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Driskill E, Zhang Z, Chi J, Cui Q. Increased rate of complications following total knee arthroplasty in patients with systemic sclerosis. INTERNATIONAL ORTHOPAEDICS 2023; 47:2563-2569. [PMID: 37354225 DOI: 10.1007/s00264-023-05873-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Outcomes after total knee arthroplasty (TKA) for patients with systemic sclerosis (SSc) are poorly documented in the literature. The purpose of this study was to evaluate SSc as a potential risk factor for increased rate of complications after TKA. METHODS Using the PearlDiver Mariner database, 2,002 patients with SSc undergoing primary TKA were identified and compared to matched controls of 19,892 patients without SSc. Multivariable logistic regression analyses were done for medical complications up to 90 days and surgical complications up to two years. 90-day ED-visit and inpatient readmission were also documented. RESULTS Compared to the matched controls, patients with SSc demonstrated higher rates of medical complications such as cerebrovascular accident (1.5% vs 0.6%, p < 0.001), myocardial infarction (1.3% vs 0.3%, p < 0.001), and sepsis (1.1% vs 0.4%, p < 0.001). Additionally, patients with SSc displayed elevated rates of surgical complications, including wound complications (3.9% vs 2.2%, p < 0.001) and aseptic loosening at 90 days (0.2% vs 0.1%; OR 3.53 [1.13-9.28]), one year (0.7% vs 0.4%; OR 1.78 [0.96-3.05]), and two years (1.4% vs 0.9%; OR 1.68 [1.10-2.45]). Patients with SSc also had higher rates of emergency department visits (21.2% vs 11.4%, p < 0.001). CONCLUSIONS Patients with SSc are at higher risks of postoperative complications, encompassing both medical and surgical complications. Specifically, patients with SSc have a significantly higher likelihood of experiencing wound complications, cerebrovascular accident, and myocardial infarction. It is crucial for orthopaedic surgeons and patients alike to consider the elevated risks when determining a course of TKA for patients with SSc.
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Affiliation(s)
- Elizabeth Driskill
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA
| | - Zhichang Zhang
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, Henan, China
| | - Jialun Chi
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA.
- , Charlottesville, USA.
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Navas-Otero A, Gómez-De-Castro S, Ortiz-Rubio A, Heredia-Ciuró A, Martín-Núñez J, Calvache-Mateo A, Valenza MC. Effects of non-pharmacological therapies on hand function and the ability to perform daily activities in people with systemic sclerosis: A systematic review and meta-analysis of randomized control trials. Int J Rheum Dis 2023. [PMID: 37137818 DOI: 10.1111/1756-185x.14721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/03/2023] [Accepted: 04/19/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Systemic sclerosis (SSc) is an autoimmune rheumatic disease. Individuals with a diagnosis of SSc describe repercussions on their activities of daily living and instrumental activities of daily living that affect their everyday functional capacity. The objective of this systematic review was to explore the effectiveness of non-pharmacological interventions to improve hand function and the ability to perform activities of daily living. METHODS A systematic review was conducted on the Cochrane Library, Medline/PubMed, OTseeker, PEDro, Scopus, Web of Science up to September 10, 2022. Inclusion criteria were defined following PICOS recommendations (Populations, Intervention, Comparison and Outcome measures). Methodological quality was assessed with the Downs and Black Scale and risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). A meta-analysis of each outcome was performed. RESULTS A total of 8 studies met the inclusion criteria, providing data on 487 individuals with SSc. The non-pharmacological intervention applied the most was exercise. The effects of non-pharmacological interventions were better than those of the waiting list or no treatment control conditions in both outcomes - hand function (mean difference [MD] = -6.98; 95% CI [-11.45, - 2.50], P = 0.002, I2 = 0%) and performance of daily activities (MD = -0.19; 95% CI [-0.33, - 0.04], P = 0.01, I2 = 0%). Moderate risk of bias was found in the majority of the studies included. CONCLUSION There is emerging evidence that non-pharmacological interventions can improve hand function and performance of daily activities in individuals with a diagnosis of SSc. Given the moderate risk of bias found in the studies included, the results should be considered with caution.
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Affiliation(s)
- Alba Navas-Otero
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Sheila Gómez-De-Castro
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Araceli Ortiz-Rubio
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Alejandro Heredia-Ciuró
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Javier Martín-Núñez
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Andrés Calvache-Mateo
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie Carmen Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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Morrisroe K, Sandorfi N, Barron M. Health Care Utilization. Rheum Dis Clin North Am 2023; 49:359-375. [PMID: 37028840 DOI: 10.1016/j.rdc.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Systemic sclerosis (SSc), also known as scleroderma, is a chronic autoimmune connective tissue disease and is associated with a significant economic burden resulting from health care utilization costs in addition to indirect costs attributable to SSc resulting from early retirement and lost productivity in those that remain in employment.
