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Barnes H, Ghazipura M, Herman D, Macrea M, Knight SL, Silver RM, Montesi SB, Raghu G, Hossain T. Cyclophosphamide in Patients with Systemic Sclerosis-associated Interstitial Lung Disease: A Systematic Review and Meta-Analysis. Ann Am Thorac Soc 2024; 21:122-135. [PMID: 37772975 DOI: 10.1513/annalsats.202301-053oc] [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: 01/21/2023] [Accepted: 08/01/2023] [Indexed: 09/30/2023] Open
Abstract
Background: The American Thoracic Society convened an international, multidisciplinary panel to develop clinical practice guidelines for the treatment of systemic sclerosis-associated interstitial lung disease (SSc-ILD). Objective: To conduct a systematic review and evaluate the literature to determine whether patients with SSc-ILD should be treated with cyclophosphamide. Data Sources: A literature search was conducted across the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases through June 2022 for studies using cyclophosphamide to treat patients with SSc-ILD. Data Extraction: Mortality, disease progression, quality of life, and adverse event data were extracted, and meta-analyses were performed when possible. The Grading of Recommendations, Assessment, Development and Evaluation Working Group method was used to assess the quality of evidence. Synthesis: Five studies were included; two randomized controlled trials compared cyclophosphamide versus placebo, and one randomized controlled trial and two retrospective case-control studies compared cyclophosphamide versus mycophenolate. Compared with placebo, there was a 2.83% reduction in the decline at 12 months for forced vital capacity (FVC) % predicted using cyclophosphamide (95% confidence interval [CI], 0.80-4.87; low evidence). There were improvements in breathlessness (Transition Dyspnea Index mean difference [MD], 2.90; 95% CI, 1.94-3.86; minimum clinically important difference, 1; moderate evidence) and disability (Health Assessment Questionnaire-Disability Index MD, -0.16; 95% CI, -0.28 to -0.04; minimum clinically important difference, -0.14; moderate evidence). There were increased risks of leukopenia and constitutional symptoms using cyclophosphamide, but no difference in mortality. When cyclophosphamide was compared with mycophenolate, there were differences in diffusing capacity of the lung for carbon monoxide % predicted favoring mycophenolate at 6 months (MD, -3.67%; 95% CI, -6.3% to -1.1% unadjusted; MD, -4.88%; 95% CI, -7.3% to -2.5% adjusted for alveolar volume; moderate evidence), 12 months (MD, -5.90%; 95% CI, -8.4% to -3.4% adjusted for alveolar volume; moderate evidence), and 18 months (MD, -3.26%; 95% CI, -6.1% to -0.4%; moderate evidence), but not at 24 months. There were no differences in FVC % predicted, mortality, or quality-of-life outcomes, but participants were more likely to prematurely discontinue cyclophosphamide compared with mycophenolate (relative risk, 1.70; 95% CI, 1.10-2.63; high-certainty evidence). Conclusions: A review of the published evidence shows that cyclophosphamide is effective in SSc-ILD compared with placebo, with an increased risk of side effects. However, mycophenolate may be equivocal or better than cyclophosphamide. Clinicians and patients should weigh the potential benefits and risks with respect to individual patient circumstances and preferences.
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Affiliation(s)
- Hayley Barnes
- Clinical School and
- Centre for Occupational and Environmental Health, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Marya Ghazipura
- Global Health Economics and Outcomes Research, ZS Associates, New York, New York
- Divisions of Epidemiology and Biostatistics, Department of Population Health, and
| | - Derrick Herman
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, The Ohio State Wexner Medical Center, Columbus, Ohio
| | - Madalina Macrea
- Division of Pulmonary and Sleep Medicine, Salem Veterans Affairs Medical Center, Salem, Virginia
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Shandra L Knight
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Richard M Silver
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Sydney B Montesi
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts; and
| | - Ganesh Raghu
- Center for Interstitial Lung Diseases, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine and Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Tanzib Hossain
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University Grossman School of Medicine, New York University Langone Health, New York, New York
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Yeo J, Yoon SH, Kim JY, Lee JS, Lee EY, Goo JM, Pourzand L, Goldin JG, Kim GJ, Ha Y. Quantitative interstitial lung disease scores in idiopathic inflammatory myopathies: longitudinal changes and clinical implications. Rheumatology (Oxford) 2023; 62:3690-3699. [PMID: 36929924 PMCID: PMC10629794 DOI: 10.1093/rheumatology/kead122] [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: 07/22/2022] [Revised: 02/01/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES To investigate computer-aided quantitative scores from high-resolution CT (HRCT) images and determine their longitudinal changes and clinical significance in patients with idiopathic inflammatory myopathies (IIMs)-related interstitial lung disease (IIMs-ILD). METHODS The clinical data and HRCT images of 80 patients with IIMs who underwent serial HRCT scans at least twice were retrospectively analysed. Quantitative ILD (QILD) scores (%) were calculated as the sum of the extent of lung fibrosis, ground-glass opacity, and honeycombing. The individual time-estimated ΔQILD between two consecutive scans was derived using a linear approximation of yearly changes. RESULTS The baseline median QILD (interquartile range) scores in the whole lung were 28.1% (19.1-43.8). The QILD was significantly correlated with forced vital capacity (r = -0.349, P = 0.002) and diffusing capacity for carbon monoxide (r = -0.381, P = 0.001). For ΔQILD between the first two scans, according to the visual ILD subtype, QILD aggravation was more frequent in patients with usual interstitial pneumonia (UIP) than non-UIP (80.0% vs 44.4%, P = 0.013). Multivariable logistic regression analyses identified UIP was significantly related to radiographic ILD progression (ΔQILD >2%, P = 0.015). Patients with higher baseline QILD scores (>28.1%) had a higher risk of lung transplantation or death (P = 0.015). In the analysis of three serial HRCT scans (n = 41), dynamic ΔQILD with four distinct patterns (improving, worsening, convex and concave) was observed. CONCLUSION QILD changes in IIMs-ILD were dynamic, and baseline UIP patterns seemed to be related to a longitudinal progression in QILD. These may be potential imaging biomarkers for lung function, changes in ILD severity and prognosis in IIMs-ILD.
