical examinations were performed according to standardized protocols. The associations of OHrQoL with disease characteristics and socioeconomic status were examined. Results Thirty-one consecutive patients with SSc were enrolled (29 women; mean age, 56.45 ± 13.60 years). OHIP 49 scores were significantly correlated with disease activity and severity. Furthermore, OHrQoL was positively correlated with skin involvement as evaluated by the modified Rodnan skin score. Impaired OHrQoL was positively correlated with the severity of general, skin, gastrointestinal, and joint/tendon involvement. The OHIP 49 score differed between patients who were positive and negative for anti-topoisomerase I antibody. Higher OHIP 49 scores were detected in patients with lower SES (primary school educational level). Conclusion Collaboration between rheumatologists and dental professionals is required to improve dental care and oral health outcomes of SSc.
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Affiliation(s)
- Katica Parat
- 1 Department of Oral Medicine and Periodontology, Study of Dental Medicine, School of Medicine, University of Split, Croatia
| | - Mislav Radić
- 2 Division of Rheumatology and Clinical Immunology, Center of Excellence for Systemic Sclerosis in Croatia, University Hospital Split, Split, Croatia
| | - Katarina Borić
- 2 Division of Rheumatology and Clinical Immunology, Center of Excellence for Systemic Sclerosis in Croatia, University Hospital Split, Split, Croatia
| | - Dijana Perković
- 2 Division of Rheumatology and Clinical Immunology, Center of Excellence for Systemic Sclerosis in Croatia, University Hospital Split, Split, Croatia
| | - Dolores Biočina Lukenda
- 1 Department of Oral Medicine and Periodontology, Study of Dental Medicine, School of Medicine, University of Split, Croatia
| | - Dušanka Martinović Kaliterna
- 2 Division of Rheumatology and Clinical Immunology, Center of Excellence for Systemic Sclerosis in Croatia, University Hospital Split, Split, Croatia
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18
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Royle JG, Lanyon PC, Grainge MJ, Abhishek A, Pearce FA. The incidence, prevalence, and survival of systemic sclerosis in the UK Clinical Practice Research Datalink. Clin Rheumatol 2018; 37:2103-2111. [PMID: 29961234 PMCID: PMC6061074 DOI: 10.1007/s10067-018-4182-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 05/11/2018] [Accepted: 06/17/2018] [Indexed: 11/30/2022]
Abstract
To estimate the incidence, prevalence, and survival of systemic sclerosis in the United Kingdom. We conducted a historical cohort study using data from the Clinical Practice Research Datalink (CPRD). We calculated the incidence and survival of systemic sclerosis between 1994 and 2013 and examined its association with age, sex, and socioeconomic status. We calculated point prevalence on 1 July 2013 and examined its association with the same exposures. We identified 1327 cases with incident systemic sclerosis. Annual incidence was 19.4 per million person-years between 1994 and 2013. The incidence was 4.7 times higher in women than in men, was not influenced by socioeconomic status, and has remained stable over the 20 year study period. The peak age of onset was 55-69 years. Survival at 1, 5, and 10 years was 94.2, 80.0, and 65.7%, respectively. The prevalence was 307 (290-323) per million with the highest prevalence in the 70-84 years age group. We estimate there are currently 1180 new cases of systemic sclerosis each year in the UK, and 19,390 people living with systemic sclerosis. Due to the predicted growth and aging of the population, we predict a 24% increase in incident cases and 26% increase in prevalent cases in 20 years' time. Our estimates of incidence and prevalence are higher than previously reported in the UK, but similar to recent USA and Swedish studies, and do not support a north-south gradient of the occurrence of systemic sclerosis in Europe.
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Affiliation(s)
- Jeremy G Royle
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter C Lanyon
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Matthew J Grainge
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Abhishek Abhishek
- Division of Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Fiona A Pearce
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
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19
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Chalifoux SL, Konyn PG, Choi G, Saab S. Extrahepatic Manifestations of Primary Biliary Cholangitis. Gut Liver 2018; 11:771-780. [PMID: 28292174 PMCID: PMC5669592 DOI: 10.5009/gnl16365] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 08/16/2016] [Indexed: 12/11/2022] Open
Abstract
Primary biliary cholangitis (PBC) is an autoimmune liver disease characterized by progressive destruction of the intrahepatic bile ducts, leading to cholestasis. PBC is known to have both hepatic and extrahepatic manifestations. Extrahepatic manifestations are seen in up to 73% of patients with PBC, with the most common being Sjogren’s syndrome, thyroid dysfunction and systemic sclerosis. It is thought that patients with PBC are at increased risk of developing these extrahepatic manifestations, almost all of which are autoimmune, because patients with autoimmune disease are at higher risk of developing another autoimmune condition. Due to the high prevalence of extrahepatic diseases in patients with PBC, it is important to complete a thorough medical history at the time of diagnosis. Prompt recognition of extrahepatic disease can lead to improved patient outcomes and quality of life. The following review summarizes the most common extrahepatic conditions associated with PBC.
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Affiliation(s)
- Sara L Chalifoux
- Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Peter G Konyn
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - Gina Choi
- Department of Medicine, University of California, Los Angeles, CA, USA.,Department of Surgery, University of California, Los Angeles, CA, USA
| | - Sammy Saab
- Department of Medicine, University of California, Los Angeles, CA, USA.,Department of Surgery, University of California, Los Angeles, CA, USA
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Ingegnoli F, Ughi N, Mihai C. Update on the epidemiology, risk factors, and disease outcomes of systemic sclerosis. Best Pract Res Clin Rheumatol 2018; 32:223-240. [DOI: 10.1016/j.berh.2018.08.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/22/2018] [Accepted: 07/26/2018] [Indexed: 12/12/2022]
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21
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Fischer A, Zimovetz E, Ling C, Esser D, Schoof N. Humanistic and cost burden of systemic sclerosis: A review of the literature. Autoimmun Rev 2017; 16:1147-1154. [PMID: 28899803 DOI: 10.1016/j.autrev.2017.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 08/17/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Systemic sclerosis (SSc), or systemic scleroderma, is a chronic multisystem autoimmune disease characterised by widespread vascular injury and progressive fibrosis of the skin and internal organs. Patients with SSc have decreased survival, with pulmonary involvement as the main cause of death. Current treatments for SSc manage a range of symptoms but not the cause of the disease. Our review describes the humanistic and cost burden of SSc. METHODS A structured review of the literature was conducted, using predefined search strategies to search PubMed, Embase, and the Cochrane Library. Grey literature searches also were conducted. RESULTS In total, 2226 articles were identified in the databases and 52 were included; an additional 10 sources were included from the grey literature. The review identified six studies reporting relevant cost estimates conducted in five different countries and four studies that assessed the humanistic burden of SSc. Total direct annual medical costs per patient for Europe varied from €3544 to €8452. For Canada, these costs were reported to be from Can$5038 to Can$10,673. In the United States, the total direct health care costs were reported to be US$17,365 to US$18,396. Different key drivers of direct costs were reported, including hospitalisations, outpatients, and medication. The total annual costs per patient were reported at Can$18,453 in Canada and varied from €11,074 to €22,459 in Europe. Indirect costs represented the largest component of the total costs. EQ-5D utility scores were lower for patients with SSc than those observed in the general population, with reported mean values of 0.49 and 0.68, respectively. The average value of the Health Assessment Questionnaire for patients with SSc was significantly higher than the control population (0.94), and the average value of the SF-36 was significantly lower than the control population: 49.99 for the physical dimension and 58.42 for the mental dimension. CONCLUSIONS Overall, there is a paucity of information on the burden of SSc. Nonetheless, our review indicates that the quality of life of patients with SSc is considerably lower than that of the general population. In addition, SSc places a considerable economic burden on health care systems and society as a whole.