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4
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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: 0] [Impact Index Per Article: 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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5
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Martin Calderon L, Chaudhury M, Pope JE. Healthcare utilization and economic burden in systemic sclerosis: a systematic review. Rheumatology (Oxford) 2021; 61:3123-3131. [PMID: 34849627 DOI: 10.1093/rheumatology/keab847] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/22/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Systemic Sclerosis (SSc) is characterized by vasculopathy, fibrosis of skin and internal organs, and autoimmunity with complications including interstitial lung disease, pulmonary hypertension, and digital ulcers with substantial morbidity and disability. Patients with SSc may require considerable healthcare resources with economic impact. The purpose of this systematic review was to provide a narrative synthesis of the economic impact and healthcare resource utilization associated with SSc. METHODS MEDLINE and EMBASE were searched from inception to January 20th, 2021. Studies were included if they provided information regarding the total, direct and indirect cost of SSc. The cost of SSc subtypes and associated complications was determined. Risk of bias assessments through the Joanna Briggs Institute cross-sectional and case series checklists, and the Newcastle-Ottawa Cohort and Case-Control study scales were performed. A narrative synthesis of included studies was planned. RESULTS 1777 publications were retrieved, of which 33 were included representing 20 cross-sectional, 10 cohort, and 3 case-control studies. Studies used various methods of calculating cost including prevalence-based cost-of-illness approach and health resource units cost analysis. Overall SSc total annual cost ranged from USD$14 959-$23 268 in USA, CAD$10 673-$18 453 in Canada, €4,607-€30 797 in Europe, and AUD$7,060-$11 607 in Oceania. Annual cost for SSc-associated interstitial lung disease and pulmonary hypertension was USD$31 285-$55 446 and $44 454-$63 320, respectively. CONCLUSION Cost-calculation methodology varied greatly between included studies. SSc represents significant patient and health resource economic burden. SSc-associated complications increase economic burden and are variable depending on geographical location, and access.
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Affiliation(s)
- Leonardo Martin Calderon
- Schulich School of Medicine and Dentistry, University of Western Ontario, Department of Medicine, London, Ontario, Canada
| | - Mitali Chaudhury
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Janet E Pope
- Schulich School of Medicine and Dentistry, University of Western Ontario, Division of Rheumatology, St. Joseph's Health Care, London, Ontario, Canada
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Coffey CM, Sandhu AS, Crowson CS, Asante D, Matteson EL, Osborn TG, Warrington KJ, Makol A. Outpatient healthcare utilization among incident cases of systemic sclerosis: results from a population-based US cohort (1988-2016). Scand J Rheumatol 2021; 51:323-328. [PMID: 34232106 DOI: 10.1080/03009742.2021.1932581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is a complex, heterogeneous connective tissue disease with multiorgan dysfunction. This study aimed to compare healthcare utilization among incident cases of SSc versus age- and gender-matched comparators. METHOD A population-based cohort of physician-diagnosed patients with SSc in Olmsted County, MN, USA, from 1 January 1988 to 31 December 2016 was assembled. A 2:1 cohort of age- and gender-matched non-SSc subjects was randomly selected for comparison. Patients were followed until death, migration from Olmsted County, or 31 December 2017. Outpatient utilization data were obtained beginning 12 months before the SSc incidence/index date and compared using negative binomial and multinomial models. Services were summarized as visit-days to avoid overestimation of services provided. RESULTS The study included 69 incident SSc cases and 138 non-SSc comparators (mean ± sd age 57 ± 16 years at diagnosis/index, 90% female). Patients with SSc had higher utilization of outpatient physician, laboratory, and combined radiology visit-days annually for the year before and for each of the first 5 years after diagnosis than comparators. Among patients with SSc, healthcare utilization was highest during the year of SSc diagnosis. Rate ratios comparing utilization in patients with and without SSc ranged from 1.8 to 3.0 for all comparisons. CONCLUSION Higher utilization of outpatient physician, laboratory, and radiology visit-days was observed among patients with SSc compared to non-SSc subjects throughout 5 years of disease duration, indicating high and continued care needs in this patient population. The highest utilization of services among SSc patients occurred during the year of SSc diagnosis.