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Affiliation(s)
- Jina Yeo
- Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ju Yeon Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong Seok Lee
- Clinic Pappalardo Center, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
- GENOME INSIGHT Inc, Daejeon, Republic of Korea
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Lila Pourzand
- Department of Radiological Sciences, David-Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jonathan G Goldin
- Department of Radiological Sciences, David-Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Grace‐Hyun J Kim
- Department of Radiological Sciences, David-Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - You‐Jung Ha
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi‐Do, Republic of Korea
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3
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Cerro-Chiang G, Ayres M, Rivas A, Romero T, Parker SJ, Mastali M, Elashoff D, Chen P, Van Eyk JE, Wolters PJ, Boin F, Zaman T. Protein biomarkers of disease progression in patients with systemic sclerosis associated interstitial lung disease. Sci Rep 2023; 13:8645. [PMID: 37244972 DOI: 10.1038/s41598-023-35840-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/24/2023] [Indexed: 05/29/2023] Open
Abstract
Systemic sclerosis is a rare connective tissue disease; and interstitial lung disease (SSc-ILD) is associated with significant morbidity and mortality. There are no clinical, radiologic features, nor biomarkers that identify the specific time when patients are at risk for progression at which the benefits from treatment outweigh the risks. Our study aimed to identify blood protein biomarkers associated with progression of interstitial lung disease in patients with SSc-ILD using an unbiased, high-throughput approach. We classified SSc-ILD as progressive or stable based on change in forced vital capacity over 12 months or less. We profiled serum proteins by quantitative mass spectrometry and analyzed the association between protein levels and progression of SSc-ILD via logistic regression. The proteins associated with at a p value of < 0.1 were queried in the ingenuity pathway analysis (IPA) software to identify interaction networks, signaling, and metabolic pathways. Through principal component analysis, the relationship between the top 10 principal components and progression was evaluated. Unsupervised hierarchical clustering with heatmapping was done to define unique groups. The cohort consisted of 72 patients, 32 with progressive SSc-ILD and 40 with stable disease with similar baseline characteristics. Of a total of 794 proteins, 29 were associated with disease progression. After adjusting for multiple testing, these associations did not remain significant. IPA identified five upstream regulators that targeted proteins associated with progression, as well as a canonical pathway with a higher signal in the progression group. Principal component analysis showed that the ten components with the highest Eigenvalues represented 41% of the variability of the sample. Unsupervised clustering analysis revealed no significant heterogeneity between the subjects. We identified 29 proteins associated with progressive SSc-ILD. While these associations did not remain significant after accounting for multiple testing, some of these proteins are part of pathways relevant to autoimmunity and fibrogenesis. Limitations included a small sample size and a proportion of immunosuppressant use in the cohort, which could have altered the expression of inflammatory and immunologic proteins. Future directions include a targeted evaluation of these proteins in another SSc-ILD cohort or application of this study design to a treatment naïve population.
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Affiliation(s)
- Giuliana Cerro-Chiang
- Division of Pulmonary and Critical Care Medicine, Cedars Sinai Medical Center, 8700 Beverly Blvd., South Tower Room 6723, Los Angeles, CA, 90048, USA.
| | - Matthew Ayres
- Advanced Clinical Biosystems Institute Biomedical Sciences, The Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Alejandro Rivas
- Advanced Clinical Biosystems Institute Biomedical Sciences, The Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Tahmineh Romero
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA, USA
| | - Sarah J Parker
- Advanced Clinical Biosystems Institute Biomedical Sciences, The Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Mitra Mastali
- Advanced Clinical Biosystems Institute Biomedical Sciences, The Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - David Elashoff
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA, USA
| | - Peter Chen
- Division of Pulmonary and Critical Care Medicine, Cedars Sinai Medical Center, 8700 Beverly Blvd., South Tower Room 6723, Los Angeles, CA, 90048, USA
| | - Jennifer E Van Eyk
- Advanced Clinical Biosystems Institute Biomedical Sciences, The Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Paul J Wolters
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine., University of California, San Francisco, San Francisco, CA, USA
| | - Francesco Boin
- Division of Rheumatology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Tanzira Zaman
- Division of Pulmonary and Critical Care Medicine, Cedars Sinai Medical Center, 8700 Beverly Blvd., South Tower Room 6723, Los Angeles, CA, 90048, USA
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Wells AU, Walsh SLF. Quantitative computed tomography and machine learning: recent data in fibrotic interstitial lung disease and potential role in pulmonary sarcoidosis. Curr Opin Pulm Med 2022; 28:492-497. [PMID: 35861463 DOI: 10.1097/mcp.0000000000000902] [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: 11/27/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to summarize quantitative computed tomography (CT) and machine learning data in fibrotic lung disease and to explore the potential application of these technologies in pulmonary sarcoidosis. RECENT FINDINGS Recent data in the use of quantitative CT in fibrotic interstitial lung disease (ILD) are covered. Machine learning includes deep learning, a branch of machine learning particularly suited to medical imaging analysis. Deep learning imaging biomarker research in ILD is currently undergoing accelerated development, driven by technological advances in image processing and analysis. Fundamental concepts and goals related to deep learning imaging research in ILD are discussed. Recent work highlighted in this review has been performed in patients with idiopathic pulmonary fibrosis (IPF). Quantitative CT and deep learning have not been applied to pulmonary sarcoidosis, although there are recent deep learning data in cardiac sarcoidosis. SUMMARY Pulmonary sarcoidosis presents unsolved problems for which quantitative CT and deep learning may provide unique solutions: in particular, the exploration of the long-standing question of whether sarcoidosis should be viewed as a single disease or as an umbrella term for disorders that might usefully be considered as separate diseases.
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5
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Volkmann ER, Tashkin DP, Roth MD, Goldin J, Kim GHJ. Early Radiographic Progression of Scleroderma: Lung Disease Predicts Long-term Mortality. Chest 2022; 161:1310-1319. [PMID: 34896093 PMCID: PMC9131045 DOI: 10.1016/j.chest.2021.11.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/12/2021] [Accepted: 11/27/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Radiographic end points commonly are included in therapeutic trials for systemic sclerosis (SSc)-interstitial lung disease (ILD); however, the relationship between these outcomes and long-term mortality is unclear. RESEARCH QUESTION Do short-term changes in radiographic measures of ILD predict long-term survival in patients with SSc? STUDY DESIGN AND METHODS The Scleroderma Lung Study (SLS) I and II evaluated the safety and efficacy of cyclophosphamide (in SLS I and II) and mycophenolate mofetil (in SLS II) for the treatment of SSc-ILD. Changes in the extent of ILD over time were assessed on high-resolution CT scans of the chest by quantitative image analysis, an approach that applies a computer-based algorithm to assess changes in the radiographic extent of ILD objectively. Participants subsequently were followed for up to 12 years (SLS I) and 8 years (SLS II). Cox proportional hazards models determined whether the change in the quantitative radiographic extent of ILD predicted survival, adjusting for other known predictors of survival. RESULTS Among SLS I and II participants, 82 and 90 had follow-up imaging scans, respectively, and were included in the analysis. Participants in both trials who showed an increase in the total quantitative radiographic extent of ILD scores of ≥ 2% at 12 months (SLS I) or 24 months (SLS II) experienced significantly worse long-term survival than those with change scores of < 2% (P ≤ .01, log-rank test). In the multivariate Cox models, radiographic progression remained associated with worse long-term survival in SLS I (P = .089) and SLS II (P = .014). INTERPRETATION Data from two independent clinical trial cohorts with extensive long-term follow-up demonstrated that radiographic progression of ILD over 12 to 24 months, in both treatment and placebo arms, can predict increased risk for long-term mortality in patients with SSc. These findings suggest that radiographic end points may serve as surrogates for mortality in SSc-ILD.