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Affiliation(s)
- Aryeh Fischer
- University of Colorado School of Medicine, Denver, CO, USA.
| | | | | | - Dirk Esser
- Boehringer Ingelheim GmbH, Ingelheim, Germany.
| | - Nils Schoof
- Boehringer Ingelheim GmbH, Ingelheim, Germany.
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22
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Watelet B, Jeancolas J, Lanéelle D, Bienvenu B, Le Hello C. [Prevalence of macrovascular arterial involvement of the 4 limbs in systemic sclerosis: About a case series of 14 patients]. Rev Med Interne 2017; 38:430-435. [PMID: 28602440 DOI: 10.1016/j.revmed.2016.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Trophic disorders of the extremities are a common complication of systemic sclerosis (SSc), mainly related to microvascular damage. However, SSc seems to be a risk factor for premature athero-thrombotic disease that can affect the peripheral arteries, participate in the occurrence of trophic disorders and promote the occurrence of infectious complications. The objective of this study was to assess the prevalence of arterial disease of the limbs in SSc patients. METHODS Consecutive inclusions in the context of a multidisciplinary consultation centered on disability of the hand with collection of clinical data [cardiovascular risk factors (CVRF), history of trophic disorders of ischemic origin, peripheral pulse palpation, Allen maneuver the upper (UL) and lower limbs (LL)], and hemodynamic data (flow recorded by Doppler in radial, ulnar, anterior and posterior tibial arteries, and measurement of systolic indices ankles). RESULTS Fourteen patients were included (11 right-handers, 2 left-handers, 1 ambidextrous). The sex-ratio male/female was 0.27 and the average age of 58.1±10.4 years. The main CVRF were age and smoking. In the UL, 42.8% of patients had a history of trophic disorders, Allen maneuver was abnormal for 35.7% of the superficial palmar arch, 42.9% of ulnar pulse were not perceived and there was no recordable flow in 25% of ulnar artery. In the LL, 14.3% of patients had already presented trophic disorders toes, Allen maneuver was abnormal for 15.4% of the posterior tibial artery, 25.6% of posterior tibial pulse were not perceived and flow of 15.4% of posterior tibial arteries was pathological. CONCLUSION The distal macrovascular disease preferentially affecting the ulnar and posterior tibial arteries with a high frequency to the UL and two times less at LL. The pathophysiology is unclear but it could be a proper manifestation of SSc. It seems necessary that SSc patients have a strict balance of their CVRF and a screening of macrovascular arterial lesions. There is also the question of the place of an anti-atherosclerotic therapy in these patients.
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Affiliation(s)
- B Watelet
- Service de médecine vasculaire, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
| | - J Jeancolas
- Service de médecine vasculaire, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - D Lanéelle
- Service de médecine vasculaire, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - B Bienvenu
- Service de médecine interne, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - C Le Hello
- Service de médecine vasculaire, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
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Horimoto AMC, Matos ENN, Costa MRD, Takahashi F, Rezende MC, Kanomata LB, Locatelli EPP, Finotti LT, Maegawa FKM, Rondon RMR, Machado NP, Couto FMAATD, Figueiredo TPAD, Ovidio RA, Costa IPD. Incidence and prevalence of systemic sclerosis in Campo Grande, State of Mato Grosso do Sul, Brazil. REVISTA BRASILEIRA DE REUMATOLOGIA 2017; 57:107-114. [PMID: 28343614 DOI: 10.1016/j.rbre.2016.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 05/02/2016] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Systemic sclerosis is an autoimmune disease which shows extreme heterogeneity in its clinical presentation and that follows a variable and unpredictable course. Although some discrepancies in the incidence and prevalence rates between geographical regions may reflect methodological differences in the definition and verification of cases, they may also reflect true local differences. OBJECTIVES To determine the prevalence and incidence of systemic sclerosis in the city of Campo Grande, state capital of Mato Grosso do Sul (MS), Brazil, during the period from January to December 2014. METHODS All health care services of the city of Campo Grande - MS with attending in the specialty of Rheumatology were invited to participate in the study through a standardized form of clinical and socio-demographic assessment. Physicians of any specialty could report a suspected case of systemic sclerosis, but necessarily the definitive diagnosis should be established by a rheumatologist, in order to warrant the standardization of diagnostic criteria and exclusion of other diseases resembling systemic sclerosis. At the end of the study, 15 rheumatologists reported that they attended patients with systemic sclerosis and sent the completed forms containing epidemiological data of patients. RESULTS The incidence rate of systemic sclerosis in Campo Grande for the year 2014 was 11.9 per million inhabitants and the prevalence rate was 105.6 per million inhabitants. Systemic sclerosis patients were mostly women, white, with a mean age of 50.58 years, showing the limited form of the disease with a mean duration of the disease of 8.19 years. Regarding laboratory tests, 94.4% were positive for antinuclear antibody, 41.6% for anti-centromere antibody and 19.1% for anti-Scl70; anti-RNA Polymerase III was performed in 37 patients, with 16.2% positive. CONCLUSIONS The city of Campo Grande, the state capital of MS, presented a lower incidence/prevalence of systemic sclerosis in comparison with those numbers found in US studies and close to European studies' data.
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Affiliation(s)
- Alex Magno Coelho Horimoto
- Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil; Hospital Regional de Mato Grosso do Sul, Serviço de Reumatologia, Campo Grande, MS, Brazil; Universidade Federal de Mato Grosso do Sul (UFMS), Hospital Universitário, Serviço de Reumatologia, Campo Grande, MS, Brazil.