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Affiliation(s)
- C M Coffey
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - A S Sandhu
- Department of Internal Medicine, Kettering Medical Center, Kettering, OH, USA
| | - C S Crowson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - D Asante
- Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - E L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - T G Osborn
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - K J Warrington
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - A Makol
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Tran-Duy A, Morrisroe K, Clarke P, Stevens W, Proudman S, Sahhar J, Nikpour M. Cost-Effectiveness of Combination Therapy for Patients With Systemic Sclerosis-Related Pulmonary Arterial Hypertension. J Am Heart Assoc 2021; 10:e015816. [PMID: 33759539 PMCID: PMC8174376 DOI: 10.1161/jaha.119.015816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background To evaluate the cost‐effectiveness of combination pulmonary arterial hypertension specific therapy in systemic sclerosis–related PAH. Methods and Results Health outcomes and costs were captured through data linkage. Health utility was derived from Medical Outcomes Study Short Form‐36 scores. A probabilistic discrete‐time model was developed to simulate lifetime changes in costs and health utility. Mortality was predicted using a Gompertz parametric survival model. For both treatment arms, the simulations were started using the same cohort of 10 000 patients. Probabilistic sensitivity analysis was performed using the Monte Carlo simulation with 1000 sets of sampled parameter values. Of 143 patients with systemic sclerosis–related pulmonary arterial hypertension, 89 were on monotherapy and 54 on combination therapy. Mean simulated costs per patient per year in monotherapy and combination therapy groups were AU$23 411 (US$16 080) and AU$29 129 (US$19 982), respectively. Mean life years and quality‐adjusted life years from pulmonary arterial hypertension diagnosis to death of patients receiving monotherapy were 7.1 and 3.0, respectively, and of those receiving combination therapy were 9.2 and 3.9, respectively. Incremental costs per life year and quality‐adjusted life year gained of combination therapy compared with monotherapy were AU$47 989 (US$32 920) and AU$113 823 (US$78 082), respectively. At a willingness‐to‐pay threshold of AU$102 000 (US$69 972) per life year gained, and of AU$177 222 (US$121 574) per quality‐adjusted life year gained, the probability of combination therapy being cost‐effective was 0.95. Conclusions The incremental cost per quality‐adjusted life year gained of combination therapy compared with monotherapy was substantial in the base case analysis. Given the fatal prognosis of systemic sclerosis–related pulmonary arterial hypertension and the incremental cost per life year of AU$47 989 (US$32 920), combination therapy could be considered cost‐effective in systemic sclerosis–related pulmonary arterial hypertension.
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Affiliation(s)
- An Tran-Duy
- Centre for Health PolicyMelbourne School of Population and Global HealthThe University of Melbourne Parkville VIC Australia
| | - Kathleen Morrisroe
- Department of Medicine The University of Melbourne at St Vincent's Hospital (Melbourne) Fitzroy VIC Australia.,Department of Rheumatology St Vincent's Hospital (Melbourne) Fitzroy VIC Australia
| | - Philip Clarke
- Centre for Health PolicyMelbourne School of Population and Global HealthThe University of Melbourne Parkville VIC Australia.,Health Economics Research Centre Nuffield Department of Population Health University of Oxford Headington United Kingdom
| | - Wendy Stevens
- Department of Medicine The University of Melbourne at St Vincent's Hospital (Melbourne) Fitzroy VIC Australia
| | - Susanna Proudman
- Rheumatology Unit Royal Adelaide Hospital North Terrace SA Australia.,Discipline of Medicine University of Adelaide SA Australia
| | - Joanne Sahhar
- Department of Medicine Monash University Clayton VIC Australia
| | - Mandana Nikpour
- Department of Medicine The University of Melbourne at St Vincent's Hospital (Melbourne) Fitzroy VIC Australia.,Department of Rheumatology St Vincent's Hospital (Melbourne) Fitzroy VIC Australia
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8
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Abbot S, McWilliams L, Spargo L, de Costa C, Ur-Rehman Z, Proudman S, Bossingham D. Scleroderma in Cairns: an epidemiological study. Intern Med J 2021; 50:445-452. [PMID: 31157951 DOI: 10.1111/imj.14376] [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: 02/07/2019] [Revised: 05/09/2019] [Accepted: 05/26/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Systemic sclerosis (SSc) refers to an autoimmune fibrosing disorder with high disease burden and mortality. The prevalence of 23/100 000 in South Australia (SA) is among the highest documented, but anecdotally it is higher still in Cairns. AIMS To ascertain the prevalence of SSc in Cairns and surrounding regions, and to compare the demographic and clinical characteristics of patients with SSc in Cairns with those in SA. METHODS Patients with SSc in Cairns were ascertained through hospital records and by referrals from specialist physicians in the region. These patients were interviewed and completed a structured questionnaire. Their physical findings and autoantibodies were recorded. These patients were compared with the SA patients enrolled in the Australian Scleroderma Cohort Study. RESULTS A total of 81 patients was identified in Cairns, giving an estimated cross-sectional prevalence of 33.7/100 000. Among 65 patients interviewed in Cairns, 23 were born in Cairns, 16 had migrated to Cairns to ameliorate their Raynaud phenomenon and 26 for other reasons. The clinical features in both cohorts were similar, although Cairns had a lower prevalence of digital ulcers (30.8% vs 46.6%; odds ratio (OR) = 0.5035, 95% confidence interval (CI): 0.2839-0.8929, P = 0.0271) and higher prevalence of calcinosis (29.2% vs 17.0%; OR = 2.005, 95% CI: 1.055-3.382). CONCLUSIONS The higher prevalence of SSc in Cairns is partly, but not completely, due to migration. Differences in clinical features are not entirely explained by the warmer climate. There is a need for greater rheumatologic services in the Cairns region.