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Affiliation(s)
- Elizabeth R Volkmann
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
| | - Donald P Tashkin
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Michael D Roth
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Jonathan Goldin
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Grace H J Kim
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
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Khanna D, Distler O, Cottin V, Brown KK, Chung L, Goldin JG, Matteson EL, Kazerooni EA, Walsh SLF, McNitt-Gray M, Maher TM. Diagnosis and monitoring of systemic sclerosis-associated interstitial lung disease using high-resolution computed tomography. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2022; 7:168-178. [PMID: 36211204 PMCID: PMC9537704 DOI: 10.1177/23971983211064463] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/12/2021] [Indexed: 01/09/2023]
Abstract
Patients with systemic sclerosis are at high risk of developing systemic sclerosis–associated interstitial lung disease. Symptoms and outcomes of systemic sclerosis–associated interstitial lung disease range from subclinical lung involvement to respiratory failure and death. Early and accurate diagnosis of systemic sclerosis–associated interstitial lung disease is therefore important to enable appropriate intervention. The most sensitive and specific way to diagnose systemic sclerosis–associated interstitial lung disease is by high-resolution computed tomography, and experts recommend that high-resolution computed tomography should be performed in all patients with systemic sclerosis at the time of initial diagnosis. In addition to being an important screening and diagnostic tool, high-resolution computed tomography can be used to evaluate disease extent in systemic sclerosis–associated interstitial lung disease and may be helpful in assessing prognosis in some patients. Currently, there is no consensus with regards to frequency and scanning intervals in patients at risk of interstitial lung disease development and/or progression. However, expert guidance does suggest that frequency of screening using high-resolution computed tomography should be guided by risk of developing interstitial lung disease. Most experienced clinicians would not repeat high-resolution computed tomography more than once a year or every other year for the first few years unless symptoms arose. Several computed tomography techniques have been developed in recent years that are suitable for regular monitoring, including low-radiation protocols, which, together with other technologies, such as lung ultrasound and magnetic resonance imaging, may further assist in the evaluation and monitoring of patients with systemic sclerosis–associated interstitial lung disease. A video abstract to accompany this article is available at: https://www.globalmedcomms.com/respiratory/Khanna/HRCTinSScILD
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Affiliation(s)
- Dinesh Khanna
- Scleroderma Program, Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Vincent Cottin
- Hospices Civils de Lyon, Department of Respiratory Medicine, National Coordinating Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, INRAE, UMR754, University Claude Bernard Lyon 1, Lyon, France
| | - Kevin K Brown
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Lorinda Chung
- Immunology and Rheumatology, Stanford University, Palo Alto, CA, USA
| | - Jonathan G Goldin
- David Geffen School of Medicine and UCLA Medical Center, Los Angeles, CA, USA
| | | | - Ella A Kazerooni
- Division of Cardiothoracic Radiology, Department of Radiology, Michigan Medicine, Ann Arbor, MI, USA
- Division of Pulmonary Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Simon LF Walsh
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Michael McNitt-Gray
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Physics and Biology in Medicine Graduate Program, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Toby M Maher
- National Heart and Lung Institute, Imperial College London, London, UK
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
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Ruaro B, Baratella E, Confalonieri P, Confalonieri M, Vassallo FG, Wade B, Geri P, Pozzan R, Caforio G, Marrocchio C, Cova MA, Salton F. High-Resolution Computed Tomography and Lung Ultrasound in Patients with Systemic Sclerosis: Which One to Choose? Diagnostics (Basel) 2021; 11:2293. [PMID: 34943531 PMCID: PMC8700001 DOI: 10.3390/diagnostics11122293] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 02/07/2023] Open
Abstract
Imaging plays a pivotal role in systemic sclerosis for both diagnosis management of pulmonary complications, and high-resolution computed tomography (HRCT) is the most sensitive technique for the evaluation of systemic sclerosis-associated interstitial lung disease (SSc-ILD). Indeed, several studies have demonstrated that HRCT helps radiologists and clinicians to make a correct diagnosis on the basis of recognised typical patterns for SSc-ILD. Most SSc patients affected by ILD have a non-specific interstitial pneumonia pattern (NISP) on HRCT scan, whilst a minority of cases fulfil the criteria for usual interstitial pneumonia (UIP). Moreover, several recent studies have demonstrated that lung ultrasound (LUS) is an emergent tool in SSc diagnosis and follow-up, although its role is still to be confirmed. Therefore, this article aims at evaluating the role of LUS in SSc screening, aimed at limiting the use of CT to selected cases.
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Affiliation(s)
- Barbara Ruaro
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Paola Confalonieri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Marco Confalonieri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Fabio Giuseppe Vassallo
- Department of Pulmonology, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34149 Trieste, Italy;
| | - Barbara Wade
- AOU City of Health and Science of Turin, Department of Science of Public Health and Pediatrics, University of Torino, 10124 Torino, Italy;
| | - Pietro Geri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Riccardo Pozzan
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Gaetano Caforio
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
| | - Cristina Marrocchio
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Maria Assunta Cova
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Francesco Salton
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (P.C.); (M.C.); (P.G.); (R.P.); (G.C.); (F.S.)
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8
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Vonk MC, Smith V, Sfikakis PP, Cutolo M, Del Galdo F, Seibold JR. Pharmacological treatments for SSc-ILD: Systematic review and critical appraisal of the evidence. Autoimmun Rev 2021; 20:102978. [PMID: 34718159 DOI: 10.1016/j.autrev.2021.102978] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
Many therapies have been investigated for systemic sclerosis-associated interstitial lung disease (SSc-ILD), including immunosuppressive therapies, antifibrotic agents, immunomodulators and monoclonal antibodies. There is a high unmet medical need to better understand the current evidence for treatment efficacy and safety. This systematic review aims to present the existing literature on different drug treatments investigated for SSc-ILD and to critically assess the level of evidence for these drugs. A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A structured literature search was performed for clinical trials and observational studies on the treatment of SSc-ILD with pharmaceutical interventions from 1 January 1990 to 15 December 2020. The quality of each reference was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria. A total of 77 references were reviewed and 13 different treatments were identified. We found high-quality evidence for the use of cyclophosphamide, nintedanib, mycophenolate and tocilizumab. Therefore, we would posit that the clinical community has four valid options for treatment of SSc-ILD. Further research is mandatory to provide more evidence for the optimal treatment strategy in SSc-ILD, including the optimal time to initiate treatment, selection of patients for treatment and upfront combination therapy.