| | - Erica Naomi Naka Matos
- Universidade Federal de Mato Grosso do Sul (UFMS), Hospital Universitário, Serviço de Reumatologia, Campo Grande, MS, Brazil; Universidade de Brasília (UnB), Brasília, DF, Brazil; Prefeitura Municipal de Campo Grande, Ambulatório de Especialidades Médicas, Campo Grande, MS, Brazil
| | - Márcio Reis da Costa
- Universidade Federal de Mato Grosso do Sul (UFMS), Hospital Universitário, Serviço de Reumatologia, Campo Grande, MS, Brazil
| | - Fernanda Takahashi
- Prefeitura Municipal de Campo Grande, Ambulatório de Especialidades Médicas, Campo Grande, MS, Brazil; Universidade Anhanguera (Uniderp), Faculdade de Medicina, Ambulatório de Especialidades Médicas, Campo Grande, MS, Brazil
| | | | - Letícia Barrios Kanomata
- Caixa de Assistência aos Servidores do Mato Grosso do Sul (CASSEMS), Ambulatório de Especialidades Médicas, Coxim, MS, Brazil
| | | | - Leandro Tavares Finotti
- Universidade Federal de Mato Grosso do Sul (UFMS), Hospital Universitário, Serviço de Reumatologia, Campo Grande, MS, Brazil; Prefeitura Municipal de Campo Grande, Ambulatório de Especialidades Médicas, Campo Grande, MS, Brazil
| | | | | | - Natália Pereira Machado
- Universidade Federal de Mato Grosso do Sul (UFMS), Hospital Universitário, Serviço de Reumatologia, Campo Grande, MS, Brazil; Universidade Anhanguera (Uniderp), Faculdade de Medicina, Ambulatório de Especialidades Médicas, Campo Grande, MS, Brazil; Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | | | - Raphael Antonio Ovidio
- Universidade Federal da Grande Dourados (UFGD), Hospital Universitário, Serviço de Reumatologia, Dourados, MS, Brazil
| | - Izaias Pereira da Costa
- Universidade Federal de Mato Grosso do Sul (UFMS), Hospital Universitário, Serviço de Reumatologia, Campo Grande, MS, Brazil; Universidade de São Paulo (USP), São Paulo, SP, Brazil
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Horimoto AMC, Matos ENN, Costa MRD, Takahashi F, Rezende MC, Kanomata LB, Locatelli EPP, Finotti LT, Maegawa FKM, Rondon RMR, Machado NP, Couto FMAATD, Figueiredo TPAD, Ovidio RA, Costa IPD. Incidência e prevalência de esclerose sistêmica em Campo Grande, Estado de Mato Grosso do Sul, Brasil. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2016.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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25
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Meyer A, Chifflot H, Chatelus E, Kleinmann JF, Ronde-Ousteau C, Klein D, Jégu J, Geny B, Hirshi S, Canuet M, Blaison G, Kieffer P, Lipsker D, Martin T, Sauleau E, Velten M, Sibilia J. Brief Report: Spatial Heterogeneity of Systemic Sclerosis in France: High Prevalence in the Northeast Region. Arthritis Rheumatol 2016; 68:1731-7. [DOI: 10.1002/art.39613] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/21/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Alain Meyer
- Centre de Référence des Maladies Auto-immunes Rares, Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Hélène Chifflot
- Centre de Référence des Maladies Auto-immunes Rares, Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Emmanuel Chatelus
- Centre de Référence des Maladies Auto-immunes Rares, Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Jean-François Kleinmann
- Centre de Référence des Maladies Auto-immunes Rares, Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | | | | | | | - Bernard Geny
- Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Sandrine Hirshi
- Centre de Compétence des Maladies Pulmonaires Rares, Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Matthieu Canuet
- Centre de Compétence des Maladies Pulmonaires Rares and Centre de Compétences des Hypertensions Pulmonaires Sévères, Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Gilles Blaison
- Centre de Compétence des Maladies Auto-immunes Rares, Centre Hospitalier; Colmar France
| | | | - Dan Lipsker
- Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Thierry Martin
- Centre de Référence des Maladies Auto-immunes Rares, Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Erik Sauleau
- Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | | | - Jean Sibilia
- Centre de Référence des Maladies Auto-immunes Rares, Hôpitaux Universitaires de Strasbourg; Strasbourg France
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Abstract
Systemic sclerosis is a heterogeneous condition characterized by microvascular damage, dysregulation of the immune system, and progressive fibrosis affecting skin and internal organs. Currently, there are no approved disease-modifying therapies, and management mostly involves treatment of organ-specific complications. In recent years, major advances have greatly improved our understanding of the disease process, especially the molecular mechanisms by which fibrosis becomes self-sustaining. We discuss selected aspects of these mechanisms with a focus on those relevant to ongoing efforts to develop disease-modifying therapies. We also discuss advances in identification of patient subtypes, and selected examples of potential disease-modifying therapies in clinical development.
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Patterson KA, Roberts-Thomson PJ, Lester S, Tan JA, Hakendorf P, Rischmueller M, Zochling J, Sahhar J, Nash P, Roddy J, Hill C, Nikpour M, Stevens W, Proudman SM, Walker JG. Interpretation of an Extended Autoantibody Profile in a Well-Characterized Australian Systemic Sclerosis (Scleroderma) Cohort Using Principal Components Analysis. Arthritis Rheumatol 2016; 67:3234-44. [PMID: 26246178 DOI: 10.1002/art.39316] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/30/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To determine the relationships between systemic sclerosis (SSc)-related autoantibodies, as well as their clinical associations, in a well-characterized Australian patient cohort. METHODS Serum from 505 Australian SSc patients were analyzed with a commercial line immunoassay (EuroLine; Euroimmun) for autoantibodies to centromere proteins CENP-A and CENP-B, RNA polymerase III (RNAP III; epitopes 11 and 155), the 90-kd nucleolar protein NOR-90, fibrillarin, Th/To, PM/Scl-75, PM/Scl-100, Ku, topoisomerase I (topo I), tripartite motif-containing protein 21/Ro 52, and platelet-derived growth factor receptor. Patient subgroups were identified by hierarchical clustering of the first 2 dimensions of a principal components analysis of quantitative autoantibody scores. Results were compared with detailed clinical data. RESULTS A total of 449 of the 505 patients were positive for at least 1 autoantibody by immunoblotting. Heatmap visualization of autoantibody scores, along with principal components analysis clustering, demonstrated strong, mutually exclusive relationships between CENP, RNAP III, and topo I. Five patient clusters were identified: CENP, RNAP III strong, RNAP III weak, topo I, and other. Clinical features associated with CENP, RNAP III, and topo I were consistent with previously published reports concerning limited cutaneous and diffuse cutaneous SSc. A novel finding was the statistical separation of RNAP III into 2 clusters. Patients in the RNAP III strong cluster had an increased risk of gastric antral vascular ectasia, but a lower risk of esophageal dysmotility. Patients in the other cluster were more likely to be male and to have a history of smoking and a history of malignancy, but were less likely to have telangiectasia, Raynaud's phenomenon, and joint contractures. CONCLUSION Five major autoantibody clusters with specific clinical and serologic associations were identified in Australian SSc patients. Subclassification and disease stratification using autoantibodies may have clinical utility, particularly in early disease.
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Affiliation(s)
- K A Patterson
- Flinders University, Bedford Park, South Australia, and Commonwealth Scientific and Industrial Research Organization (CSIRO), Adelaide, South Australia, Australia
| | - P J Roberts-Thomson
- Flinders University and Flinders Medical Centre, Bedford Park, South Australia, and SA Pathology, Adelaide, South Australia, Australia
| | - S Lester
- Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - J A Tan
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - P Hakendorf
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - M Rischmueller
- University of Adelaide, Adelaide, South Australia, and Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - J Zochling
- Menzies Institute for Medical Research, Hobart, Tasmania, Australia
| | - J Sahhar
- Monash Health and Monash University, Melbourne, Victoria, Australia
| | - P Nash
- University of Queensland, Brisbane, Queensland, Australia
| | - J Roddy
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - C Hill
- University of Adelaide, Adelaide, South Australia, and Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - M Nikpour
- University of Melbourne and St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - W Stevens
- St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - S M Proudman
- University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - J G Walker
- Flinders University and Flinders Medical Centre, Bedford Park, South Australia, and Repatriation General Hospital, Daw Park, South Australia, Australia
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Simeón-Aznar CP, Fonollosa-Plá V, Tolosa-Vilella C, Espinosa-Garriga G, Campillo-Grau M, Ramos-Casals M, García-Hernández FJ, Castillo-Palma MJ, Sánchez-Román J, Callejas-Rubio JL, Ortego-Centeno N, Egurbide-Arberas MV, Trapiellla-Martínez L, Caminal-Montero L, Sáez-Comet L, Velilla-Marco J, Camps-García MT, de Ramón-Garrido E, Esteban-Marcos EM, Pallarés-Ferreres L, Navarrete-Navarrete N, Vargas-Hitos JA, Torre RGDL, Salvador-Cervello G, Rios-Blanco JJ, Vilardell-Tarrés M. Registry of the Spanish Network for Systemic Sclerosis: Survival, Prognostic Factors, and Causes of Death. Medicine (Baltimore) 2015; 94:e1728. [PMID: 26512564 PMCID: PMC4985378 DOI: 10.1097/md.0000000000001728] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Systemic sclerosis (SSc) is a rare, multisystem disease showing a large individual variability in disease progression and prognosis. In the present study, we assess survival, causes of death, and risk factors of mortality in a large series of Spanish SSc patients. Consecutive SSc patients fulfilling criteria of the classification by LeRoy were recruited in the survey. Kaplan-Meier and Cox proportional-hazards models were used to analyze survival and to identify predictors of mortality. Among 879 consecutive patients, 138 (15.7%) deaths were registered. Seventy-six out of 138 (55%) deceased patients were due to causes attributed to SSc, and pulmonary hypertension (PH) was the leading cause in 23 (16.6%) patients. Survival rates were 96%, 93%, 83%, and 73% at 5, 10, 20, and 30 years after the first symptom, respectively. Survival rates for diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc were 91%, 86%, 64%, and 39%; and 97%, 95%, 85%, and 81% at 5, 10, 20, and 30 years, respectively (log-rank: 67.63, P < 0.0001). The dcSSc subset, male sex, age at disease onset older than 65 years, digital ulcers, interstitial lung disease (ILD), PH, heart involvement, scleroderma renal crisis (SRC), presence of antitopoisomerase I and absence of anticentromere antibodies, and active capillaroscopic pattern showed reduced survival rate. In a multivariate analysis, older age at disease onset, dcSSc, ILD, PH, and SRC were independent risk factors for mortality. In the present study involving a large cohort of SSc patients, a high prevalence of disease-related causes of death was demonstrated. Older age at disease onset, dcSSc, ILD, PH, and SRC were identified as independent prognostic factors.