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Affiliation(s)
- Samuel Abbot
- Cairns Clinical School, James Cook University College of Medicine and Dentistry, Cairns, Queensland, Australia.,Department of Medicine, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,Department of Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Leah McWilliams
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Llewellyn Spargo
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Caroline de Costa
- Cairns Clinical School, James Cook University College of Medicine and Dentistry, Cairns, Queensland, Australia
| | - Zia Ur-Rehman
- Rheumatology Department, Cairns Hospital, Cairns, Queensland, Australia
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - David Bossingham
- Cairns Clinical School, James Cook University College of Medicine and Dentistry, Cairns, Queensland, Australia
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Morrisroe K, Baron M, Frech T, Nikpour M. Small intestinal bacterial overgrowth in systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2020; 5:33-39. [PMID: 35382403 PMCID: PMC8922590 DOI: 10.1177/2397198319863953] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 06/24/2019] [Indexed: 11/09/2023]
Abstract
Systemic sclerosis is a multi-organ autoimmune disease characterized by vasculopathy and fibrosis, and it is arguably the most devastating of the rheumatological diseases. The gastrointestinal tract is the most commonly involved internal organ in systemic sclerosis. Gastrointestinal tract involvement is reported in up to 90% of SSc patients, is the leading cause of morbidity, and is the third most common cause of mortality in this disease. Among all gastrointestinal tract manifestations, small intestinal bacterial overgrowth is one manifestation that may be ameliorated and even eradicated with appropriate treatment, if recognized early. Small intestinal bacterial overgrowth occurs with a prevalence of approximately 39% in systemic sclerosis and presents with a range of non-specific gastrointestinal tract symptoms, including diarrhea, flatulence, abdominal pain, bloating, and early satiety. These manifestations occur due to an alteration and overgrowth of small intestinal bacteria occurring in the setting of gastrointestinal tract dysmotility and slow transit time. The clinical diagnosis of small intestinal bacterial overgrowth is commonly based on the presence of characteristic clinical symptoms together with a positive hydrogen breath test and response to a therapeutic trial of oral antibiotics used sequentially. Almost two-thirds of systemic sclerosis patients with small intestinal bacterial overgrowth have an improvement in their gastrointestinal tract symptoms with rotating antibiotics. Untreated small intestinal bacterial overgrowth can lead to malnutrition, and thus an important aspect of treatment is the identification and treatment of any associated vitamin and mineral deficiencies. This article focuses on small intestinal bacterial overgrowth, an important and understudied area in systemic sclerosis that remains a diagnostic and therapeutic challenge for both patients and clinicians alike.
