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Kuchinad KE, Kim JS, Woods A, Leatherman G, Gutierrez-Alamillo L, Mayes MD, Domsic R, Ramos PS, Silver RM, Varga J, Saketkoo LA, Kafaja S, Shanmugan VK, Gordon J, Chung L, Bernstein EJ, Gourh P, Boin F, Kastner DL, Zeger SL, Casciola-Rosen L, Wigley FM, Shah AA. Racial variability in immune responses only partially explains differential systemic sclerosis disease severity. Ann Rheum Dis 2024:ard-2023-225458. [PMID: 39019570 DOI: 10.1136/ard-2023-225458] [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: 01/02/2024] [Accepted: 06/19/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVE To understand if autoantibodies account for racial variation in disease severity, we compared autoantibody distribution and associated phenotype between self-identified black and white systemic sclerosis (SSc) patients. METHODS 803 black and 2178 white SSc patients had systematic testing for autoantibodies using Euroimmun (centromere (ACA), RNA-polymerase III (POLR3), Scl70, PM/Scl, NOR90, Th/To, Ku, U3RNP and Ro52) and commercial ELISA (U1RNP). In this observational study, logistic regression was performed to assess the association between self-identified race and outcomes, adjusting for autoantibodies. To estimate whether the effect of race was mediated by autoantibody status, race coefficients from multivariate models including and excluding autoantibodies were compared. RESULTS Anti-Scl70, anti-U1RNP, anti-U3RNP, anti-Th/To, anti-Ku and anti-NOR90 were more common in the black cohort than in the white cohort, which was enriched for ACA, anti-POLR3 and anti-PM/Scl. Black individuals had a higher prevalence of severe Raynaud's, skin, lung, gastrointestinal and renal disease whereas white individuals had a higher prevalence of severe heart and muscle disease. Adjusting for autoantibodies decreased the effect of race on outcome for telangiectasias, forced vital capacity <70%, pulmonary hypertension and severe lung, heart, muscle and gastrointestinal disease by 11%-44% and increased the association between race and renal crisis and severe kidney disease by 37%-52%. CONCLUSIONS This study is the largest systematic analysis of autoantibody responses in a geographically diverse population of black SSc patients. Black and white individuals with SSc have distinct autoantibody profiles. Autoantibodies explain only a fraction of the effect of race on clinical outcomes, suggesting other factors contribute to disparate outcomes between these groups.
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Affiliation(s)
- Kamini E Kuchinad
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ji Soo Kim
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Adrianne Woods
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gwen Leatherman
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laura Gutierrez-Alamillo
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maureen D Mayes
- Division of Rheumatology and Clinical Immunogenetics, The University of Texas Health Science Center John P and Katherine G McGovern Medical School, Houston, Texas, USA
| | - Robyn Domsic
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Paula S Ramos
- Department of Medicine, Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Richard M Silver
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John Varga
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Section of Pulmonary Medicine, University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Suzanne Kafaja
- Internal Medicine/Division of Rheumatology, University of California Los Angeles, Los Angeles, California, USA
| | - Victoria K Shanmugan
- Office of Autoimmune Disease Research, National Institute of Health, Bethesda, Maryland, USA
| | - Jessica Gordon
- Department of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA
| | - Elana J Bernstein
- Division of Rheumatology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Pravitt Gourh
- NIAMS, National Institutes of Health, Bethesda, Maryland, USA
| | - Francesco Boin
- Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Daniel L Kastner
- National Human Genome Research Institute Division of Intramural Research, Bethesda, Maryland, USA
| | - Scott L Zeger
- Biostatistics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Livia Casciola-Rosen
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Fredrick M Wigley
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ami A Shah
- Division of Rheumatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Muntyanu A, Aw K, Kaouache M, Rahme E, Osman M, Baron M, Ghazal S, Netchiporouk E. Epidemiology of systemic sclerosis in Quebec, Canada: a population-based study. LANCET REGIONAL HEALTH. AMERICAS 2024; 35:100790. [PMID: 38962065 PMCID: PMC11220520 DOI: 10.1016/j.lana.2024.100790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/18/2024] [Accepted: 05/14/2024] [Indexed: 07/05/2024]
Abstract
Background Systemic sclerosis (SSc) is a systemic life-threatening autoimmune rheumatic disease. We aimed to assess the incidence, prevalence, mortality and spatiotemporal trends of SSc in Quebec, Canada with stratification by sex and age. Methods SSc cases were identified from Quebec populational databases from 1989 to 2019. Negative Binomial (NB) Generalized Linear Models were used for age-standardized incidence rates (ASIR) analyses and NB random walk for prevalence and mortality. A Poisson Besag-York-Mollié regression model was used for spatial analysis. Findings 8180 incident SSc cases were identified between 1996 and 2019 with an average age of 57.3 ± 16.3 years. The overall ASIR was 4.14/100,000 person-years (95%, Confidence Interval (CI) 4.05-4.24) with a 4:1 female predominance. ASIR increased steadily over time with an Average Annual Percent Change (AAPC) of 3.94% (95% CI 3.49-4.38). While the highest incidence rates were in those aged 60-79 years old among females and >80 years old among males, the highest AAPC (∼10%) was seen in children. Standarized incidence ratios varied geographically between 0.52 to 1.64. The average prevalence was 28.96/100,000 persons (95% CI 28.72-29.20). The Standardized Mortality Ratio (SMR) decreased from 4.18 (95% CI 3.64-4.76) in 1996 to 2.69 (95% CI 2.42-2.98) in 2019. Females had a greater SMR until 2007 and males thereafter. The highest SMR was in children and young adults [31.2 (95% CI 8.39-79.82) in the 0-19-year age group]. Interpretation We showed an increasing trend in SSc incidence and prevalence and a decline in SMR over a 25-year period in Quebec. An uneven geographic distribution of SSc incidence was demonstrated. Funding National Scleroderma Foundation, Canadian Dermatology Foundation/Canadian Institutes of Health Research.
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Affiliation(s)
- Anastasiya Muntyanu
- Division of Experimental Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Katherine Aw
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mohammed Kaouache
- The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Elham Rahme
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mohamed Osman
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Murray Baron
- Division of Rheumatology, Department of Medicine, Jewish General Hospital, Montreal, Quebec, Canada
| | - Stephanie Ghazal
- Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
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Dal Santo T, Golberg M, Nassar EL, Carrier ME, Hu S, Kwakkenbos L, Bartlett SJ, Fox RS, Lee YC, Varga J, Benedetti A, Thombs BD. Protocol for the development of a tool to map systemic sclerosis pain sources, patterns, and management experiences: a Scleroderma Patient-centered Intervention Network patient-researcher partnership. BMC Rheumatol 2024; 8:28. [PMID: 38907303 PMCID: PMC11191384 DOI: 10.1186/s41927-024-00398-3] [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: 04/04/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024] Open
Abstract
INTRODUCTION Systemic sclerosis (SSc) is a rare, complex autoimmune rheumatic disease with multiple factors that contribute to pain. People with SSc emphasize the effect pain has on their quality of life, but no studies have systematically examined the frequency and relative importance of different SSc pain sources, patterns of pain from different sources, and pain management experiences. Our objectives are to (1) develop a tool, jointly with researchers, health care providers, and patients, to map sources of pain in SSc, determine patterns of pain from different sources, and understand pain management experiences; and (2) administer the final tool version to participants in the large multinational Scleroderma Patient-centered Intervention Network (SPIN) Cohort. METHODS First, we will use validated pain assessment tools as templates to develop an initial version of our pain assessment tool, and we will obtain input from patient advisors to adapt it for SSc. The tool will include questions on pain sources, pain patterns, pain intensity, pain management techniques, and barriers to pain management in SSc. Second, we will conduct nominal group technique sessions with people living with SSc and health care providers who care for people with SSc to further refine the tool. Third, we will conduct individual usability testing sessions with SPIN Cohort participants. Once the tool has been finalized, we will administer it to individuals in the multinational SPIN Cohort, which currently includes over 1,300 active participants from 54 sites in 7 countries. We will perform unsupervised clustering using the KAy-Means for MIxed LArge data (KAMILA) method to identify participant subgroups with similar profiles of pain sources (present or absent) and to evaluate predictors of subgroup membership. We will use latent profile analysis to identify subgroups of participants with similar profiles based on pain intensity scores for each pain source and evaluate predictors. DISCUSSION Once completed, our pain assessment tool will allow our team and other researchers to map sources of pain in SSc and to understand pain management experiences of people living with SSc. This knowledge will provide avenues for studies on the pathophysiology of pain in SSc and studies of interventions to improve pain management.
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Affiliation(s)
- Tiffany Dal Santo
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Meira Golberg
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Elsa-Lynn Nassar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Sophie Hu
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Linda Kwakkenbos
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
- Department of IQ Health, Radboud University Medical Center, Nijmegen, Netherlands
- Centre for Mindfulness, Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Rina S Fox
- College of Nursing, University of Arizona, Tucson, AZ, USA
| | - Yvonne C Lee
- Department of Medicine (Rheumatology) and Preventive Medicine, Northwestern University, Evanston, IL, USA
| | - John Varga
- Department of Internal Medicine, Division of Rheumatology), University of Michigan, Ann Arbor, Michigan, USA
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, QC, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
- Department of Psychology, McGill University, Montreal, QC, Canada.
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
- Department of Medicine, McGill University, Montreal, QC, Canada.
- Biomedical Ethics Unit, McGill University, Montreal, QC, Canada.
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4
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Nies JF, Krusche M. [Fever in rheumatological diseases]. Z Rheumatol 2024; 83:341-353. [PMID: 38634905 DOI: 10.1007/s00393-024-01505-y] [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] [Accepted: 02/20/2024] [Indexed: 04/19/2024]
Abstract
Fever is a frequent and important symptom in patients with rheumatological diseases and can be an expression of activity of the underlying rheumatological disease. There is great variability in the incidence of fever as a symptom of the disease between individual diseases. The growing understanding of the molecular signatures of the diseases can help to explain these discrepancies: A genetic overactivation of potently pyrogenic cytokines is the reason why fever is nearly always present in autoinflammatory syndromes. In contrast, fever is less common in polyarthritis and myositis and mostly limited to severe courses of disease. In the diagnostic work-up of fever, frequent differential diagnoses, such as infections, malignancies, side effects of drugs and hypersensitivity reactions should be considered. This article provides an overview of the physiology of the development of fever, describes the relevance of fever in individual rheumatological diseases and proposes a workflow for the clinical clarification of rheumatological patients who present with fever.
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Affiliation(s)
- Jasper F Nies
- Klinik II für Innere Medizin: Nephrologie, Rheumatologie, Diabetologie und Allgemeine Innere Medizin, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Martin Krusche
- III. Medizinische Klinik und Poliklinik für Nephrologie, Rheumatologie und Endokrinologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland
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Zhang Y, Zhang D, Chen L, Zhou J, Ren B, Chen H. The progress of autoimmune hepatitis research and future challenges. Open Med (Wars) 2023; 18:20230823. [PMID: 38025543 PMCID: PMC10655690 DOI: 10.1515/med-2023-0823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/24/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023] Open
Abstract
Autoimmune hepatitis (AIH) is a chronic liver inflammatory disease with various immune system manifestations, showing a global trend of increased prevalence. AIH is diagnosed through histological abnormalities, clinical manifestations, and biochemical indicators. The biochemical markers involve interfacial hepatitis, transaminase abnormalities, positive autoantibodies, etc. Although AIH pathogenesis is unclear, gene mutations and immunological factors could be the leading factors. AIH usually presents as a chronic liver disease and sometimes as acute hepatitis, making it challenging to distinguish it from drug-related hepatitis due to similar clinical symptoms. Normalizing transaminases and serum IgG levels is essential in assessing the remission status of AIH treatment. Glucocorticoids and azathioprine are the first-line AIH treatment, with lifelong maintenance therapy in some patients. The quality of life and survival can be improved after appropriate treatment. However, certain limitations jeopardize the quality of treatment, including long treatment cycles, side effects, poor patient compliance, and inability to inhibit liver fibrosis and cirrhosis. Accurate AIH animal models will help us understand the pathophysiology of the disease while providing fresh perspectives for avoiding and treating AIH. This review will help us understand AIH better, from the cellular and molecular causes to the clinical features, and will provide insight into new therapy techniques with fewer side effects.
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Affiliation(s)
- Yang Zhang
- Graduate Department of Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China
- Department of Infectious Diseases, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Dehe Zhang
- Department of Infectious Diseases, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Ling Chen
- Department of Infectious Diseases, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Jing Zhou
- Department of Infectious Diseases, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Binbin Ren
- Department of Infectious Diseases, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Haijun Chen
- Department of Infectious Diseases, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
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6
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Williams KA, Wondimu B, Ajayi AM, Sokumbi O. Skin of color in dermatopathology: does color matter? Hum Pathol 2023; 140:240-266. [PMID: 37146946 DOI: 10.1016/j.humpath.2023.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Abstract
Skin of color (SoC) remains an understudied and under taught area of dermatology despite its rising importance. Race and ethnicity play a particularly important role in dermatology as skin pigmentation can affect the manifestation and presentation of many common dermatoses. With this review, we seek to review pertinent differences in SoC histology, as well as highlight the histopathology of conditions more common in SoC and address inherent bias that may affect accurate dermatopathology sign out.
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Affiliation(s)
- Kyle A Williams
- Department of Dermatology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Bitania Wondimu
- Department of Laboratory Medicine and Pathology, University of Washington Medical Center, Seattle, WA, 98195, USA
| | - Ayodeji M Ajayi
- Department of Dermatology, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Olayemi Sokumbi
- Department of Dermatology, Mayo Clinic, Jacksonville, FL, 32224, USA; Department of Laboratory Medicine & Pathology, Mayo Clinic, Jacksonville, FL, 32224, USA.