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Affiliation(s)
- C P Simeón-Aznar
- From the Department of Internal Medicine, Hospital Valld'Hebron (CPS-A, VF-P, MV-T); Department of Internal Medicine, Hospital Parc Taulí, Sabadell (CT-V); Department of Autoimmune Diseases, Hospital Clinic (GE-G, MR-C); Laboratori of Computacional Medicine, Bioestatistics Unit, Universitat Autònoma de Barcelona, Bellaterra, Barcelona (MC-G); Unit of Connective Tissue Diseases, Department of Internal Medicine, Hospital Virgen del Rocio, Sevilla (FJG-H, MJC-P, JS-R); Unit of Autoimmune Systemic Diseases, Department of Internal Medicine, Hospital Clínico San Cecilio, Granada (JLC-R, NO-C); Department of Internal Medicine, Hospital de Cruces, Galdakano, Bilbao (MVE-A); Department of Internal Medicine, Hospital de Cabueñes, Gijón (LT-M); Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo (LC-M); Department of Internal Medicine, Hospital Miguel Servet, Zaragoza (LS-C, JV-M); Department of Internal Medicine, Hospital Carlos Haya, Málaga (MTC-G, ER-G); Department of Internal Medicine, Hospital Son Espases, Palma de Mallorca (EME-M, LP-F); Department of Internal Medicine, Hospital Virgen de las Nieves, Granada (NN-N, JAV-H); Department of Internal Medicine, Hospital San Agustín, Avilés (RGT); Department of Internal Medicine, Hospital La Fe, Valencia (GS-C); and Department of Internal Medicine, Hospital La Paz, Madrid (JJR-B), Systemic Autoimmune Diseases Group (GEAS), Spanish Scleroderma Study Group (SSSG), Spanish Society of Internal Medicine, Spain
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Population-based analysis of hospitalizations for patients with systemic sclerosis in a West-European region over the period 2001–2012. Rheumatol Int 2015. [DOI: 10.1007/s00296-015-3330-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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D'Amico F, Skarmoutsou E, Mazzarino MC. The sex bias in systemic sclerosis: on the possible mechanisms underlying the female disease preponderance. Clin Rev Allergy Immunol 2015; 47:334-43. [PMID: 24126759 DOI: 10.1007/s12016-013-8392-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Systemic sclerosis is a multifactorial and heterogeneous disease. Genetic and environmental factors are known to interplay in the onset and progression of systemic sclerosis. Sex plays an important and determinant role in the development of such a disorder. Systemic sclerosis shows a significant female preponderance. However, the reason for this female preponderance is incompletely understood. Hormonal status, genetic and epigenetic differences, and lifestyle have been considered in order to explain female preponderance in systemic sclerosis. Sex chromosomes play a determinant role in contributing to systemic sclerosis onset and progression, as well as in its sex-biased prevalence. It is known, in fact, that X chromosome contains many sex- and immuno-related genes, thus contributing to immuno tolerance and sex hormone status. This review focuses mainly on the recent progress on epigenetic mechanisms--exclusively linked to the X chromosome--which would contribute to the development of systemic sclerosis. Furthermore, we report also some hypotheses (dealing with skewed X chromosome inactivation, X gene reactivation, acquired monosomy) that have been proposed in order to justify the female preponderance in autoimmune diseases. However, despite the intensive efforts in elucidating the mechanisms involved in the pathogenesis of systemic sclerosis, many questions remain still unanswered.
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Affiliation(s)
- Fabio D'Amico
- Department of Bio-medical Sciences, University of Catania, via Androne 83, 95124, Catania, Italy,
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Mayes MD, Assassi S. Classification and epidemiology of scleroderma. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00140-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Chevreul K, Brigham KB, Gandré C, Mouthon L. The economic burden and health-related quality of life associated with systemic sclerosis in France. Scand J Rheumatol 2014; 44:238-46. [PMID: 25521915 DOI: 10.3109/03009742.2014.976653] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To provide data on the economic burden and health-related quality of life (HRQoL) associated with systemic sclerosis (SSc) in France and to raise awareness of the repercussions of this disease for patients and caregivers and on the health and social care system. METHOD A cross-sectional study was carried out on 147 patients recruited through the Association des Sclérodermiques de France (ASF), the French association for SSc patients. Data on the patients' use of resources were obtained retrospectively from an online questionnaire and costs were estimated by a bottom-up approach. The HRQoL patients and caregivers was assessed with the five-level EURQol-5 Dimension (EQ-5D-5L) health questionnaire. RESULTS The average annual cost of SSc was estimated at EUR 22,459 per patient. Direct healthcare costs amounted to EUR 8452, direct non-healthcare formal costs to EUR 1606, direct non-healthcare informal costs to EUR 1875, and indirect costs resulting from patients' absence from the labour market to EUR 10,526. The main contributors to SSc costs were hospitalizations and early retirement. Mean EQ-5D utility scores were 0.49 for patients and 0.66 for caregivers. CONCLUSIONS Although SSc is a rare disease, its economic burden from a societal perspective is substantial and the consequences for HRQoL are significant for both patients and caregivers in France, underscoring the need to develop tailored policies targeted at improving patients' care and reducing the long-term impact of SSc.
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Affiliation(s)
- K Chevreul
- Paris Diderot University, Sorbonne Paris Cité, ECEVE, UMRS 1123 , Paris , France
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La crise rénale sclérodermique. MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-014-0929-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hoffmann-Vold AM, Gunnarsson R, Garen T, Midtvedt Ø, Molberg Ø. Performance of the 2013 American College of Rheumatology/European League Against Rheumatism Classification Criteria for Systemic Sclerosis (SSc) in large, well-defined cohorts of SSc and mixed connective tissue disease. J Rheumatol 2014; 42:60-3. [PMID: 25274890 DOI: 10.3899/jrheum.140047] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the 2013 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Classification Criteria for Systemic Sclerosis (SSc) on defined subgroups of SSc and in mixed connective tissue disease (MCTD) as an SSc-related disease. METHODS The 2013 ACR/EULAR criteria were assessed in 425 consecutive patients suspected to have SSc and seen at Oslo University Hospital, and in the nationwide Norwegian MCTD cohort (n = 178). In the SSc group, 239/425 patients had disease duration < 3 years (in 82 of these, duration was < 1 yr). Patients were subgrouped as limited SSc (n = 294), diffuse SSc (n = 97), SSc sine scleroderma (n = 10), and early SSc (prescleroderma; n = 24). Item data were complete, except nailfold capillaroscopy and telangiectasia results, missing in the MCTD cohort. RESULTS The 2013 ACR/EULAR SSc criteria were met by 409/425 patients (96%) in the SSc group. For comparison, only 75% (293/391) met the 1980 ACR SSc classification criteria. All the novel items in the 2013 ACR/EULAR criteria were frequent in the SSc cohort. Considering that there were missing data on 2 items, 10% (18/178) of the MCTD cohort met the 2013 ACR/EULAR criteria, giving an estimated specificity of 90% toward this SSc-like disorder. CONCLUSION In our large and representative group of consecutive patients with SSc, the 2013 ACR/EULAR SSc criteria were more sensitive than the ACR 1980 criteria. However, the new criteria did not completely segregate SSc from MCTD, making specificity a potential issue.