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Affiliation(s)
- Madelon C Vonk
- Department of Rheumatic Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, Ghent, Belgium; Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Petros P Sfikakis
- National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology, Postgraduate School of Rheumatology, Department of Internal Medicine, University of Genova, IRCCS San Martino Polyclinic Genova, Genoa, Italy
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9
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Ruaro B, Baratella E, Confalonieri P, Wade B, Marrocchio C, Geri P, Busca A, Pozzan R, Andrisano AG, Cova MA, Confalonieri M, Salton F. High-Resolution Computed Tomography: Lights and Shadows in Improving Care for SSc-ILD Patients. Diagnostics (Basel) 2021; 11:1960. [PMID: 34829307 PMCID: PMC8617987 DOI: 10.3390/diagnostics11111960] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/11/2022] Open
Abstract
The diagnosis and classification of systemic sclerosis-associated interstitial lung disease (SSc-ILD) is essential to improve the prognosis of systemic sclerosis (SSc) patients. The risk-stratification of disease severity and follow-up requires a multidisciplinary approach, integrating high-resolution computed tomography (HRTC) of the lung, pulmonary function tests (PFT), along with clinical and symptomatic evaluations. The use of HRCT in detecting SSc-ILD is not so much based on a definitive validation, but rather reflects the widespread clinician recognition of dissatisfaction with other modalities. However, due to the heterogeneity of SSc-ILD and the potential absence of symptoms in early or mild disease, it is prudent to consider as many parameters as possible in the assessment and monitoring of newly diagnosed patients. An early diagnosis meets the primary goal, i.e., the prevention of disease progression. The current first line treatment regimens are mainly centered on immunosuppressive therapy. This review assesses the role HRCT plays in optimizing care and improving clinical outcomes in SSc-ILD patients.
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Affiliation(s)
- Barbara Ruaro
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Paola Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Barbara Wade
- AOU City of Health and Science of Turin, Department of Science of Public Health and Pediatrics, University of Torino, 10124 Torino, Italy;
| | - Cristina Marrocchio
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Pietro Geri
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Annalisa Busca
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Riccardo Pozzan
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Alessia Giovanna Andrisano
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Maria Assunta Cova
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (E.B.); (C.M.); (M.A.C.)
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
| | - Francesco Salton
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (P.C.); (P.G.); (A.B.); (R.P.); (A.G.A.); (M.C.); (F.S.)
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The Extent and Diverse Trajectories of Longitudinal Changes in Rheumatoid Arthritis Interstitial Lung Diseases Using Quantitative HRCT Scores. J Clin Med 2021; 10:jcm10173812. [PMID: 34501260 PMCID: PMC8432030 DOI: 10.3390/jcm10173812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/17/2021] [Indexed: 02/08/2023] Open
Abstract
We aimed to validate quantitative high-resolution computed tomography (HRCT) imaging analyses of interstitial lung disease (ILD) in rheumatoid arthritis (RA) patients, and to delineate a broad spectrum of annual longitudinal changes of ILD severity in the RA-ILD cohorts. Retrospective cohort 1 (n = 26) had matched PFT results and prospective cohort 2 (n = 34) were followed for over two years with baseline serum specimen. Automated quantitative analysis of HRCT was expressed as the extent of ground-glass opacity, lung fibrosis, honeycombing, and their summation-the total extent of quantitative ILD (QILD). Higher QILD score was associated with lower pulmonary function especially for DLCO% (ρ = -0.433, p = 0.027). Higher serum level of Krebs von den Lungen 6 were significantly associated with high QILD scores (ρ = 0.400, p = 0.026). Regarding QILD score changes in whole lung, even a single point increase was significantly associated with interval progression detected by the radiologist. Four distinct patterns (improvement, worsening, convex-like, and concave-like) during the 24 months were described by QILD scores. Prolonged disease duration of ILD at baseline was significantly associated with worsening of QILD scores. QILD has the potential to reliably evaluate the dynamic severity changes in patients with RA-ILD.
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Ariani A, Sverzellati N, Becciolni A, Milanese G, Silva M. Using quantitative computed tomography to predict mortality in patients with interstitial lung disease related to systemic sclerosis: implications for personalized medicine. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2020. [DOI: 10.1080/23808993.2021.1858053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Alarico Ariani
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria Di Parma, Parma, Italy
| | - Nicola Sverzellati
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria Di Parma, Parma, Italy
| | - Andrea Becciolni
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria Di Parma, Parma, Italy
| | - Gianluca Milanese
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria Di Parma, Parma, Italy
| | - Mario Silva
- Department of Medicine, Internal Medicine and Rheumatology Unit - Azienda Ospedaliero Universitaria Di Parma, Parma, Italy
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12
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Ni Z, Ng TSC, Liu J, Huang S, Li X, Xu X, Chen H. Quantitative assessment of pulmonary function in lymphangioleiomyomatosis patients using high-resolution computed tomography and pulmonary function tests. J Thorac Dis 2020; 12:6466-6475. [PMID: 33282349 PMCID: PMC7711362 DOI: 10.21037/jtd-20-1104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background To explore the feasibility of using quantitative high-resolution computed tomography (HRCT) to evaluate pulmonary function in patients with pulmonary lymphangioleiomyomatosis (PLAM). Methods Pulmonary function tests (PFTs) were performed in 30 patients with pathologically confirmed PLAM with the use of HRCT. These results were correlated with quantitative HRCT in 21 patients. Results There were significant correlations between the HRCT parameters for lung function and PFT parameters. Among these parameters, emphysema volume (EV), pulmonary volume with a pixel index less than the trigger threshold (−950 HU) to account for a proportion of total lung volume [PI-950 (%)] and forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC (%)] had the strongest correlations, reaching values between −0.71 and −0.68. HRCT lung function might therefore also be helpful for predicting changes in lung function before and after treatment. Conclusions HRCT is helpful for the assessment of pulmonary function in PLAM patients and can assist in the clinical evaluation of lung function and treatment response in patients with this disease.