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7
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Namas R, Elarabi M, Khan S, Mubashir A, Memisoglu E, El-Kaissi M, Joshi A, Chapman J, Jassim I, Khogali H, Hassan N, Sabbour H, Saleh K, Alnaqbi KA, Zayat AS, Diab S, Awir Z, Abu Taha N, Ginawi A, Al Ansari A, Rifaai H, Alrawi Z, Al Dhaheri A, Ibrahim G, Abogamal A, Al Shehhi W, Teir J, Khan T, Musgrave M, Hameed B, Khan B, Mosallam N, Hussien N, Hussein I, Abdulelhamid A, Ali A, Hannawi S, Al Izzi M, Badsha H, Al Saleh J. Comprehensive description of the prevalence, serological and clinical characteristics, and visceral involvement of systemic sclerosis (scleroderma) in a large cohort from the United Arab Emirates Systemic Sclerosis Registry. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2023; 8:137-150. [PMID: 37287950 PMCID: PMC10242692 DOI: 10.1177/23971983221145788] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/28/2022] [Indexed: 06/04/2024]
Abstract
Systemic sclerosis is an autoimmune condition characterized by a wide range of clinical presentations. Registries may serve to expand understanding about systemic sclerosis and aid in patient care and follow-up. The objective of this study was to analyze the prevalence of systemic sclerosis in a large cohort from the United Arab Emirates Systemic Sclerosis Registry and find the significant similarities and differences between the different subsets. All scleroderma patients in the United Arab Emirates were included in this multicenter national retrospective analysis. Data on demographics, comorbidities, serological characteristics, clinical aspects, and treatment were collected and analyzed, highlighting the most common traits identified. A total of 167 systemic scleroderma patients from diverse ethnic backgrounds were enrolled. Overall, 54.5% (91/167) of the patients were diagnosed with diffuse cutaneous systemic sclerosis, and 45.5% (76/167) with limited cutaneous systemic sclerosis. The prevalence of systemic sclerosis was 1.66 per 100,000 for the total registry and 7.78 per 100,000 for United Arab Emirates patients. Almost all patients in the diffuse cutaneous systemic sclerosis and limited cutaneous systemic sclerosis groups tested positive for the immunofluorescence antinuclear antibody. Antibodies against Scl-70 were significantly more associated with diffuse cutaneous systemic sclerosis, whereas anticentromere antibodies were significantly more associated with the limited cutaneous systemic sclerosis group (p < 0.001). Sclerodactyly, shortness of breath, and digital ulcers were more common in diffuse cutaneous systemic sclerosis patients compared with the limited cutaneous systemic sclerosis subtype in terms of clinical symptoms and organ involvement. Telangiectasia was much more common in the limited cutaneous systemic sclerosis group. Furthermore, diffuse cutaneous systemic sclerosis patients had more lung fibrosis (interstitial lung disease) than limited cutaneous systemic sclerosis patients (70.5% vs 45.7%), and pulmonary arterial hypertension was twice as common in limited cutaneous systemic sclerosis patients as it was in diffuse cutaneous systemic sclerosis patients. Local registries are paramount to understanding the clinical/serological characteristics of scleroderma. This study emphasizes the importance of raising disease awareness and distinguishing between the various systemic sclerosis subsets to implement patient-tailored strategies for early detection, better management, and higher quality of care.
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Affiliation(s)
- Rajaie Namas
- Division of Rheumatology, Department of Internal Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Mohamed Elarabi
- Division of Rheumatology, Department of Internal Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Saniya Khan
- Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Asia Mubashir
- Division of Rheumatology, Department of Internal Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Esat Memisoglu
- Imaging Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | | | - Abhay Joshi
- Division of Rheumatology, Burjeel Day Surgery Center, Abu Dhabi, UAE
| | - Jeffrey Chapman
- Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Imad Jassim
- Department of Rheumatology, Tawam Hospital, Al Ain, UAE
| | - Hiba Khogali
- Department of Rheumatology, Tawam Hospital, Al Ain, UAE
| | - Nada Hassan
- Department of Rheumatology, Mediclinic Parkview Hospital, Dubai, UAE
| | - Hani Sabbour
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Khaled Saleh
- Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | | | - Ahmed S Zayat
- Division of Rheumatology, University Hospital Sharjah, Sharjah, UAE
| | - Sehriban Diab
- Division of Rheumatology, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Zyiad Awir
- Department of Rheumatology, Yas Healthcare, Abu Dhabi, UAE
| | - Nehad Abu Taha
- Department of Rheumatology, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Amel Ginawi
- Division of Rheumatology, Mediclinic City Hospital, Dubai, UAE
| | - Atheer Al Ansari
- Division of Rheumatology, Mediclinic Airport Road Hospital, Abu Dhabi, UAE
| | - Hazem Rifaai
- Department of Rheumatology, Mediclinic Al Noor Hospital, Abu Dhabi, UAE
| | - Zaid Alrawi
- Department of Rheumatology, Clemenceau Medical Center Hospital, Dubai, UAE
| | | | - Gamal Ibrahim
- Department of Rheumatology, Dr. Sulaiman Al Habib Hospital, Dubai, UAE
| | - Ahmed Abogamal
- Department of Rheumatology, Dr. Sulaiman Al Habib Hospital, Dubai, UAE
| | | | - Jamal Teir
- Department of Rheumatology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Tahir Khan
- Department of Rheumatology,Yas Clinic Khalifa City, Abu Dhabi, UAE
| | - Maisam Musgrave
- Dubai, UAE Department of Rheumatology, Mediclinic City Hospital, Dubai, UAE
| | - Beena Hameed
- Department of Rheumatology, King’s College Hospital, Dubai, UAE
| | - Bhavna Khan
- Division of Rheumatology, King’s College Hospital, Dubai, UAE
| | - Nagwa Mosallam
- Department of Rheumatology, Burjeel Hospital, Abu Dhabi, UAE
| | - Nahla Hussien
- Department of Rheumatology, Medeor Hospital, Abu Dhabi, UAE
| | - Iman Hussein
- Department of Rheumatology,Yas Clinic Khalifa City, Abu Dhabi, UAE
| | | | - Ahmed Ali
- Department of Rheumatology, Ibrahim Bin Hamad Obaidullah Hospital, Ras Al Khaima, UAE
| | - Suad Hannawi
- Department of Rheumatology, Ministry of Health and Prevention Ibrahim Bin Hamad Obaidullah, Dubai, UAE
| | - Mustafa Al Izzi
- Department of Rheumatology, Mediclinic Welcare Hospital, Dubai, UAE
| | - Humeira Badsha
- Department of Rheumatology, Dr. Humeira Badsha Medical Center, Dubai, UAE
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8
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Zhao K, Kong C, Shi N, Jiang J, Li P. Potential angiogenic, immunomodulatory, and antifibrotic effects of mesenchymal stem cell-derived extracellular vesicles in systemic sclerosis. Front Immunol 2023; 14:1125257. [PMID: 37251412 PMCID: PMC10213547 DOI: 10.3389/fimmu.2023.1125257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Systemic sclerosis (SSc) is an intricate systemic autoimmune disease with pathological features such as vascular injury, immune dysregulation, and extensive fibrosis of the skin and multiple organs. Treatment options are limited; however, recently, mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) have been acknowledged in preclinical and clinical trials as being useful in treating autoimmune diseases and are likely superior to MSCs alone. Recent research has also shown that MSC-EVs can ameliorate SSc and the pathological changes in vasculopathy, immune dysfunction, and fibrosis. This review summarizes the therapeutic effects of MSC-EVs on SSc and the mechanisms that have been discovered to provide a theoretical basis for future studies on the role of MSC-EVs in treating SSc.
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Affiliation(s)
- Kelin Zhao
- Department of Rheumatology and Immunology, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Chenfei Kong
- Scientific Research Center, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Naixu Shi
- Department of Stomatology, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Jinlan Jiang
- Scientific Research Center, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Ping Li
- Department of Rheumatology and Immunology, China-Japan Union Hospital, Jilin University, Changchun, China
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Chernis J, Buni M, Kazzaz S, Ying J, Lyons M, Assassi S, Mayes M. Predictors of Perceived Functional Status in Early Systemic Sclerosis: A Prospective Longitudinal Study of an Early Disease Cohort. Arthritis Care Res (Hoboken) 2023; 75:1066-1070. [PMID: 34738736 PMCID: PMC9068830 DOI: 10.1002/acr.24812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 09/27/2021] [Accepted: 10/21/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The modified Health Assessment Questionnaire (M-HAQ) is a well-established patient-reported outcome measure in systemic sclerosis (SSc) studies that reflects how a patient functions in several categories of activities of daily living. This study analyzed clinical, demographic, and socioeconomic factors that predict M-HAQ scores over time. METHODS This study included 388 patients with baseline M-HAQ scores from the Genetics versus Environment in Scleroderma Outcome Study (GENISOS) early disease cohort with a mean disease duration of 2.5 years, mean follow-up time of 3.9 years, and median follow-up of 7.2 years. A total of 1,950 M-HAQ measurements were analyzed. Baseline disease characteristics were recorded, and the association of these characteristics with the M-HAQ score was analyzed at baseline and longitudinally. RESULTS Lower income and education levels, older age, and more severe skin involvement at enrollment were independent predictors of worse perceived functional disability over time (i.e., higher longitudinal M-HAQ levels). Higher longitudinal modified Rodnan skin scores correlated with higher M-HAQ scores, whereas higher longitudinal forced vital capacity percentage predicted values correlated with lower M-HAQ scores over time (P < 0.001 for both univariable and multivariable analyses). Moreover, higher baseline M-HAQ scores predicted higher mortality (hazard ratio 1.29, 95% confidence interval 1.09-1.52, P = 0.003). CONCLUSION This large, longitudinal study of early disease SSc demonstrates that severity of skin disease and socioeconomic factors such as educational level and income are important predictors of perceived functional disability in SSc.
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Affiliation(s)
- Julia Chernis
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Maryam Buni
- The University of Texas MD Anderson Cancer Center, Houston
| | | | | | - Marka Lyons
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Shervin Assassi
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Maureen Mayes
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
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10
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Nassar EL, Abdulkareem DA, Thombs BD. Results from a living systematic review of the prevalence of mood and anxiety disorders and factors associated with symptoms in systemic sclerosis. Sci Rep 2023; 13:5181. [PMID: 36997795 PMCID: PMC10063612 DOI: 10.1038/s41598-023-31919-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
We aimed to synthesize evidence on (1) the prevalence of mood and anxiety disorders and (2) factors associated with symptoms in systemic sclerosis (SSc). We searched MEDLINE, CINAHL, EMBASE, Cochrane CENTRAL, and PsycINFO via an ongoing living systematic review with automated monthly searches. We identified 6 eligible studies through March 1, 2023. Based on 3 studies (N = 93 to 345), current or 30-day major depressive disorder prevalence was 4% (95% confidence interval [CI] 2%, 6%) in a sample of Canadian outpatients (N = 345), 18% (95% CI 12%, 27%) in a study of Indian outpatients (N = 93), 10% (95% CI 4%, 21%) for French patient conference attendees (N = 51), and 29% (95% CI 18%, 42%) for French inpatients (N = 49). Current or 30-day prevalence of any anxiety disorder was 49% (95% CI 36%, 62%) for French conference attendees and 51% (95% CI 38%, 64%) for French inpatients; current or 30-day prevalence of generalized anxiety disorder was 3% for Indian outpatients (95% CI 1%, 9%; N = 93). In 3 studies (N = 114 to 376) that examined factors associated with depressive symptoms, higher education and being married or living as married were associated with lower symptoms and pulmonary involvement, breathing problems, and tender joint counts with higher symptoms; age and disease severity markers were not associated. Only 1 study (N = 114) assessed factors associated with anxiety symptoms and found no statistically significant associations. Limitations included heterogeneous populations and assessment methods, small samples, and substantial risk of bias concerns. Mood and anxiety disorder prevalence appear high in SSc, but estimates vary, and existing studies have important limitations. Future research should assess mood and anxiety prevalence and factors associated with symptoms using large representative samples and validated classification and assessment methods.Review registration: PROSPERO (CRD 42021251339).
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Affiliation(s)
- Elsa-Lynn Nassar
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste Catherine Road, Pavilion H4.83, Montreal, QC, H3T 1E2, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Dalal A Abdulkareem
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste Catherine Road, Pavilion H4.83, Montreal, QC, H3T 1E2, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Cote Ste Catherine Road, Pavilion H4.83, Montreal, QC, H3T 1E2, Canada.
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.
- Department of Psychology, McGill University, Montreal, QC, Canada.
- Department of Medicine, McGill University, Montreal, QC, Canada.
- Biomedical Ethics Unit, McGill University, Montreal, QC, Canada.