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Affiliation(s)
- Anna-Maria Hoffmann-Vold
- From the Department of Rheumatology, Oslo University Hospital-Rikshospitalet; and the Institute of Clinical Medicine, University of Oslo, Oslo, Norway.A-M. Hoffmann-Vold, Dr. med; R. Gunnarsson, Dr. med, Department of Rheumatology, Oslo University Hospital-Rikshospitalet and Institute of Clinical Medicine, University of Oslo; T. Garen; Ø. Midtvedt, MD, Department of Rheumatology, Oslo University Hospital-Rikshospitalet; Ø. Molberg, MD, Professor of Medicine, Department of Rheumatology, Oslo University Hospital-Rikshospitalet, and Institute of Clinical Medicine, University of Oslo.
| | - Ragnar Gunnarsson
- From the Department of Rheumatology, Oslo University Hospital-Rikshospitalet; and the Institute of Clinical Medicine, University of Oslo, Oslo, Norway.A-M. Hoffmann-Vold, Dr. med; R. Gunnarsson, Dr. med, Department of Rheumatology, Oslo University Hospital-Rikshospitalet and Institute of Clinical Medicine, University of Oslo; T. Garen; Ø. Midtvedt, MD, Department of Rheumatology, Oslo University Hospital-Rikshospitalet; Ø. Molberg, MD, Professor of Medicine, Department of Rheumatology, Oslo University Hospital-Rikshospitalet, and Institute of Clinical Medicine, University of Oslo
| | - Torhild Garen
- From the Department of Rheumatology, Oslo University Hospital-Rikshospitalet; and the Institute of Clinical Medicine, University of Oslo, Oslo, Norway.A-M. Hoffmann-Vold, Dr. med; R. Gunnarsson, Dr. med, Department of Rheumatology, Oslo University Hospital-Rikshospitalet and Institute of Clinical Medicine, University of Oslo; T. Garen; Ø. Midtvedt, MD, Department of Rheumatology, Oslo University Hospital-Rikshospitalet; Ø. Molberg, MD, Professor of Medicine, Department of Rheumatology, Oslo University Hospital-Rikshospitalet, and Institute of Clinical Medicine, University of Oslo
| | - Øyvind Midtvedt
- From the Department of Rheumatology, Oslo University Hospital-Rikshospitalet; and the Institute of Clinical Medicine, University of Oslo, Oslo, Norway.A-M. Hoffmann-Vold, Dr. med; R. Gunnarsson, Dr. med, Department of Rheumatology, Oslo University Hospital-Rikshospitalet and Institute of Clinical Medicine, University of Oslo; T. Garen; Ø. Midtvedt, MD, Department of Rheumatology, Oslo University Hospital-Rikshospitalet; Ø. Molberg, MD, Professor of Medicine, Department of Rheumatology, Oslo University Hospital-Rikshospitalet, and Institute of Clinical Medicine, University of Oslo
| | - Øyvind Molberg
- From the Department of Rheumatology, Oslo University Hospital-Rikshospitalet; and the Institute of Clinical Medicine, University of Oslo, Oslo, Norway.A-M. Hoffmann-Vold, Dr. med; R. Gunnarsson, Dr. med, Department of Rheumatology, Oslo University Hospital-Rikshospitalet and Institute of Clinical Medicine, University of Oslo; T. Garen; Ø. Midtvedt, MD, Department of Rheumatology, Oslo University Hospital-Rikshospitalet; Ø. Molberg, MD, Professor of Medicine, Department of Rheumatology, Oslo University Hospital-Rikshospitalet, and Institute of Clinical Medicine, University of Oslo
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Dumoitier N, Lofek S, Mouthon L. Pathophysiology of systemic sclerosis: state of the art in 2014. Presse Med 2014; 43:e267-78. [PMID: 25179277 DOI: 10.1016/j.lpm.2014.08.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 08/05/2014] [Indexed: 02/06/2023] Open
Abstract
Major work has been done in order to improve the understanding of systemic sclerosis (SSc) pathogenesis. A number of new experimental models have been set up, that should help to understand the disease pathogenesis and test new therapeutic targets. Reactive oxygen species represent a hallmark of the pathogenesis of SSc, both at the fibroblast and at the endothelial cell levels. Although a large number of genetic studies have been conducted, it is still difficult to identify a genetic background specific to SSc, and the major progress in this setting is probably the identification of an interferon signature. Besides endothelial cells and fibroblasts, major development has been made in the understanding of the role of B cells and autoantibodies in the pathogenesis of SSc. Plasmacytoid dendritic cells seem to play a major role in the pathogenesis of SSc through the secretion of CXCL4, although these data will need to be confirmed in the near future.
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Affiliation(s)
- Nicolas Dumoitier
- Institut Cochin, Inserm U1016, CNRS UMR 8104, 8, rue Méchain, 75014 Paris, France; Université Paris Diderot, 75013 Paris, France
| | - Sébastien Lofek
- Institut Cochin, Inserm U1016, CNRS UMR 8104, 8, rue Méchain, 75014 Paris, France
| | - Luc Mouthon
- Institut Cochin, Inserm U1016, CNRS UMR 8104, 8, rue Méchain, 75014 Paris, France; Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Cochin, centre de référence pour les vascularites nécrosantes et la sclérodermie systémique, service de médecine interne, Université Paris Descartes, 75014 Paris, France.
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Abstract
Scleroderma renal crisis (SRC) is characterized by malignant hypertension and oligo-anuric acute renal failure. It occurs in 5% of patients with systemic sclerosis (SSc), particularly in patients with diffuse disease during the first years. SRC is more common in patients receiving corticosteroids, the risk increasing with increasing dose. The disease is sometimes triggered by use of nephrotoxic drugs and/or intravascular volume depletion. Left ventricular insufficiency and hypertensive encephalopathy are typical clinical features. Thrombotic microangiopathy is detected in 43% of cases, and anti-RNA-polymerase III antibodies are present in one-third of patients. Renal biopsy is not necessary if SRC presents classical features. However, biopsy may help to define the prognosis and guide treatment in atypical forms. The prognosis of SRC has greatly improved with the introduction of angiotensin-converting enzyme (ACE) inhibitors. However, the 5-year survival for SSc patients with full SRC remains low (65%). The treatment of SRC relies on aggressive blood pressure control with an ACE inhibitor, combined with other antihypertensive drugs if needed. Dialysis is frequently indicated but can be stopped in about half of patients, mainly those with good blood pressure control. Patients who need dialysis for more than 2 years qualify for renal transplantation.