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Affiliation(s)
- Zhiwen Ni
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Thomas S C Ng
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jie Liu
- Department of Respiratory, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Suidan Huang
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoling Li
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoyin Xu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Huai Chen
- Department of Radiology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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13
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Lancaster L, Goldin J, Trampisch M, Kim GH, Ilowite J, Homik L, Hotchkin DL, Kaye M, Ryerson CJ, Mogulkoc N, Conoscenti CS. Effects of Nintedanib on Quantitative Lung Fibrosis Score in Idiopathic Pulmonary Fibrosis. Open Respir Med J 2020; 14:22-31. [PMID: 33088361 PMCID: PMC7539538 DOI: 10.2174/1874306402014010022] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/17/2020] [Accepted: 07/02/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Nintedanib slows disease progression in patients with Idiopathic Pulmonary Fibrosis (IPF) by reducing decline in Forced Vital Capacity (FVC). The effects of nintedanib on abnormalities on high-resolution computed tomography scans have not been previously studied. Objective: We conducted a Phase IIIb trial to assess the effects of nintedanib on changes in Quantitative Lung Fibrosis (QLF) score and other measures of disease progression in patients with IPF. Methods: 113 patients were randomized 1:1 to receive nintedanib 150 mg bid or placebo double-blind for ≥6 months, followed by open-label nintedanib. The primary endpoint was the relative change from baseline in QLF score (%) at month 6. Analyses were descriptive and exploratory. Results: Adjusted mean relative changes from baseline in QLF score at month 6 were 11.4% in the nintedanib group (n=42) and 14.6% in the placebo group (n=45) (difference 3.2% [95% CI: −9.2, 15.6]). Adjusted mean absolute changes from baseline in QLF score at month 6 were 0.98% and 1.33% in these groups, respectively (difference 0.35% [95% CI: −1.27, 1.96]). Adjusted mean absolute changes from baseline in FVC at month 6 were −14.2 mL and −83.2 mL in the nintedanib (n=54) and placebo (n=54) groups, respectively (difference 69.0 mL [95% CI: −8.7, 146.8]). Conclusion: Exploratory data suggest that in patients with IPF, 6 months’ treatment with nintedanib was associated with a numerically smaller degree of fibrotic change in the lungs and reduced FVC decline versus placebo. These data support previous findings that nintedanib slows the progression of IPF.
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Affiliation(s)
- Lisa Lancaster
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan Goldin
- Department of Radiology, University of California, Los Angeles, California, USA
| | | | - Grace Hyun Kim
- Department of Radiology, University of California, Los Angeles, California, USA.,Department of Biostatistics, University of California, Los Angeles, California, USA
| | - Jonathan Ilowite
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York
| | - Lawrence Homik
- Department of Respiratory Medicine and Bronchoscopy, Winnipeg Clinic, Winnipeg, Manitoba, Canada
| | - David L Hotchkin
- The Oregon Clinic, Division of Pulmonary, Critical Care & Sleep Medicine, Portland, Oregon, USA
| | - Mitchell Kaye
- Department of Pulmonary Medicine, Minnesota Lung Center, Ltd., Minneapolis, Minnesota, USA
| | - Christopher J Ryerson
- Department of Medicine & Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Nesrin Mogulkoc
- Department of Pulmonology, Ege University Hospital, Bornova, Izmir, Turkey
| | - Craig S Conoscenti
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut, USA
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14
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Khanna D, Tashkin DP, Denton CP, Renzoni EA, Desai SR, Varga J. Etiology, Risk Factors, and Biomarkers in Systemic Sclerosis with Interstitial Lung Disease. Am J Respir Crit Care Med 2020; 201:650-660. [PMID: 31841044 PMCID: PMC7068837 DOI: 10.1164/rccm.201903-0563ci] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Systemic sclerosis (SSc) is a complex, multiorgan, autoimmune disease. Lung fibrosis occurs in ∼80% of patients with SSc; 25% to 30% develop progressive interstitial lung disease (ILD). The pathogenesis of fibrosis in SSc-associated ILD (SSc-ILD) involves cellular injury, activation/differentiation of mesenchymal cells, and morphological/biological changes in epithelial/endothelial cells. Risk factors for progressive SSc-ILD include older age, male sex, degree of lung involvement on baseline high-resolution computed tomography imaging, reduced DlCO, and reduced FVC. SSc-ILD does not share the genetic risk architecture observed in idiopathic pulmonary fibrosis (IPF), with key risk factors yet to be identified. Presence of anti-Scl-70 antibodies and absence of anti-centromere antibodies indicate increased likelihood of progressive ILD. Elevated levels of serum Krebs von den Lungen-6 and C-reactive protein are both associated with SSc-ILD severity and predict SSc-ILD progression. A promising prognostic indicator is serum chemokine (C-C motif) ligand 18. SSc-ILD shares similarities with IPF, although clear differences exist. Histologically, a nonspecific interstitial pneumonia pattern is commonly observed in SSc-ILD, whereas IPF is defined by usual interstitial pneumonia. The course of SSc-ILD is variable, ranging from minor, stable disease to a progressive course, whereas all patients with IPF experience progression of disease. Although appropriately treated patients with SSc-ILD have better chances of stabilization and survival, a relentlessly progressive course, akin to IPF, is seen in a minority. Better understanding of cellular and molecular pathogenesis, genetic risk, and distinctive features of SSc-ILD and identification of robust prognostic biomarkers are needed for optimal disease management.
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Affiliation(s)
- Dinesh Khanna
- Division of Rheumatology, Department of Internal Medicine, University of Michigan Scleroderma Program, Ann Arbor, Michigan
| | - Donald P Tashkin
- Department of Medicine, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California
| | - Christopher P Denton
- University College London Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, London, United Kingdom
| | - Elisabetta A Renzoni
- Interstitial Lung Disease Unit and.,National Institute for Health Research Clinical Research Facility, Royal Brompton Hospital, London, United Kingdom
| | - Sujal R Desai
- National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Department of Radiology, Royal Brompton & Harefield National Health Services Foundation Trust Hospital, London, United Kingdom; and
| | - John Varga
- Northwestern Scleroderma Program, Feinberg School of Medicine, Chicago, Illinois
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15
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Salaffi F, Carotti M, Tardella M, Di Carlo M, Fraticelli P, Fischetti C, Giovagnoni A, Gabrielli A. Computed tomography assessment of evolution of interstitial lung disease in systemic sclerosis: Comparison of two scoring systems. Eur J Intern Med 2020; 76:71-75. [PMID: 32089425 DOI: 10.1016/j.ejim.2020.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/29/2020] [Accepted: 02/11/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study was to evaluate and compare the internal and external responsiveness of a computed-aided method (CaM) with a conventional visual reader-based score (CoVR) to measure interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) on high resolution computed tomography (HRCT). METHODS Forty-five patients were evaluated in this retrospective cohort. HRCTs were collected at baseline and after 1 year. HRCT abnormalities were evaluated according to a CoVR (Warrick's method) and a quantitative CaM. Internal 1-year responsiveness was tested with a standardized mean response (SRM). Analyses of the receiver operating characteristic curves (ROCs) evaluated the sensitivity and specificity of the two methods to discriminate between clinically relevant progression and no relevant progression, using expert judgment as the gold standard (external responsiveness). RESULTS In one year, lung involvement was stable/improved in 17 of the 45 patients (37.8%) and worsened in 28 patients (62.2%). HRCT scores changed moderately over the follow-up period. Using SFM, CaM was significantly more responsive in detecting changes due to treatment than the CoVR method. Likewise, in the analysis of the ROC curve, CaM scores showed the highest performance (AUC ROC CaM vs. CoVR, 0.951 vs. 0.807; p = 0.0065). CONCLUSION Quantitative analysis of CaM was more responsive than the CoVR method to accurately evaluate and monitor SSc-ILD progression or response to therapy.