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11
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Barbacki A, Baron M, Wang M, Zhang Y, Stevens W, Sahhar J, Proudman S, Nikpour M, Man A. Damage Trajectories in Systemic Sclerosis Using Group-Based Trajectory Modeling. Arthritis Care Res (Hoboken) 2023; 75:640-647. [PMID: 35226416 DOI: 10.1002/acr.24873] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 02/11/2022] [Accepted: 02/24/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is an autoimmune disease characterized by progressive organ damage, which can be measured using the Scleroderma Clinical Trials Consortium Damage Index (SCTC-DI). We aimed to identify whether distinct trajectories of damage accrual exist and to determine which variables are associated with different trajectory groups. METHODS Incident cases of SSc (<2 years) were identified in the Australian Scleroderma Interest Group and Canadian Scleroderma Research Group prospective registries. Group-based trajectory modeling was used to identify SCTC-DI trajectories over the cohort's first 5 annual visits. Baseline variables associated with trajectory membership in a univariate analysis were examined in multivariable models. RESULTS A total of 410 patients were included. Three trajectory groups were identified: low (54.6%), medium (36.2%), and high (10.3%) damage. Patients with faster damage accrual had higher baseline SCTC-DI scores. Older age (odds ratio [OR] 1.57 [95% confidence interval (95% CI) 1.18-2.10]), male sex (OR 2.55 [95% CI 1.10-5.88]), diffuse disease (OR 6.7 [95% CI 2.57-17.48]), tendon friction rubs (OR 5.4 [95% CI 1.86-15.66]), and elevated C-reactive protein level (OR 1.98 [95% CI 1.49-2.63]) increased the odds of being in the high-damage group versus the reference (low damage), whereas White ethnicity (OR 0.31 [95% CI 0.12-0.75]) and anticentromere antibodies (OR 0.24 [95% CI 0.07-0.77]) decreased the odds. CONCLUSION We identified 3 trajectories of damage accrual in a combined incident SSc cohort. Several characteristics increased the odds of belonging to worse trajectories. These findings may be helpful in recognizing patients in whom early aggressive treatment is necessary.
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Affiliation(s)
- Ariane Barbacki
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Murray Baron
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Mianbo Wang
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Yuqing Zhang
- Massachusetts General Hospital, Harvard Medical School, Boston
| | - Wendy Stevens
- St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | | | - Susanna Proudman
- Royal Adelaide Hospital, North Terrace, Adelaide, South Australia
| | - Mandana Nikpour
- University of Melbourne at St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Ada Man
- University of Manitoba, Winnipeg, Manitoba, Canada
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12
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Renaud L, Waldrep KM, da Silveira WA, Pilewski JM, Feghali-Bostwick CA. First Characterization of the Transcriptome of Lung Fibroblasts of SSc Patients and Healthy Donors of African Ancestry. Int J Mol Sci 2023; 24:3645. [PMID: 36835058 PMCID: PMC9966000 DOI: 10.3390/ijms24043645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/25/2023] [Accepted: 02/04/2023] [Indexed: 02/16/2023] Open
Abstract
Systemic sclerosis (SSc) is a connective tissue disorder that results in fibrosis of the skin and visceral organs. SSc-associated pulmonary fibrosis (SSc-PF) is the leading cause of death amongst SSc patients. Racial disparity is noted in SSc as African Americans (AA) have a higher frequency and severity of disease than European Americans (EA). Using RNAseq, we determined differentially expressed genes (DEGs; q < 0.1, log2FC > |0.6|) in primary pulmonary fibroblasts from SSc lungs (SScL) and normal lungs (NL) of AA and EA patients to characterize the unique transcriptomic signatures of AA-NL and AA-SScL fibroblasts using systems-level analysis. We identified 69 DEGs in "AA-NL vs. EA-NL" and 384 DEGs in "AA-SScL vs. EA-SScL" analyses, and a comparison of disease mechanisms revealed that only 7.5% of DEGs were commonly deregulated in AA and EA patients. Surprisingly, we also identified an SSc-like signature in AA-NL fibroblasts. Our data highlight differences in disease mechanisms between AA and EA SScL fibroblasts and suggest that AA-NL fibroblasts are in a "pre-fibrosis" state, poised to respond to potential fibrotic triggers. The DEGs and pathways identified in our study provide a wealth of novel targets to better understand disease mechanisms leading to racial disparity in SSc-PF and develop more effective and personalized therapies.
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Affiliation(s)
- Ludivine Renaud
- Department of Medicine, Rheumatology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Kristy M. Waldrep
- Department of Medicine, Rheumatology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Willian A. da Silveira
- Department of Biological Sciences, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - Joseph M. Pilewski
- Department of Medicine, Pulmonary, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Carol A. Feghali-Bostwick
- Department of Medicine, Rheumatology, Medical University of South Carolina, Charleston, SC 29425, USA
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13
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Singh RR, Singh DR, Yen EY. Worsening premature death burden gap from systemic sclerosis in men and black persons: A US nationwide population-based study. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2023; 8:20-26. [PMID: 36743809 PMCID: PMC9896199 DOI: 10.1177/23971983221140538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/25/2022] [Indexed: 12/13/2022]
Abstract
Objective Male sex and black race incur poor prognosis in systemic sclerosis (SSc). There is no nationwide population-based assessment of premature SSc death burden by sex and race. Methods This is a population-based study comprising all recorded SSc deaths across the United States. We constructed histograms depicting the number of SSc deaths for each age by sex and race, and calculated the cumulative percent death at each age and the median age of death. We determined the odds ratios for the risk of premature death from SSc by sex and race. We then calculated the percent of total SSc deaths for different age groups by sex and race from 1970 to 2015. We performed chi-square test with Yates's correction and quantified the odds ratio (OR) with 95% confidence interval (CI). Results The median age of SSc death was 63 years in males versus 68 years in females, and 57 years in blacks versus 70 years in whites. The odds for SSc death before 65 years age was 1.8 (95% CI, 1.6-2.0) for males compared with females and 5.1 (95% CI, 4.4-6.0) for blacks compared with whites. The higher odds for premature death in males than in females was similar for both races. Differences in the proportions of premature deaths from 1970 to 2015 increased between males and females (-5% to 17%) and between blacks and whites (14% to 36%). Conclusion Males and black persons die of SSc at younger ages. The worsening premature death burden gap between the two sexes and races over the last five decades is troublesome.
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Affiliation(s)
- Ram Raj Singh
- Autoimmunity and Tolerance Laboratory,
Division of Rheumatology, Department of Medicine, University of California at Los
Angeles (UCLA), David Geffen School of Medicine, Los Angeles, CA, USA
- Molecular Toxicology Interdepartmental
Program, University of California at Los Angeles (UCLA), Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center,
University of California at Los Angeles (UCLA), Los Angeles, CA, USA
- Department of Pathology and Laboratory
Medicine, University of California at Los Angeles (UCLA), Los Angeles, CA, USA
- Ram Raj Singh, Autoimmunity and Tolerance
Laboratory, Division of Rheumatology, Department of Medicine, University of
California at Los Angeles (UCLA), David Geffen School of Medicine, 1000 Veteran
Avenue, Room 32-59, Los Angeles, CA 90095-1670, USA.
| | - Devanshu R Singh
- Autoimmunity and Tolerance Laboratory,
Division of Rheumatology, Department of Medicine, University of California at Los
Angeles (UCLA), David Geffen School of Medicine, Los Angeles, CA, USA
- Johns Hopkins Whiting School of
Engineering, Baltimore, MD, USA
| | - Eric Y Yen
- Autoimmunity and Tolerance Laboratory,
Division of Rheumatology, Department of Medicine, University of California at Los
Angeles (UCLA), David Geffen School of Medicine, Los Angeles, CA, USA
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14
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García-Carrasco M, Mendoza-Pinto C, Etchegaray-Morales I, Munguía-Realpozo P, Osorio-Peña ÁD, Navarro-Milán O, Montiel-Jarquín ÁJ, Ayón-Aguilar J, Méndez-Martínez S. Temporal Trends in Mortality in Patients with Systemic Sclerosis in Public Hospitals Across Mexico from 1998-2017. Arch Med Res 2022; 53:610-616. [PMID: 36038446 DOI: 10.1016/j.arcmed.2022.07.005] [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: 04/27/2022] [Revised: 06/05/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate national temporal trends over time in mortality rates in patients with systemic sclerosis (SSc) in Mexico between 1998 and 2017. METHODS Deaths between 1998 and 2017 were extracted from General Board of Health Information (DGIS) Open Access datasets. 2We identified all persons aged ≥15 years with a diagnosis of SSc (ICD-10 code M34). We calculated the age-standardized mortality rate (ASMR) for SSc and non-SSc (information provided by the National Institute of Statistics, Geography, and Informatics). A Joinpoint regression model was used to determine mortality trends by sex and geographic regions. Annual percentage change (APC) and average APC (AAPC) were calculated using Joinpoint analysis. RESULTS From 1998 to 2017, the overall ASMR of SSc increased (AAPC = 2.5%), whereas the ASMR for non-SSc remained stable. By subpopulations, females, and males with SSc had a significant uptrend in the ASMR (APC = 4.6 and 4.4%, respectively), between 1998 and 2008 for the former and between 1998 and 2010 for the later. Females had a non-significant ASMR uptrend between 2008 and 2017 and males a non-significant ASMR decline between 2010 and 2017. Women had a higher SSc-ASMR to non-SSc-ASMR ratio than males. The relative cumulative change between 1998 and 2017 differed between females (78.1%) and males (50.8%), and residents of the Southern region had the largest cumulative change (147.8%). CONCLUSIONS SSc mortality rate increased in Mexico between 1998 to 2017, with SSc mortality higher than non-SSc mortality. However, the SSc mortality rate steeply increased in the first ten years but has plateaued in the last 10 years of the study period. Variations by sex and geographic regions were also identified.
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Affiliation(s)
- Mario García-Carrasco
- Departamento de Reumatología, Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla, México
| | - Claudia Mendoza-Pinto
- Departamento de Reumatología, Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla, México; Unidad de Investigación de Enfermedades Autoinmunes Sistémicas, Unidad Médica de Alta Especialidad, Hospital de Especialidades-Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Puebla, México
| | - Ivet Etchegaray-Morales
- Departamento de Reumatología, Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla, México.
| | - Pamela Munguía-Realpozo
- Departamento de Reumatología, Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla, México; Unidad de Investigación de Enfermedades Autoinmunes Sistémicas, Unidad Médica de Alta Especialidad, Hospital de Especialidades-Centro de Investigación Biomédica de Oriente, Instituto Mexicano del Seguro Social, Puebla, México
| | - Ángel David Osorio-Peña
- Departamento de Reumatología, Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla, México
| | - Olivia Navarro-Milán
- Departamento de Reumatología, Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla, México
| | - Álvaro José Montiel-Jarquín
- Dirección de Educación e Investigación en Salud, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Instituto Mexicano del Seguro Social, Puebla, México
| | - Jorge Ayón-Aguilar
- Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Puebla, México
| | - Socorro Méndez-Martínez
- Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social, Puebla, México
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15
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Cavazzana I, Vojinovic T, Airo' P, Fredi M, Ceribelli A, Pedretti E, Lazzaroni MG, Garrafa E, Franceschini F. Systemic Sclerosis-Specific Antibodies: Novel and Classical Biomarkers. Clin Rev Allergy Immunol 2022; 64:412-430. [PMID: 35716254 PMCID: PMC10167150 DOI: 10.1007/s12016-022-08946-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/28/2022]
Abstract
Disease-specific autoantibodies are considered the most important biomarkers for systemic sclerosis (SSc), due to their ability to stratify patients with different severity and prognosis. Anti-nuclear antibodies (ANA), occurring in subjects with isolated Raynuad's phenomenon, are considered the strongest independent predictors of definite SSc and digital microvascular damage, as observed by nailfold videocapillaroscopy. ANA are present in more than 90% of SSc, but ANA negativity does not exclude SSc diagnosis: a little rate of SSc ANA negative exists and shows a distinct subtype of disease, with less vasculopathy, but more frequent lower gastrointestinal involvement and severe disease course. Anti-centromere, anti-Th/To, and anti-Topoisomerase I antibodies could be considered as classical biomarkers, covering about 60% of SSc and defining patients with well-described cardio-pulmonary complications. In particular, anti-Topoisomerase I represent a risk factor for development of diffuse cutaneous involvement and digital ulcers in the first 3 years of disease, as well as severe interstitial lung disease (ILD). Anti-RNA polymerase III is a biomarker with new clinical implications: very rapid skin thickness progression, gastric antral vascular ectasia, the occurrence of synchronous cancers, and possible association with silicone breast implants rupture. Moreover, novel SSc specific autoantibodies have been globally described in about 10% of "seronegative" SSc patients: anti-elF2B, anti-RuvBL1/2 complex, anti-U11/U12 RNP, and anti-BICD2 depict specific SSc subtypes with severe organ complications. Many autoantibodies could be considered markers of overlap syndromes, including SSc. Anti-Ku are found in 2-7% of SSc, strictly defining the PM/SSc overlap. They are associated with synovitis, joint contractures, myositis, and negatively associated with vascular manifestation of disease. Anti-U3RNP are associated with a well-defined clinical phenotype: Afro-Caribbean male patients, younger at diagnosis, and higher risk of pulmonary hypertension and gastrointestinal involvement. Anti-PM/Scl define SSc patients with high frequency of ILD, calcinosis, dermatomyositis skin changes, and severe myositis. The accurate detection of autoantibodies SSc specific and associated with overlap syndromes is crucial for patients' stratification. ANA should be correctly identified using indirect immunofluorescent assay and a standardized way of patterns' interpretation. The gold-standard technique for autoantibodies' identification in SSc is still considered immunoprecipitation, for its high sensitivity and specificity, but other assays have been widely used in routine practice. The identification of SSc autoantibodies with high diagnostic specificity and high predictive value is mandatory for early diagnosis, a specific follow-up and the possible definition of the best therapy for every SSc subsets. In addition, the validation of novel autoantibodies is mandatory in wider cohorts in order to restrict the gap of so-called seronegative SSc patients.