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Affiliation(s)
- Luc Mouthon
- From the Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP); Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes; Université Paris Descartes, Faculté de Médecine Paris Descartes, Service d'Anatomopathologie, and Service de néphrologie, hôpital Necker, AP-HP, Paris, France.L. Mouthon, MD, PhD; G. Bussone, MD, PhD; A. Berezné, MD, Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, AP-HP, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes; L-H. Noël, MD, Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes, and Faculté de Médecine Paris Descartes, Service d'Anatomopathologie, and Service de néphrologie, hôpital Necker, AP-HP; L. Guillevin, MD, Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, AP-HP, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes.
| | - Guillaume Bussone
- From the Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP); Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes; Université Paris Descartes, Faculté de Médecine Paris Descartes, Service d'Anatomopathologie, and Service de néphrologie, hôpital Necker, AP-HP, Paris, France.L. Mouthon, MD, PhD; G. Bussone, MD, PhD; A. Berezné, MD, Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, AP-HP, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes; L-H. Noël, MD, Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes, and Faculté de Médecine Paris Descartes, Service d'Anatomopathologie, and Service de néphrologie, hôpital Necker, AP-HP; L. Guillevin, MD, Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, AP-HP, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes
| | - Alice Berezné
- From the Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP); Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes; Université Paris Descartes, Faculté de Médecine Paris Descartes, Service d'Anatomopathologie, and Service de néphrologie, hôpital Necker, AP-HP, Paris, France.L. Mouthon, MD, PhD; G. Bussone, MD, PhD; A. Berezné, MD, Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, AP-HP, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes; L-H. Noël, MD, Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes, and Faculté de Médecine Paris Descartes, Service d'Anatomopathologie, and Service de néphrologie, hôpital Necker, AP-HP; L. Guillevin, MD, Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, AP-HP, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes
| | - Laure-Hélène Noël
- From the Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP); Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes; Université Paris Descartes, Faculté de Médecine Paris Descartes, Service d'Anatomopathologie, and Service de néphrologie, hôpital Necker, AP-HP, Paris, France.L. Mouthon, MD, PhD; G. Bussone, MD, PhD; A. Berezné, MD, Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, AP-HP, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes; L-H. Noël, MD, Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes, and Faculté de Médecine Paris Descartes, Service d'Anatomopathologie, and Service de néphrologie, hôpital Necker, AP-HP; L. Guillevin, MD, Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, AP-HP, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes
| | - Loïc Guillevin
- From the Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP); Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes; Université Paris Descartes, Faculté de Médecine Paris Descartes, Service d'Anatomopathologie, and Service de néphrologie, hôpital Necker, AP-HP, Paris, France.L. Mouthon, MD, PhD; G. Bussone, MD, PhD; A. Berezné, MD, Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, AP-HP, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes; L-H. Noël, MD, Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes, and Faculté de Médecine Paris Descartes, Service d'Anatomopathologie, and Service de néphrologie, hôpital Necker, AP-HP; L. Guillevin, MD, Université Paris Descartes, Service de Médecine Interne, Centre de Référence pour les vascularites nécrosantes et la sclérodermie systémique, hôpital Cochin, AP-HP, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Université Paris Descartes
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Hao YJ, Jiang X, Zhou W, Wang Y, Gao L, Wang Y, Li GT, Hong T, Huo Y, Jing ZC, Zhang ZL. Connective tissue disease-associated pulmonary arterial hypertension in Chinese patients. Eur Respir J 2014; 44:963-72. [DOI: 10.1183/09031936.00182813] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We sought to investigate the characteristics, survival and risk factors for mortality in Chinese patients with connective tissue disease (CTD)-associated pulmonary arterial hypertension (APAH) in modern therapy era.129 consecutive adult patients who visited one of three referral centres in China with a diagnosis of CTD-APAH confirmed by right heart catheterisation during the previous 5 years were enrolled. The end-point was all-cause death or data censoring.Systemic lupus erythematosus was the most common underlying CTD (49%) and systemic sclerosis just accounted for 6% in this cohort. The overall survival at 1 and 3 years was 92% and 80%, respectively. Pericardial effusion, a shorter 6-min walk distance, lower mixed venous oxygen saturation, higher pulmonary vascular resistance (PVR) and alkaline phosphatase (ALP), and lower total cholesterol levels were all associated with a higher risk of death among the study population. Higher PVR and ALP were independent predictors of mortality.In conclusion, unlike in western patients, systemic lupus erythematosus is the most common underlying disease in Chinese patients with CTD-APAH. The survival of Chinese patients with CTD-APAH in the modern treatment era is similar to that in western countries. Elevated PVR and ALP are independent risk factors for poor outcomes.
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Maldini C, Seror R, Fain O, Dhote R, Amoura Z, De Bandt M, Delassus JL, Falgarone G, Guillevin L, Le Guern V, Lhote F, Meyer O, Ramanoelina J, Sacré K, Uzunhan Y, Leroux JL, Mariette X, Mahr A. Epidemiology of primary Sjögren's syndrome in a French multiracial/multiethnic area. Arthritis Care Res (Hoboken) 2014; 66:454-63. [PMID: 23983119 DOI: 10.1002/acr.22115] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 08/07/2013] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To describe the epidemiology of primary Sjögren's syndrome (SS) in a multiracial/multiethnic population. METHODS A cross-sectional study with 5 case-retrieval sources identified adults with primary SS living in the Greater Paris area (population 1,172,482 adults) in 2007. Diagnoses were verified by the American-European Consensus Group (AECG) criteria and study-specific enlarged criteria based on the presence of ≥3 of 4 AECG items among subjective oral or ocular dryness, anti-SSA/SSB positivity, and positive minor salivary gland biopsy results. Prevalence estimates were standardized to those for the world population and a 5-source capture-recapture analysis (CRA) was used. Racial/ethnic differences in primary SS features were evaluated. RESULTS In all, 133 subjects met the AECG criteria and 203 met the enlarged criteria. The 2007 prevalence of primary SS was 1.02 cases per 10,000 adults (95% confidence interval [95% CI] 0.85-1.22) for the AECG criteria and 1.52 cases per 10,000 adults (95% CI 1.30-1.76) for the enlarged criteria. The CRA indicated completeness of case findings of ∼90%. Compared to subjects with European backgrounds, those with non-European backgrounds had 2.1-2.3 times higher primary SS prevalence and were younger (P < 0.0001) and were more likely to have polyclonal hypergammaglobulinemia (P < 0.0001) and anti-SSA/SSB antibodies (P = 0.0005 and P < 0.0001 for the AECG and enlarged criteria, respectively). CONCLUSION The figure of 1.02–1.52 cases per 10,000 adults we found and estimates from the few other population-based census surveys support that the prevalence of diagnosed primary SS is between 1 and 9 cases per 10,000 (0.01-0.09%) [corrected] in the general population. Non-European race/ethnicity may be associated with increased primary SS risk and a distinct disease profile.
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Affiliation(s)
- Carla Maldini
- Hôpital Saint-Louis, Université Paris 7-Paris Diderot, Paris, France
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Liberal R, Grant CR, Sakkas L, Bizzaro N, Bogdanos DP. Diagnostic and clinical significance of anti-centromere antibodies in primary biliary cirrhosis. Clin Res Hepatol Gastroenterol 2013; 37:572-85. [PMID: 23876351 DOI: 10.1016/j.clinre.2013.04.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 03/31/2013] [Accepted: 04/23/2013] [Indexed: 02/04/2023]
Abstract
Primary biliary cirrhosis (PBC) is an autoimmune disease of the liver characterised by biochemical evidence of cholestasis, elevated alkaline phosphatase levels and the presence of the highly disease specific anti-mitochondrial autoantibodies. Extra-hepatic autoimmune manifestations are common, including rheumatic disorders, such as systemic sclerosis (SSc). Notably, PBC is the most frequent autoimmune liver disease in SSc patients. Based on skin lesion extension, two major SSc disease subgroups are recognised: limited cutaneous SSc (lSSc) and diffuse cutaneous SSc. Anti-centromere antibody (ACA) positivity is highly characteristic of SSc, with up to 90% prevalence in lSSc patients. ACA has also been found in up to 30% of PBC patients and 80% of patients with a PBC/SSc overlap syndrome. The diagnostic and clinical significance of ACA positivity in patients with PBC without SSc has recently been under investigation, with several studies highlighting links to severe bile duct injury and portal hypertension. This review discusses the diagnostic and clinical relevance of ACA in patients with PBC, with or without SSc.
