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Wildt M, Andréasson K, Hamberg V, Hesselstrand R, Wuttge DM. Treatment with mycophenolate mofetil is associated with improved nailfold vasculature in systemic sclerosis. Rheumatology (Oxford) 2024; 63:385-391. [PMID: 37158586 PMCID: PMC10836996 DOI: 10.1093/rheumatology/kead207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/27/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE To investigate the evolution of nailfold capillary density in patients with SSc in relation to immunosuppressive treatment and autoantibodies. METHODS This was a prospective study cohort. Consecutive newly diagnosed SSc patients were included into this study who, in a retrospective review, had at least two nailfold capillary microscopy measurements performed during the first 48 months of follow-up. Capillary density per 3 mm was measured with widefield nailfold capillary microscopy. Improvement of capillary density per finger and mean capillary density were analysed. Longitudinal measurements of mean capillary density were analysed by generalized estimating equation. RESULTS Eighty patients (68 women, 12 men) met the inclusion criteria. The median follow-up time was 27 months. Twenty-eight patients had an improved capillary density in per-finger analysis. MMF was associated with fewer numbers of fingers that had worsened in capillary density. Anti-topoisomerase antibodies were associated with low mean capillary density. Anti-RNA polymerase III antibodies were associated with improvement and anti-centromere antibodies with worsening of capillary density in per-finger analysis. MMF treatment was associated with less steep capillary density decline in a moderated generalized estimating equation model including presence of anti-topoisomerase antibodies and the interaction of MMF with follow-up time. CONCLUSION Nailfold capillary density improved over time in a substantial proportion of SSc patients. MMF treatment had a positive impact on the evolution of capillary density in these patients. SSc autoantibody phenotype may affect the capillary density development. The data support previous hypotheses that early immunosuppression may favourably affect vascular regeneration in SSc.
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Affiliation(s)
- Marie Wildt
- Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Kristofer Andréasson
- Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Viggo Hamberg
- Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Roger Hesselstrand
- Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Dirk M Wuttge
- Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University and Skåne University Hospital, Lund, Sweden
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Ghosh S, O’Connell KA, Kwun S, Smith HB, Phillips CH, Silaphet T, Jiang B, McNeil AJ, Saknite I, Frech TM, Tkaczyk ER. Rapid handheld measurements of skin and subcutaneous tissue stiffness in systemic sclerosis. Rheumatology (Oxford) 2024; 63:e17-e19. [PMID: 37549062 PMCID: PMC10765152 DOI: 10.1093/rheumatology/kead355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/04/2023] [Accepted: 07/05/2023] [Indexed: 08/09/2023] Open
Affiliation(s)
- Shramana Ghosh
- Medicine Service and Research Service, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katie A O’Connell
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shinwho Kwun
- Medicine Service and Research Service, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hayden B Smith
- Medicine Service and Research Service, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Catherine H Phillips
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tyra Silaphet
- Medicine Service and Research Service, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bohan Jiang
- Medicine Service and Research Service, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew J McNeil
- Medicine Service and Research Service, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Inga Saknite
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tracy M Frech
- Medicine Service and Research Service, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA
- Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University Medical Center, and Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Eric R Tkaczyk
- Medicine Service and Research Service, Department of Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt University School of Medicine, Nashville, TN, USA
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Dyball S, Rodziewicz M, Mendoza-Pinto C, Bruce IN, Parker B. Predicting progression from undifferentiated connective tissue disease to definite connective tissue disease: A systematic review and meta-analysis. Autoimmun Rev 2022; 21:103184. [PMID: 36031048 DOI: 10.1016/j.autrev.2022.103184] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/21/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Undifferentiated connective tissue disease (UCTD) encapsulates a broad range of conditions including incomplete forms of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc), some of whom progress to a formal clinical diagnosis over time. This systematic review (SR) and meta-analysis aimed to identify clinical and laboratory features and biomarkers that can predict progression of UCTD. METHODS A systematic literature search was carried out on MEDLINE, EMBASE and the Cochrane Central Register of Randomized Controlled Trials. Abstracts and full-text manuscripts were screened by two reviewers. Publications were included if they included at least 20 UCTD patients, a minimum of six months of follow up, and provided data on at least one risk factor for developing a defined CTD. The QUIPS tool was used to assess risk of bias (RoB) and GRADE for grading the quality of the evidence. The study is registered with PROSPERO (ID: CRD42021237725). RESULTS Fifty-nine studies were included in the SR, and forty-one in the meta-analysis. The predictors for progression to SLE with the highest certainty of evidence included those with younger age (MD -5.96 [-11.05-0.87 years]), serositis (RR 2.69 [1.61-4.51]), or the presence of anti-dsDNA antibodies (RR 4.27 [1.92-9.51]). For SSc, the highest certainty of evidence included puffy fingers (RR [3.09 [1.48-6.43]), abnormal nailfold changes (NFC) (avascular areas [RR 5.71 (3.03-10.8)] or active or late SSc pattern [RR 2.24 (1.25-4.01)] and anti-topoisomerase-I (RR 1.83 [1.45-2.30]). No novel biomarkers were included in the meta-analysis; however HLA molecules, regulatory T cell shift, pro-inflammatory cytokines and complement activation products were identified as potential predictors for evolution of disease. CONCLUSIONS Clinical and immunological parameters may predict which patients with UCTD progress to definitive disease; however, the heterogeneous nature and RoB in most studies limits the ability to apply these results in routine clinical practice. Limited data suggest that some novel biomarkers may provide additional predictive value but these will need larger well designed studies to fully delineate their clinical utility.
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Affiliation(s)
- Sarah Dyball
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester, UK
| | - Mia Rodziewicz
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester, UK
| | - Claudia Mendoza-Pinto
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester, UK; Systemic Autoimmune Diseases Research Unit Specialties Hospital UMAE-CIBIOR, Mexican Social Security Institute, Puebla, Mexico
| | - Ian N Bruce
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK
| | - Ben Parker
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK.
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