Marcatto de Abreu MF, Landin S, Yuamoto FY, Lins C, Magalhães EP, Etchebehere M. Screening tool development for hand surgery referrals in systemic sclerosis.
Clinics (Sao Paulo) 2023;
78:100270. [PMID:
37597472 PMCID:
PMC10460938 DOI:
10.1016/j.clinsp.2023.100270]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/03/2023] [Accepted: 07/26/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND
Systemic Sclerosis (SSc) patients may need hand surgery.
OBJECTIVE
To develop a screening tool for rheumatologists to identify potential candidates with systemic sclerosis for hand surgery, optimizing referrals.
METHODS
A pilot cross-sectional study from January 2015 to December 2016.
SAMPLE SIZE
51 participants.
INCLUSION CRITERIA
≥ 18 years old, meeting the 2013 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for SSc and hand impairment.
DATA COLLECTED
age, sex, race, disease duration, SSc subtypes, vasodilator use, skin thickness, finger stiffness, presence of Digital Ulcers (DU) and/or calcinosis, presence of Raynaud's Phenomenon (RP) attacks, health status and disability, disease status, pain intensity and functional status of the hands. Data were analyzed by a multivariate logistic regression model.
RESULTS
Fulfillment of surgical criteria: 68.8%. The surgical group had higher scores on the HAQ-DI (1.39 vs. 0.96, p = 0.032) and CHFS (25.0 vs. 12.0, p = 0.005) questionnaires, and a higher frequency of DU (91.43% vs. 18.75%, p < 0.0010), calcinosis (60.0% vs. 0.0%, p < 0.001), use of vasodilators (100.0% vs. 75.0%, p = 0.007) and digital stiffness (28.57% vs. 0.0%, p = 0.017). The presence of DU increased the chance of surgical indication by 46.2 times (ORIC 95% = 8.23 to 259.49). The statistical model showed good accuracy (86.3%, p < 0.001), sensitivity (91.4%), and specificity (81.2%).
CONCLUSION
The presence of DU in SSc could be used as a screening feature for early identification and referral of potential candidates for hand surgery.
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