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Affiliation(s)
- Rodrigo Liberal
- Institute of Liver Studies, King's College London School of Medicine at King's College Hospital, Denmark Hill Campus, London SE5 9RS, UK; Faculty of Medicine, University of Porto, Porto, Portugal.
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Mouthon L. L’atteinte de la main dans la sclérodermie systémique. Presse Med 2013; 42:1616-26. [DOI: 10.1016/j.lpm.2013.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 10/22/2013] [Indexed: 12/01/2022] Open
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Andréasson K, Saxne T, Bergknut C, Hesselstrand R, Englund M. Prevalence and incidence of systemic sclerosis in southern Sweden: population-based data with case ascertainment using the 1980 ARA criteria and the proposed ACR-EULAR classification criteria. Ann Rheum Dis 2013; 73:1788-92. [PMID: 23897770 DOI: 10.1136/annrheumdis-2013-203618] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To estimate the prevalence and incidence of systemic sclerosis (SSc) in southern Sweden. METHODS In Skåne, the southernmost region of Sweden (total population 1.2 million), healthcare provided is registered in the Skåne Healthcare Register. We identified all Skåne residents who had received an International Classification of Diseases 10 diagnosis of SSc (M34) or Raynaud's phenomenon (I73.0) between 1998 and 2010. Every single case was ascertained by review of medical records in reference to the 1980 American Rheumatism Association preliminary classification criteria for SSc and the proposed American College of Rheumatology (ACR)-European League Against Rheumatism (EULAR) classification criteria presented at the ACR/Association of Rheumatology Health Professionals Annual Meeting 2012. We calculated the point prevalence by the end of 2010 by linkage with the population register to exclude deceased persons and we also estimated the mean annual cumulative incidence for 2006-2010. RESULTS Using the 1980 ARA criteria, the adult prevalence and annual incidence of SSc in the Skåne region were 235 and 14 per 1 million inhabitants respectively. Applying the proposed ACR-EULAR criteria, the corresponding figures were 305 and 19 per 1 million inhabitants. A majority (82%) of the prevalent cases had the limited cutaneous SSc subtype. CONCLUSIONS The prevalence and incidence of SSc in southern Sweden, based on the 1980 ARA criteria, are higher than previously reported in northern Europe and do not support the concept of a north-south gradient of SSc occurrence in Europe. Application of the proposed ACR-EULAR classification criteria in this population results in about 30-40% higher estimates of SSc prevalence and incidence compared to the 1980 ARA criteria.
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Affiliation(s)
- K Andréasson
- Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden
| | - T Saxne
- Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden
| | - C Bergknut
- Epi-centre Skåne, Skåne University Hospital, Lund, Sweden Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - R Hesselstrand
- Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden
| | - M Englund
- Epi-centre Skåne, Skåne University Hospital, Lund, Sweden Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden Clinical Epidemiology Research and Training Unit, Boston University, Boston, Massachusetts, USA
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El Adssi H, Cirstea D, Virion JM, Guillemin F, de Korwin JD. Estimating the prevalence of systemic sclerosis in the Lorraine region, France, by the capture-recapture method. Semin Arthritis Rheum 2013; 42:530-8. [PMID: 23290691 DOI: 10.1016/j.semarthrit.2012.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 10/04/2012] [Accepted: 10/09/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the prevalence of systemic sclerosis (SSc) in the Lorraine region, France. METHODS Data from three sources - general practitioners and community and hospital specialists, medical records departments, and regional and national laboratories-and a capture-recapture method with log-linear models were used to estimate SSc prevalence in the region. Double recording was checked, and reported cases were validated after a review of medical records. RESULTS We identified 560 records of suspected SSc cases corresponding to 327 unique suspected SSc cases existing on June 30, 2006, in Lorraine. On the basis of the 193 validated cases (22 [11.4%] with diffuse disease, 136 [70.5%] with limited disease, 31 [16.1%] with limited involvement and 4 unknown), the observed overall crude prevalence of SSc was 105.4 cases per million adult inhabitants (95% confidence interval [CI]: 91.0; 121.4). With the capture-recapture method, the estimated number of SSc cases was 233 (95% CI: 217.3; 260.0), so an estimated 40 cases were not identified by the three sources. The estimated overall prevalence was 132.2 cases per million adult inhabitants (95% CI: 115.8; 154.0). CONCLUSIONS Our study provides the first estimate of SSc prevalence in the Lorraine region. The capture-recapture method allowed us to estimate an additional 21% of unobserved cases and is a good alternative to the community-based study design for estimating the prevalence of rare diseases.
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Affiliation(s)
- Haritina El Adssi
- Nancy University Hospital-Clinical Epidemiology and Evaluation, Nancy, France
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Jeon CH, Chai JY, Seo YI, Jun JB, Koh EM, Lee SK. Pulmonary hypertension associated with rheumatic diseases: baseline characteristics from the Korean registry. Int J Rheum Dis 2012; 15:e80-9. [PMID: 23083052 DOI: 10.1111/j.1756-185x.2012.01815.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The REgistry of Pulmonary Hypertension Associated with Rheumatic Disease (REOPARD) was established in Korea. The baseline data are described from the second year of the registry's operation. METHODS Patients with a connective tissue disease (CTD) who met the modified definition of the WHO group I pulmonary arterial hypertension (PAH) were enrolled. PAH was defined as a systolic pulmonary arterial pressure> 40 mmHg by echocardiography or mean pulmonary arterial pressure> 25 mmHg by right heart catheterization. Hemodynamic parameters and clinical data such as demographics, functional class, underlying disease, organ involvement, laboratory tests and current treatment were recorded. RESULTS A total of 321 patients were enrolled during the 2-year study period from 2008 to 2010. The mean age of the patients at registration was 51.9 years and 87.5% were female. Most patients were diagnosed by echocardiography and only 24 patients (7.5%) underwent cardiac catheterization. Exertional dyspnea was present in 63.6% of patients and 31.8% were New York Heart Association class III or IV. Among the patients, systemic lupus erythematosus accounted for 35.3%, systemic sclerosis 28.3%, rheumatoid arthritis 7.8%, overlap syndrome 9.0%, and mixed connective tissue disease 5.9%. There were no significant differences in hemodynamics, functional class, diffusing capacity and N-terminal pro-brain natriuretic peptide levels between the disease subgroups. Treatments consisted of calcium antagonists (57.0%), endothelin antagonists (32.7%), prostanoids (27.1%), phosphodiesterase-5 inhibitors (14.3%) and combinations (37.4%). CONCLUSION Compared with previous studies, the results showed some differences: underlying diseases, functional status and treatments. This may be due to differences in ethnic background and diagnostic methods of our study.