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Affiliation(s)
- Ilaria Cavazzana
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, piazzale Spedali Civili 1, Brescia, 25123, Italy.
| | - Tamara Vojinovic
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, piazzale Spedali Civili 1, Brescia, 25123, Italy
| | - Paolo Airo'
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, piazzale Spedali Civili 1, Brescia, 25123, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, piazzale Spedali Civili 1, Brescia, 25123, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Angela Ceribelli
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Eleonora Pedretti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Grazia Lazzaroni
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, piazzale Spedali Civili 1, Brescia, 25123, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Emirena Garrafa
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Department of Laboratory Diagnostics, ASST Spedali Civili, Brescia, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, piazzale Spedali Civili 1, Brescia, 25123, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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16
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Palomino L, Gaffo A, Sun D, Sattui SE. Clinical Features of ANCA-Associated Vasculitis in African American Patients in the United States: A Single-Center Medical Records Review Study. J Clin Rheumatol 2022; 28:212-216. [PMID: 35319534 DOI: 10.1097/rhu.0000000000001838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE The aim of this study was to compare the clinical features at presentation of ANCA-associated vasculitis (AAV) between African American (AA) and White patients. METHODS This is a chart review of cases between January 2003 and December 2018. African American patients with AAV were identified and matched in a 1:2 ratio with White comparators based on the year of diagnosis (±4 years). Data on demographics, clinical, and laboratory features and outcomes at presentation were collected. Descriptive statistics were used to compare the characteristics between groups. RESULTS Thirty-two of 56 AA patients with AAV had complete data and were included for analysis. When compared with 64 matched White patients with AAV, AA patients were younger (47.5 vs 61.0 years, p = 0.001). Compared with White patients, AA patients with granulomatosis with polyangiitis (GPA) (35 vs 55 years, p = 0.0006) and microscopic polyangiitis (MPA) (55.5 vs 65.0 years, p = 0.05) were younger. African American patients with GPA were more frequently female (p = 0.008), whereas AA patients with MPA were more frequently male (p = 0.03). No differences in disease manifestations, disease activity, and outcomes were observed between AA and White patients with AAV. CONCLUSIONS In this single-center study, AA patients with AAV were diagnosed at a younger age than Whites; this was found in both the GPA and MPA disease phenotypes. No other significant differences were observed. Future studies are needed to confirm our findings and better describe differences of AAV in racial/ethnic minorities.
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Affiliation(s)
- Luis Palomino
- From the Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina at Chapel Hill, NC
| | | | - Dongmei Sun
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham
| | - Sebastian E Sattui
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
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17
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Castelino FV, VanBuren JM, Startup E, Assassi S, Bernstein EJ, Chung L, Correia C, Evnin LB, Frech TM, Gordon JK, Hant FN, Hummers LK, Khanna D, Sandorfi N, Shah AA, Shanmugam VK, Steen V. Baseline characteristics of systemic sclerosis patients with restrictive lung disease in a multi-center US-based longitudinal registry. Int J Rheum Dis 2022; 25:163-174. [PMID: 34841681 DOI: 10.1111/1756-185x.14253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 11/29/2022]
Abstract
AIM Interstitial lung disease (ILD) is the leading cause of disease-related death in systemic sclerosis (SSc). Here, we assess baseline characteristics of SSc subjects with and without restrictive lung disease (RLD) in a multi-center, US-based registry. METHODS SSc patients within 5 years of disease onset were enrolled in the Collaborative National Quality and Efficacy Registry (CONQUER), a multi-center US-based registry of SSc study participants (age ≥ 18 years) enrolled at 13 expert centers. All subjects met 2013 American College of Rheumatology / European League Against Rheumatism criteria. Subjects with a pulmonary function test (PFT) at baseline before April 1, 2020 were included. High-resolution computed tomography scan of the chest was not available to characterize ILD for all subjects. RLD was defined as forced vital capacity (FVC) <80% or total lung capacity (TLC) <80% predicted. RESULTS There were 160 (45%) SSc subjects characterized as having RLD. There was no significant difference in age, gender or disease duration. RLD subjects had a mean disease duration from date of first non-Raynaud's symptom of 2.6 years and a mean FVC% predicted of 67% at baseline. In multivariable analysis, non-White race, higher physician global health assessment and modified Medical Research Council (mMRC) dyspnea scores, were independently associated with RLD. In the subgroup of RLD subjects with ILD, ILD had a negative correlation with RNA polymerase III antibody. CONCLUSION CONQUER is the largest, multi-center, prospective cohort of early SSc patients in the US. Non-White race was independently associated with RLD. In addition, 45% of CONQUER subjects already had RLD, highlighting the importance of screening for SSc-ILD at initial diagnosis.
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Affiliation(s)
- Flavia V Castelino
- Division of Rheumatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John M VanBuren
- Department or Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Emily Startup
- Department or Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Shervin Assassi
- The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Elana J Bernstein
- Division of Rheumatology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Lorinda Chung
- Division of Rheumatology, Department of Medicine and Dermatology, Stanford University and Palo Alto Veterans Affairs Health Care System, Stanford, California, USA
| | - Chase Correia
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Luke B Evnin
- Scleroderma Research Foundation, San Francisco, California, USA
| | - Tracy M Frech
- Division of Rheumatology, Department of Internal Medicine, University of Utah and Salt Lake Veterans Affair Medical Center, Salt Lake City, Utah, USA
| | | | - Faye N Hant
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Laura K Hummers
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dinesh Khanna
- University of Michigan Scleroderma Program, Ann Arbor, Michigan, USA
| | - Nora Sandorfi
- Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ami A Shah
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Victoria K Shanmugam
- Division of Rheumatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Virginia Steen
- Georgetown University School of Medicine, Washington, District of Columbia, USA
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18
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Sibanda EN, Dube Y, Chakawa M, Mduluza T, Mutapi F. Systemic Sclerosis in Zimbabwe: Autoantibody Biomarkers, Clinical, and Laboratory Correlates. Front Immunol 2021; 12:679531. [PMID: 34858387 PMCID: PMC8631108 DOI: 10.3389/fimmu.2021.679531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 09/30/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Systemic sclerosis (SScl) is an autoimmune disease whose prevalence is rarely reported in Africa. Autoantibodies are the biomarkers of the condition, precede overt disease and determine disease phenotypes. SSc specific autoantibodies also vary between racial groupings. Objective: To investigate the clinical and laboratory characteristics of Zimbabwean patients who were reactive SSc specific autoantibodies. Materials and Method 240 patients, 173 of them female with SSc specific autoantibodies were included. Autoantibodies were detected by indirect immunofluorescence microscopy and immunoblotting using a panel of 13 SScl (Euroimmun Ag., Germany). Demographic, clinical and laboratory parameters relevant to the monitoring of SScl were captured. These included pulmonary function tests, hematology, clinical chemistry, serology and thyroid function tests. Allergy skin prick tests (SPT) to inhalant and food allergen sources were conducted when indicated. Results All the 240 patients (median age was 36 years) expressed SSc specific autoantibodies. 86% were Black, 11% White and 3% Asian and a fifth (20%) were younger than 16 years. Eleven (4.6%) fulfilled the ACR/EULAR classification of SSc. Clinically they had limited cutaneous (n=6), diffuse cutaneous (n=3) and SScl/inflammatory myopathy overlap (n=2). The most frequently detected antibodies anti-RNA polymerase III (RNAP) 55%, anti-Th/To (28%) anti-RNAP 11 (22%), anti-CENPB (18%) and anti-Scl-70/ATA (13%). Racial variations in the expression of these antibodies were apparent between Black, White and Asian patients. The majority (95%), who did not fulfil the ARA/EULAR criteria were symptomatic. Raynaud’s Phenomenon was documented in 24%. Respiratory symptoms included coughing, dyspnea and wheezing. There was a restrictive ventilatory defect with increased FEV1/FVC ratio. Pruritus, urticaria and skin depigmentation were the main cutaneous features while constipation, bloating, Gastroesophageal reflux disease (GERD) and abdominal pain dominated GI symptoms. Mean blood pressure readings while normal varied with biomarkers. Haematology and biochemistry parameters were within normal reference ranges. Conclusion The expression of SSc specific autoantibodies is common and associated with known SSc symptoms. The types and frequency of autoantibodies varied with racial groupings. A fifth of the patients were children below the age of 16 years.
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Affiliation(s)
- Elopy N Sibanda
- Department of Pathology, Faculty of Medicine, National University of Science and Technology, Bulawayo, Zimbabwe.,Asthma Allergy and Immunology Clinic, Harare, Zimbabwe.,Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Yvonne Dube
- Laboratory Section, Asthma Allergy and Immunology Clinic, Harare, Zimbabwe
| | - Mazvita Chakawa
- Department of Biochemistry, University of Zimbabwe, Harare, Zimbabwe
| | - Takafira Mduluza
- Department of Biochemistry, University of Zimbabwe, Harare, Zimbabwe
| | - Francisca Mutapi
- Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
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19
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Rivas-Vargas D, Snih SA, Rodríguez MA. Characterization of Venezuelan patients with systemic sclerosis: a study in a tertiary hospital in Caracas. REUMATOLOGIA CLINICA 2021; 17:601-606. [PMID: 34823828 DOI: 10.1016/j.reumae.2020.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 06/24/2020] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim of the study was to investigate the demographic and clinical characteristics of Venezuelan patients with systemic sclerosis (SSc) seen in a tertiary hospital. METHODS Consecutive patients 18 years and older who fulfilled the 2013 ACR/EULAR classification criteria for SSc and who were followed up in the outpatient clinic of the Division of Rheumatology at the Hospital Universitario de Caracas were selected for the study. Demographic and clinical variables were registered at the time of inclusion using a standard protocol. RESULTS Forty-eight SSc patients were included; 46 (95.8%) were female; the mean age was 55.1±13.7 (mean±SD) years and all were of Hispanic ethnicity. Thirty-one (64.6%) had limited SSc and 17 (35.4%) had diffuse SSc. The mean duration of disease was 13.4±11.7 (mean±SD) years, 16.74±12.99 years for limited SSc and 7.52±5.25 years for diffuse SSc (p=0.0077). Raynaud's phenomenon was the most frequent manifestation (100%), followed by arthritis (68.8%), telangiectasia (60.4%), dyspnea (60.4%), dysphagia (58.3%) and puffy hands (56.3%). The modified Rodnan Skin Score (mRSS) and the frequency of dyspnea were higher in those with diffuse as compared to limited SSc (p=0.0211 and p=0.0003, respectively). We performed high-resolution computed tomography (HRCT) of the lungs in 31 patients; 14 (45.2%) had evidence of interstitial lung disease (ILD), 11 (68.8%) with diffuse SSc (p=0.0052). The most frequent anti-nuclear antibody pattern was nucleolar, accounting for 18 (42.8%) of the cases. Anti-centromere antibodies were present in 16.7% of the cases and were associated with the limited SSc subset (p=0.0443) and with calcinosis (p=0.0020). Anti-topoisomerase antibodies were associated with ILD (p=0.0077). CONCLUSIONS Typical clinical and serological manifestations were present in this sample of Venezuelan patients with SSc, with an expected distribution according to disease subtype. The autoantibody profile allows clinicians to identify those patients with limited forms of the disease and those without pulmonary involvement.
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Affiliation(s)
- Daniel Rivas-Vargas
- Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas, Venezuela.
| | - Soham Al Snih
- Division of Rehabilitation Sciences/School of Health Professions, Division of Geriatrics/Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Martín A Rodríguez
- Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas, Venezuela; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, United States
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20
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Abstract
Health and health care disparities in pediatric rheumatology are prevalent among socially disadvantaged and marginalized populations based on race/ethnicity, socioeconomic position, and geographic region. These groups are more likely to experience greater disease severity, morbidity, mortality, decreased quality of life, and poor mental health outcomes, which are in part due to persistent structural and institutional barriers, including decreased access to quality health care. Most of the research on health and health care disparities in pediatric rheumatology focuses on juvenile idiopathic arthritis and childhood-onset systemic lupus erythematosus; there are significant gaps in the literature assessing disparities associated with other pediatric rheumatic diseases. Understanding the underlying causes of health care disparities will ultimately inform the development and implementation of innovative policies and interventions on a federal, local, and individual level.
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Affiliation(s)
- Alisha M Akinsete
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467, USA. https://twitter.com/@akinsetemd
| | - Jennifer M P Woo
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, 111 TW Alexander Drive, Research Triangle Park, NC 27709, USA. https://twitter.com/@jmpwoo
| | - Tamar B Rubinstein
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467, USA.
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21
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Glover K, Mishra D, Singh TRR. Epidemiology of Ocular Manifestations in Autoimmune Disease. Front Immunol 2021; 12:744396. [PMID: 34795665 PMCID: PMC8593335 DOI: 10.3389/fimmu.2021.744396] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/14/2021] [Indexed: 01/19/2023] Open
Abstract
The global prevalence of autoimmune diseases is increasing. As a result, ocular complications, ranging from minor symptoms to sight-threatening scenarios, associated with autoimmune diseases have also risen. These ocular manifestations can result from the disease itself or treatments used to combat the primary autoimmune disease. This review provides detailed insights into the epidemiological factors affecting the increasing prevalence of ocular complications associated with several autoimmune disorders.