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Affiliation(s)
- Fausto Salaffi
- Rheumatological Clinic, Ospedale Carlo Urbani Jesi, Università Politecnica delle Marche, Ancona, Italy.
| | - Marina Carotti
- Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Italy.
| | - Marika Tardella
- Rheumatological Clinic, Ospedale Carlo Urbani Jesi, Università Politecnica delle Marche, Ancona, Italy.
| | - Marco Di Carlo
- Rheumatological Clinic, Ospedale Carlo Urbani Jesi, Università Politecnica delle Marche, Ancona, Italy.
| | - Paolo Fraticelli
- Department of Internal Medicine, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy.
| | - Colomba Fischetti
- Department of Internal Medicine, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy.
| | - Andrea Giovagnoni
- Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Italy.
| | - Armando Gabrielli
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
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Forestier A, Le Gouellec N, Béhal H, Kramer G, Perez T, Sobanski V, Dubois SM, Lambert M, Hatron PY, Hachulla E, Duhamel A, Matran R, Launay D, Rémy-Jardin M. Evolution of high-resolution CT-scan in systemic sclerosis-associated interstitial lung disease: Description and prognosis factors. Semin Arthritis Rheum 2020; 50:1406-1413. [PMID: 32245698 DOI: 10.1016/j.semarthrit.2020.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aims of our study were to describe the evolution of interstitial lung disease (ILD) extent on HRCT scan in systemic sclerosis (SSc), to identify baseline prognostic factors associated with ILD evolution and to assess whether the evolution of pulmonary function tests (PFTs) correlated with this evolution. METHODS 58 SSc with ILD (SSc-ILD) patients were included. All HRCT scans and PFTs available were collected. We modelized PFTs and HRCT scans evolution using linear mixed model with random effect. RESULTS Patients underwent a median number of 3 HRCT scans (total n = 203) and 5 PFTs (total n = 329), during a mean follow-up of 5.3 ± 4.9 years. Mean SSc duration was 2.5 ± 3.1 years at the diagnosis of ILD. Mean baseline ILD extent was 32.3 ± 28.7%. We found a significant mean progression of ILD extent on serial HRCT scans of 0.92 ± 0.36% per year (p = 0.018). Male sex, diffuse cutaneous SSc (dcSSc), presence of anti-topoisomerase 1 antibodies, a higher DLCO, limited ILD and a low coarseness score at baseline in bivariate analysis, and presence of antitopoisomerase 1 antibodies and a coarseness score of 0 in multivariate analysis, were associated with faster progression of ILD extent over time There was a significant correlation between the progression of ILD extent and the decline of DLCO but only a trend for FVC. ILD extent at baseline and during follow-up was associated with survival. CONCLUSION Male sex, dcSSc, anti-topoisomerase 1 antibodies and a less severe ILD at baseline were associated with a faster progression of ILD over time. Evolution of DLCO significantly correlated with change in ILD extent on HRCT scan. Our study helps defining the profile of patients at risk of experiencing a progression of ILD on HRCT scans.
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Affiliation(s)
- Alexandra Forestier
- University Lille, U995, Lille Inflammation Research International Center (LIRIC), F-59000 Lille, France; Inserm, U995, F-59000 Lille, France; Department of Internal Medicine and Clinical Immunology, CHU Lille, Hôpital Claude Huriez, 59037 Lille, France; Referral Centre for Rare Systemic Auto-immune Diseases North and North-West of France (CERAINO), F-59000 Lille, France
| | - Noémie Le Gouellec
- University Lille, U995, Lille Inflammation Research International Center (LIRIC), F-59000 Lille, France; Inserm, U995, F-59000 Lille, France; Department of Internal Medicine and Clinical Immunology, CHU Lille, Hôpital Claude Huriez, 59037 Lille, France; Referral Centre for Rare Systemic Auto-immune Diseases North and North-West of France (CERAINO), F-59000 Lille, France
| | - Hélène Béhal
- University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Unité de Biostatistiques, F-59000 Lille, France
| | - Gerdien Kramer
- Département d'Imagerie Thoracique, CHU Lille, F-59000 Lille, France
| | - Thierry Perez
- Service d'Explorations Fonctionnelles Respiratoires, INSERM U1019 - CNRS UMR 8204, CHU Lille, F-59000 Lille, France
| | - Vincent Sobanski
- University Lille, U995, Lille Inflammation Research International Center (LIRIC), F-59000 Lille, France; Inserm, U995, F-59000 Lille, France; Department of Internal Medicine and Clinical Immunology, CHU Lille, Hôpital Claude Huriez, 59037 Lille, France; Referral Centre for Rare Systemic Auto-immune Diseases North and North-West of France (CERAINO), F-59000 Lille, France
| | - Sandrine Morell Dubois
- University Lille, U995, Lille Inflammation Research International Center (LIRIC), F-59000 Lille, France; Inserm, U995, F-59000 Lille, France; Department of Internal Medicine and Clinical Immunology, CHU Lille, Hôpital Claude Huriez, 59037 Lille, France; Referral Centre for Rare Systemic Auto-immune Diseases North and North-West of France (CERAINO), F-59000 Lille, France
| | - Marc Lambert
- University Lille, U995, Lille Inflammation Research International Center (LIRIC), F-59000 Lille, France; Inserm, U995, F-59000 Lille, France; Department of Internal Medicine and Clinical Immunology, CHU Lille, Hôpital Claude Huriez, 59037 Lille, France; Referral Centre for Rare Systemic Auto-immune Diseases North and North-West of France (CERAINO), F-59000 Lille, France
| | - Pierre-Yves Hatron
- University Lille, U995, Lille Inflammation Research International Center (LIRIC), F-59000 Lille, France; Inserm, U995, F-59000 Lille, France; Department of Internal Medicine and Clinical Immunology, CHU Lille, Hôpital Claude Huriez, 59037 Lille, France; Referral Centre for Rare Systemic Auto-immune Diseases North and North-West of France (CERAINO), F-59000 Lille, France
| | - Eric Hachulla
- University Lille, U995, Lille Inflammation Research International Center (LIRIC), F-59000 Lille, France; Inserm, U995, F-59000 Lille, France; Department of Internal Medicine and Clinical Immunology, CHU Lille, Hôpital Claude Huriez, 59037 Lille, France; Referral Centre for Rare Systemic Auto-immune Diseases North and North-West of France (CERAINO), F-59000 Lille, France
| | - Alain Duhamel
- University Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Unité de Biostatistiques, F-59000 Lille, France
| | - Régis Matran
- Service d'Explorations Fonctionnelles Respiratoires, INSERM U1019 - CNRS UMR 8204, CHU Lille, F-59000 Lille, France
| | - David Launay
- University Lille, U995, Lille Inflammation Research International Center (LIRIC), F-59000 Lille, France; Inserm, U995, F-59000 Lille, France; Department of Internal Medicine and Clinical Immunology, CHU Lille, Hôpital Claude Huriez, 59037 Lille, France; Referral Centre for Rare Systemic Auto-immune Diseases North and North-West of France (CERAINO), F-59000 Lille, France.