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Affiliation(s)
- Chan Hong Jeon
- Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Bucheon, Gyeonggi-do, Korea
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VANTHUYNE MARIE, SMITH VANESSA, DE LANGHE ELLEN, VAN PRAET JENS, ARAT SEHER, DEPRESSEUX GENEVIÈVE, WESTHOVENS RENE, BLOCKMANS DANIEL, BADOT VALÉRIE, COGAN ELIE, DE KEYSER FILIP, HOUSSIAU FRÉDÉRICA. The Belgian Systemic Sclerosis Cohort: Correlations Between Disease Severity Scores, Cutaneous Subsets, and Autoantibody Profile. J Rheumatol 2012; 39:2127-33. [DOI: 10.3899/jrheum.120283] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To report baseline and followup data on the first 438 patients with systemic sclerosis (SSc) included in the Belgian Systemic Sclerosis Cohort.Methods.According to LeRoy and Medsger’s classification, 73 patients with limited SSc (lSSc), 279 with limited cutaneous SSc (lcSSc), and 86 with diffuse cutaneous SSc (dcSSc) were included. History was collected and clinical examination, blood tests, and paraclinical investigations were repeated. The Disease Activity Score (DAS) and Disease Severity Score (DSS) of several organ systems were computed. An organ system was considered to demonstrate SSc if the corresponding DSS was ≥ 1.Results.At baseline, patients with dcSSc had more general, joint/tendon, muscle, gastrointestinal, and kidney involvement. Mean DLCO was below normal in patients with lSSc, indicating unsuspected lung involvement. Patients with anti-Scl-70 had more vascular, skin, joint/tendon, and lung involvement. Patients with anti-RNA polymerase III had more skin and joint/tendon involvement compared to patients with anticentromere. Time to death was statistically shorter for patients with dcSSc. New-onset lung disease was the most common complication over time. No changes in DAS were observed. By contrast, the general and the skin DSS worsened in patients with lcSSc and lSSc, respectively. Fifteen percent of patients with lSSc shifted to lcSSc at Month 30, but neither serology nor capillaroscopy findings at baseline were helpful in identifying those at risk.Conclusion.Our data indicate that the DSS can be used to define organ involvement in SSc. Differences can be seen between subsets classified not only according to cutaneous subtypes but also to autoantibody profile.
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Epidemiology of systemic sclerosis: incidence, prevalence, survival, risk factors, malignancy, and environmental triggers. Curr Opin Rheumatol 2012; 24:165-70. [PMID: 22269658 DOI: 10.1097/bor.0b013e32834ff2e8] [Citation(s) in RCA: 199] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW To identify the recent data regarding prevalence, incidence, survival, and risk factors for systemic sclerosis (SSc) and to compare these data to previously published findings. RECENT FINDINGS SSc disease occurrence data are now available for Argentina, Taiwan, and India and continue to show wide variation across geographic regions. The survival rate is negatively impacted by older age of onset, male sex, scleroderma renal crisis, pulmonary fibrosis, pulmonary arterial hypertension, cancer, and antitopoisomerase and anti-U1 antibodies. It appears that silica exposure confers an increased risk for developing scleroderma, but this exposure accounts for a very small proportion of male patients. Smoking is not associated with increased SSc susceptibility. Malignancies are reported in scleroderma at an increased rate, but the magnitude of this risk and the type of cancer vary among reports. SUMMARY Prevalence and incidence of SSc appears to be greater in populations of European ancestry and lower in Asian groups. Exposure to silica dust appears to be an environmental trigger, but this only accounts for a small proportion of male cases. Evidence for increased risk of neoplasia is suggestive, but the magnitude of the risk and the types of malignancies vary among reports.
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Abstract
PURPOSE Producing descriptive epidemiology data is essential to understand the burden of rheumatic diseases (prevalence) and their dynamic in the population (incidence). IMPORTANT CONSIDERATIONS No matter how simple such indicators may look, the correct collection of data and the appropriate interpretation of the results face several challenges: distinguishing indicators, facing the costs of obtaining data, using appropriate definition, identifying optimal sources of data, choosing among many survey methods, dealing with estimates precision, and standardizing results. SUMMARY This study describes the underlying methodological difficulties to be overcome so as to make descriptive indicators reliable and interpretable.
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Hoffmann-Vold AM, Midtvedt Ø, Molberg Ø, Garen T, Gran JT. Prevalence of systemic sclerosis in south-east Norway. Rheumatology (Oxford) 2012; 51:1600-5. [PMID: 22539477 DOI: 10.1093/rheumatology/kes076] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the prevalence of SSc in south-east Norway. METHODS The survey was conducted in south-east Norway with a denominator population of 2,707,012, 56% of the total Norwegian population. All SSc patients living in the study area between 1 January 1999 and 31 December 2009 were included. Patients were identified by five overlapping acquisition routes, including all the rheumatology departments, private rheumatologists and the dermatology department in the study area. Only cases meeting the 1980 ACR and/or the Medsger and LeRoy classification criteria were included. The patients were assigned to three clinical subsets: limited SSc, lcSSc or dcSSc. RESULTS At the end of the study period, a total of 269 patients fulfilled the ACR and/or the Medsger and LeRoy SSc criteria, giving a point prevalence of 9.9/100,000 (95% CI 8.8, 11.2). The estimated prevalences of lSSc, lcSSc and dcSSc were 1.3/100,000, 6.9/100,000 and 1.8/100,000 (95% CIs 0.9, 1.8; 5.8, 7.8; 1.4, 2.5), respectively. The mean age at onset was 47 years and the female:male ratio was 3.8:1. The prevalence estimates of SSc in the 10 different counties in south-east Norway varied between 5.2 and 14.4/100,000 (95% CIs 2.8, 8.8; 10.3, 19.6). CONCLUSION This study establishes baseline estimates of the occurrence and disease characteristics in a large, unselected group of Norwegian SSc patients. Our data suggest that the prevalence of SSc in Norway is comparable with other northern European countries, supporting the notion of a north-south gradient of SSc in Europe with the lowest prevalence in northern Europe.
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Sardu C, Cocco E, Mereu A, Massa R, Cuccu A, Marrosu MG, Contu P. Population based study of 12 autoimmune diseases in Sardinia, Italy: prevalence and comorbidity. PLoS One 2012; 7:e32487. [PMID: 22396771 PMCID: PMC3292563 DOI: 10.1371/journal.pone.0032487] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 01/28/2012] [Indexed: 12/16/2022] Open
Abstract
Background The limited availability of prevalence data based on a representative sample of the general population, and the limited number of diseases considered in studies about co-morbidity are the critical factors in study of autoimmune diseases. This paper describes the prevalence of 12 autoimmune diseases in a representative sample of the general population in the South of Sardinia, Italy, and tests the hypothesis of an overall association among these diseases. Methods Data were obtained from 21 GPs. The sample included 25,885 people. Prevalence data were expressed with 95% Poisson C.I. The hypothesis of an overall association between autoimmune diseases was tested by evaluating the co-occurrence within individuals. Results Prevalence per 100,000 are: 552 rheumatoid arthritis, 124 ulcerative colitis, 15 Crohn's disease, 464 type 1 diabetes, 81 systemic lupus erythematosus, 124 celiac disease, 35 myasthenia gravis, 939 psoriasis/psoriatic arthritis, 35 systemic sclerosis, 224 multiple sclerosis, 31 Sjogren's syndrome, and 2,619 autoimmune thyroiditis . An overall association between autoimmune disorders was highlighted. Conclusions The comparisons with prevalence reported in current literature do not show outlier values, except possibly for a few diseases like celiac disease and myasthenia gravis. People already affected by a first autoimmune disease have a higher probability of being affected by a second autoimmune disorder. In the present study, the sample size, together with the low overall prevalence of autoimmune diseases in the population, did not allow us to examine which diseases are most frequently associated with other autoimmune diseases. However, this paper makes available an adequate control population for future clinical studies aimed at exploring the co-morbidity of specific pairs of autoimmune diseases.
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Affiliation(s)
- Claudia Sardu
- Dipartimento di Sanità Pubblica, Università di Cagliari, Cagliari, Italy.
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