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Affiliation(s)
| | | | - Thakur Raghu Raj Singh
- School of Pharmacy, Medical Biology Centre, Queen’s University Belfast, Belfast, United Kingdom
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22
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Saketkoo LA, Frech T, Varjú C, Domsic R, Farrell J, Gordon JK, Mihai C, Sandorfi N, Shapiro L, Poole J, Volkmann ER, Lammi M, McAnally K, Alexanderson H, Pettersson H, Hant F, Kuwana M, Shah AA, Smith V, Hsu V, Kowal-Bielecka O, Assassi S, Cutolo M, Kayser C, Shanmugam VK, Vonk MC, Fligelstone K, Baldwin N, Connolly K, Ronnow A, Toth B, Suave M, Farrington S, Bernstein EJ, Crofford LJ, Czirják L, Jensen K, Hinchclif M, Hudson M, Lammi MR, Mansour J, Morgan ND, Mendoza F, Nikpour M, Pauling J, Riemekasten G, Russell AM, Scholand MB, Seigart E, Rodriguez-Reyna TS, Hummers L, Walker U, Steen V. A comprehensive framework for navigating patient care in systemic sclerosis: A global response to the need for improving the practice of diagnostic and preventive strategies in SSc. Best Pract Res Clin Rheumatol 2021; 35:101707. [PMID: 34538573 PMCID: PMC8670736 DOI: 10.1016/j.berh.2021.101707] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Systemic sclerosis (SSc), the most lethal of rheumatologic conditions, is the cause of death in >50% of SSc cases, led by pulmonary fibrosis followed by pulmonary hypertension and then scleroderma renal crisis (SRC). Multiple other preventable and treatable SSc-related vascular, cardiac, gastrointestinal, nutritional and musculoskeletal complications can lead to disability and death. Vascular injury with subsequent inflammation transforming to irreversible fibrosis and permanent damage characterizes SSc. Organ involvement is often present early in the disease course of SSc, but requires careful history-taking and vigilance in screening to detect. Inflammation is potentially reversible provided that treatment intensity quells inflammation and other immune mechanisms. In any SSc phenotype, opportunities for early treatment are prone to be under-utilized, especially in slowly progressive phenotypes that, in contrast to severe progressive ILD, indolently accrue irreversible organ damage resulting in later-stage life-limiting complications such as pulmonary hypertension, cardiac involvement, and malnutrition. A single SSc patient visit often requires much more physician and staff time, organization, vigilance, and direct management for multiple organ systems compared to other rheumatic or pulmonary diseases. Efficiency and efficacy of comprehensive SSc care enlists trending of symptoms and bio-data. Financial sustainability of SSc care benefits from understanding insurance reimbursement and health system allocation policies for complex patients. Sharing care between recognised SSc centers and local cardiology/pulmonary/rheumatology/gastroenterology colleagues may prevent complications and poor outcomes, while providing support to local specialists. As scleroderma specialists, we offer a practical framework with tools to facilitate an optimal, comprehensive and sustainable approach to SSc care. Improved health outcomes in SSc relies upon recogntion, management and, to the extent possible, prevention of SSc and treatment-related complications.
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Affiliation(s)
- Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; Tulane University School of Medicine, New Orleans, USA; Louisiana State University School of Medicine, Section of Pulmonary Medicine, New Orleans, USA; University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, USA.
| | - Tracy Frech
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cecília Varjú
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Pécs, Hungary
| | | | - Jessica Farrell
- Albany College of Pharmacy and Health Sciences, Albany, NY, USA; Steffens Scleroderma Foundation, Albany, NY, USA
| | - Jessica K Gordon
- Department of Rheumatology at Hospital for Special Surgery, New York, NY, USA
| | - Carina Mihai
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Lee Shapiro
- Steffens Scleroderma Foundation, Albany, NY, USA; Division of Rheumatology, Albany Medical Center, Albany, NY, USA
| | - Janet Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, NM, USA
| | - Elizabeth R Volkmann
- University of California, David Geffen School of Medicine, UCLA Scleroderma Program and UCLA CTD-ILD Program, Division of Rheumatology, Department of Medicine, Los Angeles, CA, USA
| | | | - Kendra McAnally
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Centre, Phoenix, AZ, USA
| | - Helene Alexanderson
- Function Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Department of Medicin, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Pettersson
- Function Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Department of Medicin, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Faye Hant
- Division of Rheumatology, Medical University of South Caroline, SC, USA
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Ami A Shah
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, and Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Vivien Hsu
- Rutgers- RWJ Scleroderma Program, New Brunswick, NJ, USA
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Shervin Assassi
- Rheumatology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic San Martino Hospital, Genova, Italy
| | - Cristiane Kayser
- Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP) São Paulo, SP, Brazil
| | - Victoria K Shanmugam
- Department of Rheumatology, George Washington University, School of Medicine and Health Sciences, Washington, DC, USA
| | - Madelon C Vonk
- Department of the rheumatic diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kim Fligelstone
- Patient Research Partner, Scleroderma & Raynaud Society UK (SRUK), London, UK; Royal Free Hospital, London, UK
| | - Nancy Baldwin
- Patient Research Partner, Scleroderma Foundation, Chicago, IL, USA
| | | | - Anneliese Ronnow
- Federation of European Scleroderma Associations, Copenhagen, Denmark; Federation of European Scleroderma Associations, Budapest, Hungary; Federation of European Scleroderma Associations, London, UK
| | - Beata Toth
- Federation of European Scleroderma Associations, Copenhagen, Denmark; Federation of European Scleroderma Associations, Budapest, Hungary; Federation of European Scleroderma Associations, London, UK
| | | | - Sue Farrington
- Patient Research Partner, Scleroderma & Raynaud Society UK (SRUK), London, UK; Federation of European Scleroderma Associations, Copenhagen, Denmark; Federation of European Scleroderma Associations, Budapest, Hungary; Federation of European Scleroderma Associations, London, UK
| | - Elana J Bernstein
- Columbia University/New York-Presbyterian Scleroderma Program, Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | - László Czirják
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Pécs, Hungary
| | - Kelly Jensen
- Tulane University School of Medicine, New Orleans, USA; Oregon Health and Science University, Portland, OR, USA
| | - Monique Hinchclif
- Yale School of Medicine, Department of Internal Medicine, Section of Rheumatology, Allergy & Immunology, USA
| | - Marie Hudson
- Division of heumatology and Department of Medicine, Jewish General Hospital and McGill University, Montreal, QC, Canada
| | - Matthew R Lammi
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; Louisiana State University School of Medicine, Section of Pulmonary Medicine, New Orleans, USA; University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, USA
| | | | - Nadia D Morgan
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Fabian Mendoza
- Rheumatology Division, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mandana Nikpour
- Jefferson Institute of Molecular Medicine and Scleroderma Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - John Pauling
- University of Melbourne, Melbourne at St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Gabriela Riemekasten
- Royal National Hospital for Rheumatic Diseases, Bath, UK; University of Lübeck, University Clinic of Schleswig-Holstein, Dept Rheumatology and Clinical Immunology, Lübeck, Germany
| | | | - Mary Beth Scholand
- University of Utah, Division of Pulmonary Medicine, Pulmonary Fibrosis Center, Salt Lake City, UT, USA
| | - Elise Seigart
- Department of Rheumatology and Clinical Immunology Charité - Universitätsmedizin Berlin and Berlin Institute of Health, Berlin, Germany
| | | | - Laura Hummers
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ulrich Walker
- Dept. of Rheumatology, Basel University Hospital, Basel, Switzerland
| | - Virginia Steen
- Division of Rheumatology, Department of Medicine, Georgetown University, Washington, DC, USA
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23
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Insights Into Systemic Sclerosis from Gene Expression Profiling. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2021. [DOI: 10.1007/s40674-021-00183-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Wilfong EM, Vowell KN, Bunn KE, Rizzi E, Annapureddy N, Dudenhofer RB, Barnado A, Bonami RH, Johnson JE, Crofford LJ, Kendall PL. CD19 + CD21 lo/neg cells are increased in systemic sclerosis-associated interstitial lung disease. Clin Exp Med 2021; 22:209-220. [PMID: 34374937 PMCID: PMC8828801 DOI: 10.1007/s10238-021-00745-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/12/2021] [Indexed: 12/17/2022]
Abstract
Interstitial lung disease (ILD) represents a significant cause of morbidity and mortality in systemic sclerosis (SSc). The purpose of this study was to examine recirculating lymphocytes from SSc patients for potential biomarkers of interstitial lung disease (ILD). Peripheral blood mononuclear cells (PBMCs) were isolated from patients with SSc and healthy controls enrolled in the Vanderbilt University Myositis and Scleroderma Treatment Initiative Center cohort between 9/2017–6/2019. Clinical phenotyping was performed by chart abstraction. Immunophenotyping was performed using both mass cytometry and fluorescence cytometry combined with t-distributed stochastic neighbor embedding analysis and traditional biaxial gating. This study included 34 patients with SSc-ILD, 14 patients without SSc-ILD, and 25 healthy controls. CD21lo/neg cells are significantly increased in SSc-ILD but not in SSc without ILD (15.4 ± 13.3% vs. 5.8 ± 0.9%, p = 0.002) or healthy controls (5.0 ± 0.5%, p < 0.0001). While CD21lo/neg B cells can be identified from a single biaxial gate, tSNE analysis reveals that the biaxial gate is comprised of multiple distinct subsets, all of which are increased in SSc-ILD. CD21lo/neg cells in both healthy controls and SSc-ILD are predominantly tBET positive and do not have intracellular CD21. Immunohistochemistry staining demonstrated that CD21lo/neg B cells diffusely infiltrate the lung parenchyma of an SSc-ILD patient. Additional work is needed to validate this biomarker in larger cohorts and longitudinal studies and to understand the role of these cells in SSc-ILD.
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Affiliation(s)
- Erin M Wilfong
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA.,Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katherine N Vowell
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kaitlyn E Bunn
- Deparment of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elise Rizzi
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Narender Annapureddy
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rosemarie B Dudenhofer
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - April Barnado
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rachel H Bonami
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.,Deparment of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Institute for Infection, Immunology, and Inflammation, Nashville, TN, USA
| | - Joyce E Johnson
- Deparment of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leslie J Crofford
- Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.,Deparment of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Institute for Infection, Immunology, and Inflammation, Nashville, TN, USA
| | - Peggy L Kendall
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA. .,Deparment of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA. .,Vanderbilt Institute for Infection, Immunology, and Inflammation, Nashville, TN, USA. .,Division of Allergy and Immunology, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8122, St. Louis, MO, 63110, USA.
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25
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Discepola MN, Carboni-Jiménez A, Kwakkenbos L, Henry RS, Boruff J, Krishnan A, Boström C, Culos-Reed SN, Hudson M, Leader DM, Mattsson M, Mouthon L, Wojeck R, Yakes Jimenez E, Sauve M, Welling J, Guillot G, Benedetti A, Thombs BD. Effects of non-pharmacological and non-surgical interventions on health outcomes in systemic sclerosis: protocol for a living systematic review. BMJ Open 2021; 11:e047428. [PMID: 33947738 PMCID: PMC8098987 DOI: 10.1136/bmjopen-2020-047428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Systemic sclerosis (SSc; scleroderma) is a rare, chronic, autoimmune disease with a high level of burden, a significant impact on the ability to carry out daily activities, and a considerable negative impact on health-related quality of life. Non-pharmacological interventions could be provided to potentially improve mental and physical health outcomes. However, the effectiveness of non-pharmacological interventions on health and well-being among individuals with SSc has not been well established. The proposed living systematic review aims to identify and evaluate randomised controlled trial (RCT) evidence on the effectiveness of non-pharmacological and non-surgical interventions on mental and physical health outcomes and on the delivery of such services in SSc. METHODS AND ANALYSIS Eligible studies will be RCTs that examine non-pharmacological and non-surgical interventions aimed at improving health outcomes among individuals with SSc or the delivery of services intended to improve healthcare or support of people with SSc (eg, support groups). All RCTs included in a previous systematic review that sought studies published between 1990 and March 2014 will be evaluated for inclusion. Additional trials will be sought from January 2014 onwards using a similar, augmented search strategy developed by a health sciences librarian. We will search the MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library and Web of Science databases and will not restrict by language. Two independent reviewers will determine the eligibility of identified RCTs and will extract data using a prespecified standardised form in DistillerSR. Meta-analyses will be considered if ≥2 eligible RCTs report similar non-pharmacological interventions and comparable health outcomes. We will conduct a qualitative synthesis for interventions that cannot be synthesised via meta-analysis. ETHICS AND DISSEMINATION We will post initial and ongoing results via a website, publish results periodically via peer-reviewed journal publication, and present results at patient-oriented events. PROSPERO REGISTRATION NUMBER CRD42020219914.