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Quantitative computed tomography assessment for systemic sclerosis-related interstitial lung disease: comparison of different methods. Eur Radiol 2020; 30:4369-4380. [PMID: 32193641 DOI: 10.1007/s00330-020-06772-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/28/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To compare the previously defined six different histogram-based quantitative lung assessment (QLA) methods on high-resolution CT (HRCT) in patients with systemic sclerosis (SSc)-related interstitial lung disease (ILD). METHODS The HRCT images of SSc patients with ILD were reviewed, and the visual ILD score (semiquantitative) and the severity of ILD (limited or extensive) were calculated. The QLA score of ILD was evaluated using the previously defined six different methods and parameters (different lung attenuation ranges, skewness, kurtosis, mean lung attenuation, and standard deviation [SD]). Pulmonary function tests (PFTs) were also performed on all patients. Relationships among variables were evaluated using Spearman's correlation coefficient (r). Diagnostic performance of quantitative methods for the ability to differentiate the limited from extensive ILD was calculated using ROC analysis. RESULTS Fifty-five patients were included in the study. There was a significant correlation between all quantitative and semiquantitative measurement results (p < 0.0001). The QLA scores revealed a significant correlation with PFT results. The kurtosis value of the voxels between - 200 and - 1024 Hounsfield unit (HU) (Method-5) showed the best correlation with semiquantitative evaluation (r = - 0.740, p < 0.0001). The ROC analysis demonstrated the best performance of SD of the voxels between - 400 and - 950 HU (Method-6) for histogram analysis method and Method-3 (voxels between - 260 and - 600 HU were calculated as ILD) for CT density cutoff methods. CONCLUSIONS All the QLA methods are applicable in assessing the ILD score in SSc patients and have potential importance to differentiate limited from extensive ILD. KEY POINTS • Quantitative interstitial lung disease assessment helps clinicians to assess systemic sclerosis patients with interstitial lung disease. • Quantitative lung assessment methods are applicable in assessing the interstitial lung disease score in systemic sclerosis patients. • Quantitative lung assessment methods have potential importance in the management of patients.
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18
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Amjadi SS, Roofeh D, Namas R, Khanna D. Management of systemic sclerosis-associated interstitial lung disease in the current era. Int J Rheum Dis 2020; 23:137-139. [PMID: 32043307 DOI: 10.1111/1756-185x.13799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - David Roofeh
- Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
| | - Rajaie Namas
- Division of Rheumatology, Cleveland Clinic, Ab Dhabi, United Arab Emirates
| | - Dinesh Khanna
- Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
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19
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Kim GHJ, Tashkin DP, Lo P, Brown MS, Volkmann ER, Gjertson DW, Khanna D, Elashoff RM, Tseng CH, Roth MD, Goldin JG. Using Transitional Changes on High-Resolution Computed Tomography to Monitor the Impact of Cyclophosphamide or Mycophenolate Mofetil on Systemic Sclerosis-Related Interstitial Lung Disease. Arthritis Rheumatol 2020; 72:316-325. [PMID: 31430058 PMCID: PMC6994370 DOI: 10.1002/art.41085] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 08/13/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To examine changes in the extent of specific patterns of interstitial lung disease (ILD) as they transition from one pattern to another in response to immunosuppressive therapy in systemic sclerosis-related ILD (SSc-ILD). METHODS We evaluated changes in the quantitative extent of specific lung patterns of ILD using volumetric high-resolution computed tomography (HRCT) scans obtained at baseline and after 2 years of therapy in patients treated with either cyclophosphamide (CYC) for 1 year or mycophenolate mofetil (MMF) for 2 years in Scleroderma Lung Study II. ILD patterns included lung fibrosis, ground glass, honeycombing, and normal lung. Net change was calculated as the difference in the probability of change from one ILD pattern to another. Wilcoxon's signed rank test was used to compare the changes. RESULTS Forty-seven and 50 patients had baseline and follow-up scans in the CYC and MMF groups, respectively. Mean net improvements reflecting favorable changes from one ILD pattern to another in the whole lung in the CYC and MMF groups, respectively, were as follows: from lung fibrosis to a normal lung pattern, 21% and 19%; from a ground-glass pattern to a normal lung pattern, 30% and 28%; and from lung fibrosis to a ground-glass pattern, 5% and 0.5%. The mean overall improvement in transitioning from a ground-glass pattern or lung fibrosis to a normal lung pattern was significant for both treatments (all P < 0.001). CONCLUSION Significantly favorable transitions from both ground-glass and lung fibrosis ILD patterns to a normal lung pattern were observed in patients undergoing immunosuppressive treatment for SSc-ILD, suggesting the usefulness of examining these transitions for insights into the underlying pathobiology of treatment response.