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Affiliation(s)
- Kathleen Morrisroe
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
- Department of Rheumatology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Murray Baron
- Division of Rheumatology, Jewish General Hospital, Montreal, QC, Canada
| | - Tracy Frech
- Division of Rheumatology, Department of Internal Medicine, The University of Utah, Salt Lake City, UT, USA
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
- Department of Rheumatology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
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10
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Abstract
Epidemiological studies reporting demographic, clinical and serological factors predictive of various outcomes in systemic sclerosis (SSc) range from the prediction of mortality to the development and progression of disease manifestations. However, predicting the disease trajectory in the individual patient is a challenging but important step towards a stratified approach to disease management. Recent technological advances provide the opportunity for new subgroupings of disease based on risk stratification, through the systematic analysis of high-dimensional clinical data combined with genes, their transcription products and their corresponding translated proteins. In addition, these variables offer a rich vein of research to identify non-invasive biomarkers for predicting organ involvement and to assess disease activity and response to therapy. Selection of patients with a clinical phenotype or molecular signature relevant to the therapy under study combined with recent efforts to standardise outcome measures, show promise for improving clinical trial design and the identification of effective targeted therapies.
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11
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Morrisroe K, Stevens W, Sahhar J, Ngian GS, Ferdowsi N, Hansen D, Patel S, Hill CL, Roddy J, Walker J, Proudman S, Nikpour M. The economic burden of systemic sclerosis related pulmonary arterial hypertension in Australia. BMC Pulm Med 2019; 19:226. [PMID: 31775705 PMCID: PMC6881974 DOI: 10.1186/s12890-019-0989-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/13/2019] [Indexed: 11/23/2022] Open
Abstract
Background To quantify the financial cost of pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc). Methods Healthcare use was captured through data linkage, wherein clinical data for SSc patients enrolled in the Australian Scleroderma Cohort Study were linked with hospital, emergency department (ED) and ambulatory care databases (MBS) for the period 2008–2015. PAH was diagnosed on right heart catheter according to international criteria. Determinants of healthcare cost were estimated using logistic regression. Results Total median (25th–75th) healthcare cost per patient (including hospital, ED and MBS cost but excluding medication cost) for our cohort during 2008–2015 was AUD$37,685 (18,144-78,811) with an annual per patient healthcare cost of AUD$7506 (5273-10,654). Total healthcare cost was higher for SSc-PAH patients compared with those without PAH with a total cost per patient of AUD$70,034 (37,222-110,814) vs AUD$34,325 (16,093 – 69,957), p < 0.001 respectively with an annual excess healthcare cost per PAH patient of AUD$2463 (1973-1885), p < 0.001. The cost of SSc-PAH occurs early post PAH diagnosis with 89.4% utilizing a healthcare service within the first 12 months post PAH diagnosis with an associated cost per patient of AUD$4125 (0–15,666). PAH severity was the main significant determinant of increased healthcare cost (OR 2.5, p = 0.03) in our PAH cohort. Conclusions Despite SSc-PAH being a low prevalence disease, it is associated with significant healthcare resource utilization and associated economic burden, predominantly driven by the severity of PAH.
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Affiliation(s)
- Kathleen Morrisroe
- Department of Medicine, The University of Melbourne at St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia.,Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Joanne Sahhar
- Department of Medicine, Monash University, Clayton and Monash Health, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Gene-Siew Ngian
- Department of Medicine, Monash University, Clayton and Monash Health, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Nava Ferdowsi
- Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Dylan Hansen
- Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Shreeya Patel
- Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Catherine L Hill
- Rheumatology Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia.,Rheumatology Unit, The Queen Elizabeth Hospital, Woodville Road, Woodville, SA, 5011, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, Australia
| | - Jennifer Walker
- Rheumatology Unit, Flinders Medical Centre (Adelaide), Flinders Drive, Bedford Park, South Australia, 5042, Australia
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia. .,Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia.
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12
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Abstract
PURPOSE OF REVIEW This review provides important updates in systemic sclerosis (SSc)-related gastrointestinal disease, specifically focusing on the most recent literature. RECENT FINDINGS In the past year, several studies were published that present interesting insights into SSc and gastrointestinal disease. Studies focusing on newly identified risk factors, novel approaches to diagnosis and assessment of disease activity, survival and quality of life demonstrate progress in our understanding of this challenging area. Additional data on specific SSc gastrointestinal-related topics, such as the link between gastrointestinal and pulmonary disease, nutrition, and the microbiome, are also now available. SUMMARY SSc gastrointestinal disease is heterogeneous in its clinical presentation, which presents a challenge in diagnosis and management. In the past year, several studies have evaluated risk factors and clinical features associated with specific gastrointestinal complications in SSc. Objective gastrointestinal testing may help to identify specific SSc gastrointestinal subgroups and provide diagnostic accuracy to guide targeted therapies. Survival in very early SSc is affected by the severity of gastrointestinal involvement. Other important gastrointestinal subsets, including patients with esophageal disease and interstitial lung disease, should carefully be considered when developing a management plan for this patient population.
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