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Affiliation(s)
- Marie-Nicole Discepola
- Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Andrea Carboni-Jiménez
- Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Linda Kwakkenbos
- Department of Clinical Psychology, Behavioural Science Institute, Radboud Universiteit, Nijmegen, The Netherlands
| | - Richard S Henry
- Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Jill Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada
| | - Ankur Krishnan
- Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
| | - Carina Boström
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | | | - Marie Hudson
- Department of Medicine, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - David M Leader
- Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Malin Mattsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Department of Physiotherapy, Sunderby Hospital, Lulea, Sweden
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares d'Ile de France, Hopital Cochin Assistance Publique - Hôpitaux de Paris (APHP), Paris, France
- APHP-CUP, Hôpital Cochin, Université de Paris, Paris, France
| | - Robyn Wojeck
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Elizabeth Yakes Jimenez
- Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico, Albuquerque, California, USA
| | - Maureen Sauve
- Scleroderma Societies of Canada and Ontario, Hamilton, Ontario, Canada
| | - Joep Welling
- FESCA Patient Research Partner, Utrecht, The Netherlands
| | | | - Andrea Benedetti
- Department of Medicine, McGill University Faculty of Medicine, Montreal, Quebec, Canada
- Departments of Medicine and of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada
| | - Brett D Thombs
- Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Department of Medicine, McGill University Faculty of Medicine, Montreal, Quebec, Canada
- Departments of Medicine and of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
- Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada
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26
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Harb S, Peláez S, Carrier ME, Kwakkenbos L, Bartlett SJ, Hudson M, Mouthon L, Sauvé M, Welling J, Shrier I, Thombs BD. Barriers and facilitators to physical activity for people with scleroderma: a Scleroderma Patient-centered Intervention Network (SPIN) Cohort study. Arthritis Care Res (Hoboken) 2021; 74:1300-1310. [PMID: 33527717 DOI: 10.1002/acr.24567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/22/2020] [Accepted: 01/28/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To support physical activity among people with systemic sclerosis (SSc; scleroderma), we sought to determine the (1) prevalence and importance of barriers and (2) likelihood of using possible facilitators. METHODS We invited 1,707 participants from an international SSc cohort to rate the (1) importance of 20 barriers (14 medical; 4 social or personal; 1 lifestyle; 1 environmental); and (2) likelihood of using 91 corresponding barrier-specific and 12 general facilitators. RESULTS Among 721 respondents, 13 barriers were experienced by ≥25% of participants, including 2 (fatigue, Raynaud's) rated 'important' or 'very important' by ≥50% of participants, 7 (joint stiffness and contractures, shortness of breath, gastrointestinal problems, difficulty grasping, pain, muscle weakness and mobility limitations, low motivation) by 26-50%, and 4 by <26%. Overall, 23 (18 medical-related) of 103 facilitators were rated by ≥75% as 'likely' or 'very likely' to use among those who experienced corresponding barriers; these facilitators focused on adapting exercise (e.g., using controlled, slow movement), taking care of one's body (e.g., stretching), keeping warm (e.g., wearing gloves), and protecting skin (e.g., covering ulcers). Among those who had previously tried the facilitator, all facilitators were rated by ≥50% as 'likely' or 'very likely' to use; among those with the barrier who had not tried the facilitator, only 12 of 103 were rated by >50% as 'likely' or 'very likely'. CONCLUSION Medical-related physical activity barriers were common and considered important. Facilitators considered as most likely to be used involved adapting exercise, taking care of one's body, keeping warm, and protecting skin.
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Affiliation(s)
- Sami Harb
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada, Quebec.,Department of Psychiatry, McGill University, Montreal, Canada, Quebec
| | - Sandra Peláez
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada, Quebec.,Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada, Quebec
| | - Linda Kwakkenbos
- Behavioural Science Institute, Clinical Psychology, Radboud University, Nijmegen, the Netherlands
| | - Susan J Bartlett
- Department of Medicine, McGill University, Montreal, Canada, Quebec
| | - Marie Hudson
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada, Quebec.,Department of Medicine, McGill University, Montreal, Canada, Quebec
| | - Luc Mouthon
- Assistance Publique - Hôpitaux de Paris, Université Paris Descartes, Paris, France.,Service de Médecine Interne, Hôpital Cohin, Paris, France
| | - Maureen Sauvé
- Scleroderma Canada and Scleroderma Society of Ontario, Hamilton, Canada, Ontario
| | - Joep Welling
- Federation of European Scleroderma Associations, Brussels, Belgium
| | - Ian Shrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada, Quebec
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada, Quebec.,Department of Psychiatry, McGill University, Montreal, Canada, Quebec.,Department of Medicine, McGill University, Montreal, Canada, Quebec.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada, Quebec.,Department of Psychology, McGill University, Montreal, Canada, Quebec.,Department of Educational and Counselling Psychology, McGill University, Montreal, Canada.,Biomedical Ethics Unit, McGill University, Montreal, Canada
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Moore DF, Steen VD. Overall mortality. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2021; 6:3-10. [PMID: 35382244 PMCID: PMC8922633 DOI: 10.1177/2397198320924873] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/14/2020] [Indexed: 11/30/2023]
Abstract
Systemic sclerosis is a highly morbid, complex autoimmune disease that is variable both in its phenotype and the attendant mortality driven by such manifestations. This review article synthesizes mortality data from the best available meta-analyses, subgroup analyses of single cohorts, and subjective comparisons of individual cohort studies, which in aggregate suggest that mortality in systemic sclerosis has been gradually improving over the past several decades. This review also summarizes the literature describing various risk factors for mortality in systemic sclerosis.
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Affiliation(s)
- Duncan F Moore
- Division of Rheumatology, Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Virginia D Steen
- Division of Rheumatology, Department of Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
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Volkmann ER, Steen V, Li N, Roth MD, Clements PJ, Furst DE, Assassi S, Khanna D, Kim GHJ, Goldin J, Elashoff RM, Tashkin DP. Racial Disparities in Systemic Sclerosis: Short- and Long-Term Outcomes Among African American Participants of SLS I and II. ACR Open Rheumatol 2020; 3:8-16. [PMID: 33277978 PMCID: PMC7811695 DOI: 10.1002/acr2.11206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/28/2020] [Indexed: 11/26/2022] Open
Abstract
Objective To evaluate short‐ and long‐term outcomes of African American (AA) participants of Scleroderma Lung Studies (SLS) I and II. Methods SLS I randomized 158 participants with systemic sclerosis‐interstitial lung disease (SSc‐ILD) to 1 year of oral cyclophosphamide (CYC) versus placebo. SLS II randomized 142 participants with SSc‐ILD to 1 year of oral CYC followed by 1 year of placebo versus 2 years of mycophenolate (MMF). Joint models compared the course of forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO) between AA and non‐AA, and Cox proportional hazard models assessed long‐term morbidity and mortality outcomes. Results In SLS I, there was no difference in the course of the FVC or DLCO between AA and non‐AA in either treatment arm. In SLS II, AA had an improved course of the FVC compared with non‐AA in the CYC arm; in the MMF arm, there was no difference in FVC course. There was no difference in DLCO course in either arm. Time to death and respiratory failure were similar for AA and non‐AA in SLS I. There was a trend for improved survival and time to respiratory failure in AA compared with non‐AA in SLS II. AA race was not independently associated with mortality in the SLS I or II in the Cox models. Conclusion Data from two randomized controlled trials demonstrated that AA patients with SSc‐ILD have similar morbidity and mortality outcomes compared with non‐AA patients. These findings contrast with the racial disparities described in prior observational studies and warrant further investigation.
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Affiliation(s)
| | | | - Ning Li
- University of California, Los Angeles
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29
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Lanata CM, Blazer A, Criswell LA. The Contribution of Genetics and Epigenetics to Our Understanding of Health Disparities in Rheumatic Diseases. Rheum Dis Clin North Am 2020; 47:65-81. [PMID: 34042055 DOI: 10.1016/j.rdc.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Socioeconomic determinants of health are associated with worse outcomes in the rheumatic diseases and contribute significantly to health disparities. However, genetic and epigenetic risk factors may affect different populations disproportionally and further exacerbate health disparities. We discuss the role of genetics and epigenetics to the health disparities observed in rheumatic diseases. We review concepts of population genetics and natural selection, current genome-wide genetic and epigenetic studies of several autoimmune diseases, and environmental exposures associated with disease risk in different populations. To understand how genomics influence health disparities in the rheumatic diseases, further studies in different populations worldwide are needed.
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Affiliation(s)
- Cristina M Lanata
- Russell/Engleman Rheumatology Research Center, University of California, San Francisco, 513 Parnassus Avenue, MSB S865, San Francisco, CA, USA
| | - Ashira Blazer
- Department of Medicine, Division of Rheumatology, NYU Langone Health, 550 1st Avenue, MSB 606, New York, NY 10029, USA
| | - Lindsey A Criswell
- Russell/Engleman Rheumatology Research Center, University of California, San Francisco, 513 Parnassus Avenue, MSB S864, San Francisco, CA, USA.
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30
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Rivas-Vargas D, Snih SA, Rodríguez MA. Characterization of Venezuelan Patients With Systemic Sclerosis: A Study in a Tertiary Hospital in Caracas. REUMATOLOGIA CLINICA 2020; 17:S1699-258X(20)30159-5. [PMID: 33039312 DOI: 10.1016/j.reuma.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 04/16/2020] [Accepted: 06/24/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the demographic and clinical characteristics of Venezuelan patients with systemic sclerosis (SSc) seen in a tertiary hospital. METHODS Consecutive patients 18 years and older who fulfilled the 2013 ACR/EULAR classification criteria for SSc and who were followed up in the outpatient clinic of the Division of Rheumatology at the Hospital Universitario de Caracas were selected for the study. Demographic and clinical variables were registered at the time of inclusion using a standard protocol. RESULTS Forty-eight SSc patients were included; 46 (95.8%) were female; the mean age was 55.1±13.7 (mean±SD) years and all were of Hispanic ethnicity. Thirty-one (64.6%) had limited SSc and 17 (35.4%) had diffuse SSc. The mean duration of disease was 13.4±11.7 (mean±SD) years, 16.74±12.99 years for limited SSc and 7.52±5.25 years for diffuse SSc (p=0.0077). Raynaud's phenomenon was the most frequent manifestation (100%), followed by arthritis (68.8%), telangiectasia (60.4%), dyspnea (60.4%), dysphagia (58.3%) and puffy hands (56.3%). The modified Rodnan Skin Score (mRSS) and the frequency of dyspnea were higher in those with diffuse as compared to limited SSc (p=0.0211 and p=0.0003, respectively). We performed high-resolution computed tomography (HRCT) of the lungs in 31 patients; 14 (45.2%) had evidence of interstitial lung disease (ILD), 11 (68.8%) with diffuse SSc (p=0.0052). The most frequent anti-nuclear antibody pattern was nucleolar, accounting for 18 (42.8%) of the cases. Anti-centromere antibodies were present in 16.7% of the cases and were associated with the limited SSc subset (p=0.0443) and with calcinosis (p=0.0020). Anti-topoisomerase antibodies were associated with ILD (p=0.0077). CONCLUSIONS Typical clinical and serological manifestations were present in this sample of Venezuelan patients with SSc, with an expected distribution according to disease subtype. The autoantibody profile allows clinicians to identify those patients with limited forms of the disease and those without pulmonary involvement.
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Affiliation(s)
- Daniel Rivas-Vargas
- Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas, Venezuela.
| | - Soham Al Snih
- Division of Rehabilitation Sciences/School of Health Professions, Division of Geriatrics/Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
| | - Martín A Rodríguez
- Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas, Venezuela; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, United States
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Abstract
Racial and ethnic disparities in systemic sclerosis are abundant. The incidence, severity of end-organ manifestations, functional impairment, quality of life, and mortality of systemic sclerosis vary by ethnic group. This article summarizes such disparities and explores the role of socioeconomic status in their development and persistence.
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Affiliation(s)
- Duncan F Moore
- Division of Rheumatology, Department of Medicine, MedStar Georgetown University Hospital, 3800 Reservoir Road, PHC 3004, Washington, DC 20007, USA.
| | - Virginia D Steen
- Division of Rheumatology, Department of Medicine, MedStar Georgetown University Hospital, 3800 Reservoir Road, PHC 3004, Washington, DC 20007, USA
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Steelandt A, Benmostefa N, Avouac J, Mouthon L, Allanore Y. Ethnic influence on the phenotype of French patients with systemic sclerosis. Joint Bone Spine 2020; 88:105081. [PMID: 32992030 DOI: 10.1016/j.jbspin.2020.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/16/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is a rare multisystem autoimmune disorder. It has a worldwide distribution but geographical and ethnic influences are poorly known. METHODS The aim of the study was to compare demographic characteristics and frequency of internal organ system involvement of Black SSc patients to those of White SSc patients in France. Patient population included 425 SSc patients recruited at Cochin Hospital in Internal medicine and Rheumatology departments. Data were collected at the baseline visit, each Black patient was matched with 2 to 3 White controls from the same department. RESULTS One hundred and five Black patients and 320 White were included. Demographic comparison highlighted an older age for the White patients (48.66±14.87 vs 39.56±10.79, P<0.0001). Phenotypic comparison showed more severe skin involvement for Black patients: they had more often diffuse skin involvement than White patients (69.2% vs. 44.7%, P<0.0001) with a higher baseline modified Rodnan skin score (15.8 vs. 11.3, P<0.001). Comparisons also showed more active ulcers (46.5% vs. 21.6%, P<0.001) and more common interstitial lung disease (73.7% vs. 43%, P<0.0001) for Black patients. Auto-antibody testing showed that White patients were more likely to harbor anti-centromere antibodies (ACA) (26.6% vs. 9%, P<0.001) whereas Black patients were more likely to have anti-U1RNP antibody (24.6% vs. 6.2%, P<0.0001). CONCLUSION In this population recruited in a disease referral center, Black patients had more severe skin and lung involvements with lower prevalence of ACA as compared to White patients, supporting a more severe phenotype.
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Affiliation(s)
- Alexia Steelandt
- Université Paris Descartes, Sorbonne Paris Cité, Service de rhumatologie A, hôpital Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, INSERM U1016, Institut Cochin, CNRS UMR8104, Paris, France
| | - Nouria Benmostefa
- Service de médecine interne, hôpital Cochin, AP-HP, université Paris Descartes, 75014 Paris, France
| | - Jérôme Avouac
- Université Paris Descartes, Sorbonne Paris Cité, Service de rhumatologie A, hôpital Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, INSERM U1016, Institut Cochin, CNRS UMR8104, Paris, France
| | - Luc Mouthon
- Service de médecine interne, hôpital Cochin, AP-HP, université Paris Descartes, 75014 Paris, France
| | - Yannick Allanore
- Université Paris Descartes, Sorbonne Paris Cité, Service de rhumatologie A, hôpital Cochin, Assistance publique-Hôpitaux de Paris (AP-HP), 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, INSERM U1016, Institut Cochin, CNRS UMR8104, Paris, France.
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Ratanawatkul P, Solomon JJ, Kim D, George MP, Matarrese McGibbon LR, Demoruelle MK, Maleki-Fischbach M, Amigues I, Kastsianok L, Fernández Pérez ER. Trends in systemic sclerosis and systemic sclerosis-related pulmonary arterial hypertension mortality in the USA. ERJ Open Res 2020; 6:00309-2019. [PMID: 32577417 PMCID: PMC7293989 DOI: 10.1183/23120541.00309-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/11/2020] [Indexed: 01/21/2023] Open
Abstract
There are limited data nationwide on the burden of systemic sclerosis (SSc)-related mortality. We aimed to determine recent trends in SSc and SSc-related pulmonary arterial hypertension (PAH) mortality overall and across population subgroups. Using death certificate data from the National Center for Health Statistics, we computed the age-adjusted mortality rates of SSc and SSc-SSc−PAH, a lethal prevailing complication, across demographic groups, geographic regions and comorbid cardiorespiratory conditions, and used Joinpoint regression analysis to calculate the average annual percentage change (APC) in mortality. From 2003 to 2016, 25 175 death records contained a code for SSc. Decedents were predominantly female (81%) and white (73%), with an average age of 66±14 years. The age-adjusted mortality rate decreased by 3% per year from 6.6 in 2003 to 4.3 per 1 000 000 population in 2016. Also, a decreasing trend was found when SSc was stratified by age, sex, race and geographic region. The prevalence of PAH was 23%. The odds of PAH were highest in female and black decedents, and in decedents with concomitant pulmonary embolism, cardiomyopathy and interstitial lung disease (ILD). SSc−PAH mortality remained stable from 2003 to 2008 then decreased by 3% per year from 2008 to 2016. In decedents with SSc−PAH, among all concomitant comorbidities, the mortality rate associated with ILD had the highest increase (average APC 6%, 95% CI 2%−10%). The mortality rate from SSc decreased from 2003 to 2016. Decreases in mortality rates were similar across demographic groups and geographic regions. SSc−PAH-related mortality remained stable. The death rate for SSc−ILD and concomitant PAH increased during this period. While SSc-PAH-related mortality remained stable, SSc-ILD and concomitant PAH mortality increased from 2003 to 2016http://bit.ly/3d9G0pp
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Affiliation(s)
- Pailin Ratanawatkul
- Division of Pulmonary and Critical Care Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Joshua J Solomon
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - Darlene Kim
- Division of Cardiology, National Jewish Health, Denver, CO, USA
| | - Marjorie P George
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | | | | | | | - Isabelle Amigues
- Division of Rheumatology, National Jewish Health, Denver, CO, USA
| | | | - Evans R Fernández Pérez
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
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Autoantibodies as biomarkers for interstitial lung disease in idiopathic inflammatory myositis and systemic sclerosis: The case of anti-eIF2B antibodies. J Transl Autoimmun 2020; 3:100049. [PMID: 32743530 PMCID: PMC7388402 DOI: 10.1016/j.jtauto.2020.100049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 12/31/2022] Open
Abstract
Objectives Serum autoantibodies are pivotal for the early detection of systemic autoimmune rheumatic diseases such as Systemic Sclerosis (SSc) and Poly/Dermatomyositis (PM/DM), and in some cases are associated with organ complications such as interstitial lung disease (ILD). A paradigmatic example is provided by the autoantibody against the Eukaryotic Initiation Factor 2B (eIF2B) that has been recently detected in SSc. Methods Sera from 118 patients with SSc, 8 Poly/Dermatomyositis, 2 overlap SSc/Polymyositis, 4 undifferentiated connective tissue disease-UCTD and 3 healthy controls were tested first by indirect immunofluorescence for anti-nuclear antibodies-ANA pattern. Further, we employed protein-radioimmunoprecipitation (IP) and IP- Western Blot for the detection and confirmation of anti-eIF2B antibodies. Serum findings were further correlated with the clinical features of patients. Results We identified 3 SSc cases (2.5%) positive for anti-eIF2B antibodies while this autoantibody was not detected in control sera. Using protein-IP all three patients manifested the 38kD protein which is the antigenic target of anti-eIF2B antibodies, and this was associated with a cytoplasmic pattern at indirect immunofluorescence. The presence of anti-eIF2B was associated with ILD and a diffuse SSc variant, in one case in association with anti-Scl70/topoI. Conclusions Our data confirm that a small subgroup (2.5%) of patients with SSc have detectable anti-eIF2B with cytoplasmic-positive staining at immunofluorescence and this reactivity is associated with ILD.
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Is Hyperpigmentation in Systemic Sclerosis a Perivascular Dermal Tattoo? J Invest Dermatol 2020; 140:2308-2312.e2. [PMID: 32234458 DOI: 10.1016/j.jid.2020.03.937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 11/23/2022]
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Chung MP, Dontsi M, Postlethwaite D, Kesh S, Simard JF, Fiorentino D, Zaba LC, Chung L. Increased Mortality in Asians With Systemic Sclerosis in Northern California. ACR Open Rheumatol 2020; 2:197-206. [PMID: 32198914 PMCID: PMC7164633 DOI: 10.1002/acr2.11126] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/18/2020] [Indexed: 11/21/2022] Open
Abstract
Objective The objective of this study is to evaluate racial/ethnic differences in disease manifestations and survival in a US cohort of patients with systemic sclerosis (SSc), with a focus on Asian patients. Methods A retrospective cohort study was conducted among Kaiser Permanente Northern California adults with an incident SSc diagnosis by a rheumatologist from 2007 to 2016, confirmed by a chart review to fulfill 2013 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria. Self‐reported race/ethnicity was categorized as non‐Hispanic white, Asian, Hispanic, and black. Disease manifestations and survival were compared, using white patients as the reference. Results A total of 609 patients with incident SSc were identified: 89% were women, and 81% had limited cutaneous SSc, with a mean age at diagnosis of 55.4 ± 14.8 years. The racial/ethnic distribution was 51% non‐Hispanic white (n = 310), 25% Hispanic (n = 154), 16% Asian (n = 96), and 8% black (n = 49). Compared with white patients, black patients had a greater prevalence of diffuse disease (14.5% vs. 44.9%; P < 0.001), and Asians had higher rates of anti‐U1‐RNP antibodies (32.1% vs. 11.9%; P = 0.005). Nine‐year overall survival rates following SSc diagnosis were lower in Asian (52.3%), black (52.2%), and Hispanic patients (68.2%) compared with white patients (75.8%). Pulmonary hypertension and infections were the leading causes of death in Asian patients. Asian race was associated with higher mortality on univariable (hazard ratio [HR] 1.83 [95% confidence interval (CI) 1.08‐2.99]; P = 0.020) and multivariable analyses (HR 1.80 [95% CI 0.99‐3.16]; P = 0.047) when adjusting for age, sex, body mass index, cutaneous subtype, smoking status, interstitial lung disease, pulmonary hypertension, renal crisis, and malabsorption syndrome. Conclusion Asian patients with SSc in this US cohort had increased mortality compared with white patients. These patients warrant close monitoring for disease progression.
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Affiliation(s)
- Melody P Chung
- Kaiser Permanente Santa Clara, Santa Clara, California, and Stanford University School of Medicine, Palo Alto, California
| | | | | | - Sumana Kesh
- Kaiser Permanente Santa Clara, Santa Clara, California
| | - Julia F Simard
- Stanford University School of Medicine, Palo Alto, California
| | | | - Lisa C Zaba
- Stanford University School of Medicine, Palo Alto, California
| | - Lorinda Chung
- Stanford University School of Medicine and Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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Mecoli CA, Shah AA. More Than Skin Deep: Bringing Precision Medicine to Systemic Sclerosis. Arthritis Rheumatol 2020; 72:383-385. [PMID: 31677364 PMCID: PMC7050332 DOI: 10.1002/art.41154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/29/2019] [Indexed: 01/16/2023]
Affiliation(s)
| | - Ami A Shah
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Hughes M, Pauling JD, Armstrong-James L, Denton CP, Galdas P, Flurey C. Gender-related differences in systemic sclerosis. Autoimmun Rev 2020; 19:102494. [PMID: 32062031 DOI: 10.1016/j.autrev.2020.102494] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/19/2019] [Indexed: 12/12/2022]
Abstract
Systemic sclerosis (SSc) is a complex autoimmune connective tissue disease which is characterised by autoimmunity, widespread tissue fibrosis of the skin and internal organs, and vasculopathic alterations. SSc is more common in women but has a more severe expression of disease including internal organ-based complications and higher mortality in men. The extant literature shows that although important pathophysiological sex differences are present in SSc, behavioural differences (e.g. higher smoking rates in men) and occupational exposures may contribute to poorer outcomes in men with SSc. The higher death male death rate in the general population and greater prevalence of lung fibrosis are likely the key factors responsible for excess mortality found in men. Other important factors include (but are not limited to) a greater prevalence of the disease subset, delayed time to diagnosis, and higher disease activity in early disease in men. SSc carries a significant burden of disease-related morbidity; however, no qualitative studies to date have focussed on gender differences in SSc. The purpose of this review is to provide a comprehensive overview of gender differences in SSc including (but not limited to) epidemiology, pathophysiology, clinical expression of disease, mortality, SSc in transgender individuals, and psychosocial aspects of disease.
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Affiliation(s)
- Michael Hughes
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, UK.
| | - John D Pauling
- Royal National Hospital for Rheumatic Diseases (at Royal United Hospitals), Bath, UK; Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | | | - Christopher P Denton
- Centre for Rheumatology, Royal Free Hospital, University College London, London, UK
| | - Paul Galdas
- Department of Health Sciences, University of York, York, UK
| | - Caroline Flurey
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
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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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Roberts MH, Erdei E. Comparative United States autoimmune disease rates for 2010-2016 by sex, geographic region, and race. Autoimmun Rev 2020; 19:102423. [PMID: 31733367 PMCID: PMC6925958 DOI: 10.1016/j.autrev.2019.102423] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 06/23/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE AIDs may disproportionately impact specific racial groups, but autoimmune (AID) prevalence information by minority racial group is sparse for many AIDs. The objective of this analysis was to supplement previously published AID prevalence rates by providing information on race rate ratios (minority race populations compared to Caucasian populations) in the United States. Preliminary to estimating race rate ratios, contemporary US-specific, health care utilization-based AID prevalence rates and female-to-male ratios were estimated and compared to previously published AID prevalence rates. METHODS We used a large national electronic medical record database of 52 million individuals to estimate age-adjusted direct standardized rates for 22 AIDs for 2010 through 2016 by gender, race, and US census division. These were compared to previously published estimates. RESULTS Female-to-male ratios were comparable with published studies. Almost all observed Multiracial AID rates were significantly higher than Caucasian rates, as well as 9 of 22 AID rates observed among Native Americans and 8 of 22 AID rates estimated among African-American patients. Regional variation was noted: highest African-American systemic lupus erythematosus rates were observed in the West North Central and South Atlantic divisions, highest African-American multiple sclerosis rates in the South Atlantic and Pacific divisions, and highest Native American rheumatoid arthritis rates in the West North Central, Mountain, and Pacific divisions. CONCLUSIONS Substantial AID heterogeneity exists by race and by geographic area. An important research area is further exploring factors related to heterogeneity such as potential interactions between genetic susceptibility and environmental factors.
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Affiliation(s)
- Melissa H Roberts
- University of New Mexico, College of Pharmacy, Albuquerque, NM, USA.
| | - Esther Erdei
- University of New Mexico, College of Pharmacy, Albuquerque, NM, USA.
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HLA and autoantibodies define scleroderma subtypes and risk in African and European Americans and suggest a role for molecular mimicry. Proc Natl Acad Sci U S A 2019; 117:552-562. [PMID: 31871193 PMCID: PMC6955366 DOI: 10.1073/pnas.1906593116] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Systemic sclerosis (SSc) is a clinically heterogeneous autoimmune disease characterized by mutually exclusive autoantibodies directed against distinct nuclear antigens. We examined HLA associations in SSc and its autoantibody subsets in a large, newly recruited African American (AA) cohort and among European Americans (EA). In the AA population, the African ancestry-predominant HLA-DRB1*08:04 and HLA-DRB1*11:02 alleles were associated with overall SSc risk, and the HLA-DRB1*08:04 allele was strongly associated with the severe antifibrillarin (AFA) antibody subset of SSc (odds ratio = 7.4). These African ancestry-predominant alleles may help explain the increased frequency and severity of SSc among the AA population. In the EA population, the HLA-DPB1*13:01 and HLA-DRB1*07:01 alleles were more strongly associated with antitopoisomerase (ATA) and anticentromere antibody-positive subsets of SSc, respectively, than with overall SSc risk, emphasizing the importance of HLA in defining autoantibody subtypes. The association of the HLA-DPB1*13:01 allele with the ATA+ subset of SSc in both AA and EA patients demonstrated a transancestry effect. A direct correlation between SSc prevalence and HLA-DPB1*13:01 allele frequency in multiple populations was observed (r = 0.98, P = 3 × 10-6). Conditional analysis in the autoantibody subsets of SSc revealed several associated amino acid residues, mostly in the peptide-binding groove of the class II HLA molecules. Using HLA α/β allelic heterodimers, we bioinformatically predicted immunodominant peptides of topoisomerase 1, fibrillarin, and centromere protein A and discovered that they are homologous to viral protein sequences from the Mimiviridae and Phycodnaviridae families. Taken together, these data suggest a possible link between HLA alleles, autoantibodies, and environmental triggers in the pathogenesis of SSc.
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Hung G, Mercurio V, Hsu S, Mathai SC, Shah AA, Mukherjee M. Progress in Understanding, Diagnosing, and Managing Cardiac Complications of Systemic Sclerosis. Curr Rheumatol Rep 2019; 21:68. [PMID: 31813082 PMCID: PMC11151284 DOI: 10.1007/s11926-019-0867-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF THE REVIEW Systemic sclerosis (scleroderma) is a complex autoimmune disease that commonly involves the cardiovascular system. Even if often subclinical, cardiac involvement is considered a poor prognostic factor as it is a leading cause of death in scleroderma patients. We review the cardiac manifestations of scleroderma, the diagnostic methods useful in detection, and current advances in therapeutic management. RECENT FINDINGS Beside the routine exams for the assessment of cardiac status (including EKG, standard echocardiography, provocative tests) novel techniques such as myocardial strain imaging on echocardiography, cardiac magnetic resonance imaging, invasive hemodynamic assessment, and endomyocardial biopsy have been demonstrated to be useful in understanding the cardiac alterations that typically affect scleroderma patients. Recent application of novel cardiac detection strategies is providing increased insight into the breadth and pathogenesis of cardiac complications of scleroderma. Further studies coupling exercise provocation, invasive and imaging assessment, and mechanistic studies in scleroderma cardiac tissue are needed to develop the optimal approach to early detection of cardiac disease in scleroderma and targeted therapies.
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Affiliation(s)
- George Hung
- Division of Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Valentina Mercurio
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Steven Hsu
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ami A Shah
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 4100, Baltimore, MD, 21224, USA
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, USA.
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Morgan ND, Gelber AC. African Americans and Scleroderma: Examining the Root Cause of the Association. Arthritis Care Res (Hoboken) 2019; 71:1151-1153. [DOI: 10.1002/acr.23860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/19/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Nadia D. Morgan
- Johns Hopkins University School of Medicine Baltimore Maryland
| | - Allan C. Gelber
- Johns Hopkins University School of Medicine Baltimore Maryland
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Moore DF, Kramer E, Eltaraboulsi R, Steen VD. Increased Morbidity and Mortality of Scleroderma in African Americans Compared to Non–African Americans. Arthritis Care Res (Hoboken) 2019; 71:1154-1163. [DOI: 10.1002/acr.23861] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 02/19/2019] [Indexed: 11/07/2022]
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Racial and Ethnic Differences in Pediatric Pulmonary Hypertension: An Analysis of the Pediatric Pulmonary Hypertension Network Registry. J Pediatr 2019; 211:63-71.e6. [PMID: 31176455 PMCID: PMC6776463 DOI: 10.1016/j.jpeds.2019.04.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/26/2019] [Accepted: 04/23/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate racial and ethnic differences in pulmonary hypertension subtypes and survival differences in a pediatric population. STUDY DESIGN This was a retrospective analysis of a cohort of patients with pulmonary hypertension (aged ≤18 years) enrolled in the Pediatric Pulmonary Hypertension Network registry between 2014 and 2018, comprising patients at eight Pediatric Centers throughout North America (n = 1417). RESULTS Among children diagnosed after the neonatal period, pulmonary arterial hypertension was more prevalent among Asians (OR, 1.83; 95% CI, 1.21-2.79; P = .0045), lung disease-associated pulmonary hypertension among blacks (OR, 2.09; 95% CI, 1.48-2.95; P < .0001), idiopathic pulmonary arterial hypertension among whites (OR, 1.58; 95% CI, 1.06-2.41; P = .0289), and pulmonary veno-occlusive disease among Hispanics (OR, 6.11; 95% CI, 1.34-31.3; P = .0184). Among neonates, persistent pulmonary hypertension of the newborn (OR, 4.07; 95% CI, 1.54-10.0; P = .0029) and bronchopulmonary dysplasia (OR, 8.11; 95% CI, 3.28-19.8; P < .0001) were more prevalent among blacks, and congenital diaphragmatic hernia was more prevalent among whites (OR, 2.29; 95% CI, 1.25-4.18; P = .0070). An increased mortality risk was observed among blacks (HR, 1.99; 95% CI, 1.03-3.84; P = .0396), driven primarily by the heightened mortality risk among those with lung disease-associated pulmonary hypertension (HR, 2.84; 95% CI, 1.15-7.04; P = .0241). CONCLUSIONS We found significant racial variability in the prevalence of pulmonary hypertension subtypes and survival outcomes among children with pulmonary hypertension. Given the substantial burden of this disease, further studies to validate phenotypic differences and to understand the underlying causes of survival disparities between racial and ethnic groups are warranted.
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Mendes C, Viana VST, Pasoto SG, Leon EP, Bonfa E, Sampaio-Barros PD. Clinical and laboratory features of African-Brazilian patients with systemic sclerosis. Clin Rheumatol 2019; 39:9-17. [PMID: 31065858 DOI: 10.1007/s10067-019-04575-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/15/2019] [Accepted: 04/22/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE African-Brazilians comprise a group of blacks and "pardos." As racial differences can be associated with distinct presentations, we evaluated the clinical and serological associations of African-Brazilians with systemic sclerosis (SSc). METHODS Sera from 260 adult SSc patients (203 whites and 57 African-Brazilians) were evaluated. Patients with overlap syndromes were excluded. Clinical and demographic data were obtained from an electronic register database. Laboratory analysis included the following: anti-CENP-A/CENP-B, Scl70, RNA polymerase III, Ku, fibrillarin, Th/To, PM-Scl75, and PM-Scl100 by line immunoassay and anti-nuclear antibodies (ANA) by indirect immunofluorescence (IIF) on HEp-2 cells. RESULTS African-Brazilian SSc patients presented shorter disease duration (12.8 ± 6.5 vs. 15.9 ± 8.1 years, p = 0.009), higher frequency of nucleolar ANA pattern (28% vs. 13%, p = 0.008), and lower frequencies of centromeric ANA pattern (14% vs. 29%, p = 0.026) and CENP-B (18% vs. 34%, p = 0.017), as well as an association with severe interstitial lung disease (58% vs. 43%; p = 0.044). Further comparison of ethnic groups according to subsets revealed that diffuse SSc African-Brazilian patients presented higher frequency of pulmonary hypertension (p = 0.017), heart involvement (p = 0.037), nucleolar ANA pattern (p = 0.036), anti-fibrillarin antibodies (p = 0.037), and higher mortality (48% vs. 19%; p = 0.009). A different pattern was observed for the limited subset with solely a lower frequency of esophageal involvement (p = 0.050) and centromeric ANA pattern (p = 0.049). Survival analysis showed that African-Brazilians had a higher mortality, when adjusted for age, gender, and clinical subset (RR 2.06, CI 95% 1.10-3.83, p = 0.023). CONCLUSION African-Brazilians have distinct characteristics according to clinical subset and an overall more severe SSc than whites, similar to the blacks from other countries.Key Points • African-Brazilian SSc patients were associated with severe interstitial lung disease and nucleolar ANA pattern when compared to white SSc patients. • When disease subsets were considered, African-Brazilian patients with diffuse SSc presented association with pulmonary hypertension, heart involvement, nucleolar ANA pattern, and anti-fibrillarin antibodies. • White SSc patients were associated with centromeric ANA pattern. • Survival analysis at 5, 10, 15, and 20 years, adjusted for age, gender, and disease subset, was significantly worse in African-Brazilian SSc patients.
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Affiliation(s)
- Cristiane Mendes
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.,Universidade Federal de Alfenas, Alfenas, Brazil
| | - Vilma S T Viana
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Sandra G Pasoto
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Elaine P Leon
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eloisa Bonfa
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Percival D Sampaio-Barros
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil. .,Disciplina de Reumatologia, Universidade de São Paulo, Avenida Dr. Arnaldo 455, sala 3142, Cerqueira César, Sao Paulo, SP, 01246-903, Brazil.
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Pokeerbux MR, Giovannelli J, Dauchet L, Mouthon L, Agard C, Lega JC, Allanore Y, Jego P, Bienvenu B, Berthier S, Mekinian A, Hachulla E, Launay D. Survival and prognosis factors in systemic sclerosis: data of a French multicenter cohort, systematic review, and meta-analysis of the literature. Arthritis Res Ther 2019; 21:86. [PMID: 30944015 PMCID: PMC6446383 DOI: 10.1186/s13075-019-1867-1] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/18/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Data on survival and prognosis factors in incident cohorts are scarce in systemic sclerosis (SStc). To describe survival, standardized mortality ratio (SMR), and prognosis factors in systemic sclerosis (SSc), we analyzed a multicenter French cohort of incident patients and performed a systematic review of the literature and meta-analysis. METHODS A multicenter, French cohort study was conducted between January 1, 2000, and December 31, 2013. Patients were followed-up until July 1, 2016. A systematic review of the literature was carried out in MEDLINE and EMBASE up to July 2017. Meta-analysis was performed using all available data on SMR and hazard ratios of prognosis factors. RESULTS A total of 625 patients (493 females, 446 lcSSc) were included. During the study period, 104 deaths (16.6%) were recorded and 133 patients were lost to follow-up. Overall survival rates at 1, 3, 5, and 10 years from diagnosis were 98.0%, 92.5%, 85.9%, and 71.7% respectively in the French cohort. Overall SMR was 5.73 (95% CI 4.68-6.94). Age at diagnosis > 60 years, diffuse cutaneous SSc, scleroderma renal crisis, dyspnea, 6-min walking distance (6MWD), forced vital capacity < 70%, diffusing capacity of the lungs for carbon monoxide < 70%, pulmonary hypertension (PH), telangiectasia, valvular disease, malignancy, anemia, and CRP > 8 mg/l were associated with a poorer survival after adjustment. Eighteen studies (11,719 patients) were included in the SMR meta-analysis and 36 studies (26,187 patients) in the prognosis factor analysis. Pooled SMR was 3.45 (95%CI 3.03-3.94). Age at disease onset, male sex, African origin, diffuse cutaneous SSc, anti-Scl70 antibodies, cardiac and renal involvement, interstitial lung disease, PH, and malignancy were significantly associated with a worse prognosis. Anti-centromere antibodies were associated with a better survival. CONCLUSIONS Overall, our study highlights a high mortality rate in SSc patients and confirms previously described prognosis factors related to skin extension and organ involvement while identifying additional prognosis factors such as autoantibody status, telangiectasia, 6MWD, and valvular disease.
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Affiliation(s)
- M R Pokeerbux
- University of Lille, U995 - LIRIC - Lille Inflammation Research International Center, F-59000, Lille, France.,INSERM, U995, F-59000, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre de Référence des Maladies Autoimmunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
| | - J Giovannelli
- University of Lille, U995 - LIRIC - Lille Inflammation Research International Center, F-59000, Lille, France.,INSERM, U995, F-59000, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre de Référence des Maladies Autoimmunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
| | - L Dauchet
- Inserm UMR1167, RID-AGE, Risk Factors and Molecular Determinants of Aging-Related Diseases, Université de Lille, Centre Hosp. Univ Lille, Institut Pasteur de Lille, Lille, France
| | - L Mouthon
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence pour les Maladies Systémiques Autoimmunes Rares d'Ile de France, Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - C Agard
- CHU Nantes, Service de Médecine Interne, Nantes, France
| | - J C Lega
- Department of Internal and Vascular Medicine, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Univ Lyon, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, CNRS, Claude Bernard University, F-69003, Lyon, France
| | - Y Allanore
- Hôpital Cochin-APHP-Service de Rhumatologie A, Université Paris Descartes, INSERM U1016, Paris, France
| | - P Jego
- INSERM U 1085 (IRSET), University of Rennes 1, Rennes, France
| | - B Bienvenu
- Service de Médecine Interne CHU Caen, Caen, France
| | - S Berthier
- Service de Médecine Interne et Immunologie Clinique, CHU Dijon, Dijon, France
| | - A Mekinian
- Hôpital Saint-Antoine-APHP-Service de Médecine Interne, Paris, France
| | - E Hachulla
- University of Lille, U995 - LIRIC - Lille Inflammation Research International Center, F-59000, Lille, France.,INSERM, U995, F-59000, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre de Référence des Maladies Autoimmunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
| | - D Launay
- University of Lille, U995 - LIRIC - Lille Inflammation Research International Center, F-59000, Lille, France. .,INSERM, U995, F-59000, Lille, France. .,CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France. .,Centre de Référence des Maladies Autoimmunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France.
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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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Elsayed AM, Elhefny AM, Abogabal MM, Mobasher SA, Abdelzaher A, Alhassanein KF, Sayed S, Haroon MM, Soliman HM. Progressive systemic sclerosis in Egyptian patients: Clinical characteristics and nail fold capillaroscopy. THE EGYPTIAN RHEUMATOLOGIST 2019. [DOI: 10.1016/j.ejr.2018.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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50
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Gelber AC, Brener MI, O'Connell K, Wu M, Paik JJ, Albayda JF. Febrile Calcinosis in Scleroderma. Am J Med 2018; 131:e500-e501. [PMID: 30076824 DOI: 10.1016/j.amjmed.2018.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Allan C Gelber
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Michael I Brener
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kaelin O'Connell
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael Wu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Julie J Paik
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jemima F Albayda
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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