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Affiliation(s)
- Grace Hyun J Kim
- David Geffen School of Medicine at University of California, Los Angeles and University of California, Los Angeles Fielding School of Public Health
| | - Donald P Tashkin
- David Geffen School of Medicine at University of California, Los Angeles
| | - Pechin Lo
- David Geffen School of Medicine at University of California, Los Angeles
| | - Matthew S Brown
- David Geffen School of Medicine at University of California, Los Angeles
| | | | | | | | - Robert M Elashoff
- David Geffen School of Medicine at University of California, Los Angeles
| | - Chi-Hong Tseng
- David Geffen School of Medicine at University of California, Los Angeles
| | - Michael D Roth
- David Geffen School of Medicine at University of California, Los Angeles
| | - Jonathan G Goldin
- David Geffen School of Medicine at University of California, Los Angeles
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Longitudinal Changes in Quantitative Interstitial Lung Disease on Computed Tomography after Immunosuppression in the Scleroderma Lung Study II. Ann Am Thorac Soc 2019; 15:1286-1295. [PMID: 30265153 DOI: 10.1513/annalsats.201802-079oc] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE The Scleroderma Lung Study II (SLS II) demonstrated significant improvements in pulmonary function and dyspnea at 24 months compared with baseline when patients with symptomatic scleroderma-related interstitial lung disease (SSc-ILD) were treated with either cyclophosphamide for 1 year (followed for another year on placebo) or mycophenolate mofetil for 2 years in a randomized, double-blind clinical trial. Physiologic and clinical outcomes of SLS II have been published previously. OBJECTIVES The aim of the study was to assess changes from baseline in the extent of SSc-ILD on high-resolution computed tomography (HRCT) measured in the SLS II participants using quantitative image analysis after 2 years and to determine whether these HRCT changes were correlated with the changes in physiologic and clinical measures over the same time interval. METHODS Ninety-seven of the 142 randomized subjects (cyclophosphamide group, 47 subjects; mycophenolate mofetil group, 50 subjects) participating in SLS II underwent thoracic volumetric thin-section HRCT at both baseline and 24 months. Quantitative computer-aided diagnosis scores using volumetric HRCT scans were obtained using a previously developed computer-aided system. The scores were quantitative lung fibrosis, quantitative ground glass, quantitative honeycomb, and quantitative interstitial lung disease (QILD), the latter representing the sum of quantitative lung fibrosis, quantitative ground glass, and quantitative honeycomb. These scores were obtained both for the whole lung and for individual lobes. Paired t tests were used for the combined (pooled) cyclophosphamide and mycophenolate mofetil groups to compare 24-month changes from baseline in both the whole lung and the lobe of maximal involvement as determined at baseline (worst lobe). RESULTS At the end of the 24-month trial, QILD in the whole lung was significantly reduced by a mean of 2.51% in the pooled groups (adjusted 95% confidence interval, -4.00 to -1.03%; P = 0.001). There was no significant difference in the QILD score improvement between the cyclophosphamide (-2.66%) and mycophenolate (-2.38%) groups when assessed separately (P = 0.88). For the pooled group, the 24-month changes in QILD scores in the whole lung correlated significantly with other outcomes, including 24-month changes in forced vital capacity (ρ = -0.37), single-breath diffusing capacity of the lung for carbon monoxide (ρ = -0.22), and breathlessness as measured by the Transition Dyspnea Index (ρ = -0.26). CONCLUSIONS Treatment of SSc-ILD with either cyclophosphamide for 1 year, followed by placebo for a second year, or mycophenolate for 2 years was associated with a significant reduction (improvement) in the extent of HRCT SSc-ILD assessed by computer-aided diagnosis scores, which correlated well with one or more other measures of treatment response. These findings demonstrate that actual changes in lung structure accompany improvements in physiologic and/or symptomatic measures in SSc-ILD.
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Roofeh D, Jaafar S, Vummidi D, Khanna D. Management of systemic sclerosis-associated interstitial lung disease. Curr Opin Rheumatol 2019; 31:241-249. [PMID: 30870216 PMCID: PMC6647025 DOI: 10.1097/bor.0000000000000592] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW To review the recently published data and provide a practical overview for management of systemic sclerosis-interstitial lung disease (SSc-ILD). RECENT FINDINGS Published evidence shows considerable practitioner variability in screening patients for ILD. Recent published data support use of cyclophosphamide or mycophenolate mofetil as first-line treatment of SSc-ILD. For patients not responding to first-line therapies, consideration is given to rituximab as rescue therapy. Recent trials of hematopoietic autologous stem cell transplantation have demonstrated benefit in patients with progressive SSc-ILD. Antifibrotic agents are approved in idiopathic pulmonary fibrosis; studies with antifibrotics are underway for SSc-ILD. SUMMARY The specter of rapidly progressive lung disease requires clinicians to risk stratify patients according to known predictors for progression and rigorously monitor for symptoms and advancing disease. The abovementioned therapies promise improved efficacy and favorable side-effect profiles compared to cyclophosphamide.
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Affiliation(s)
- David Roofeh
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program
| | - Sara Jaafar
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program
| | - Dharshan Vummidi
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Dinesh Khanna
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program
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22
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Volkmann ER, Tashkin DP, Sim M, Kim GH, Goldin J, Clements PJ. Determining progression of scleroderma-related interstitial lung disease. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2019; 4:62-70. [PMID: 35382149 PMCID: PMC8922575 DOI: 10.1177/2397198318816915] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 07/20/2023]
Abstract
Interstitial lung disease occurs in the majority of patients with systemic sclerosis. Although interstitial lung disease is the number one cause of death in systemic sclerosis, interstitial lung disease progression rates vary considerably among patients with systemic sclerosis. Some patients with systemic sclerosis-associated interstitial lung disease have sub-clinical disease and may not derive benefit from immunosuppression, while others have a more aggressive interstitial lung disease phenotype. Reliable predictors of interstitial lung disease progression are lacking. The present review describes our current approach to monitoring systemic sclerosis-associated interstitial lung disease progression in clinical practice. To illustrate the marked heterogeneity that exists in interstitial lung disease progression rates in systemic sclerosis, this review presents the individual disease course of five unique patients with systemic sclerosis-associated interstitial lung disease who participated in the Scleroderma Lung Study II. These cases illustrate that treatment response rates vary in systemic sclerosis-associated interstitial lung disease and more research is needed to determine how to predict treatment response in systemic sclerosis-associated interstitial lung disease and to develop personalized treatment approaches for patients with this devastating disease.
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Affiliation(s)
- Elizabeth R Volkmann
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Donald P Tashkin
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Myung Sim
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Grace Hyun Kim
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jonathan Goldin
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Philip J Clements
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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van Royen FS, Moll SA, van Laar JM, van Montfrans JM, de Jong PA, Mohamed Hoesein FAA. Automated CT quantification methods for the assessment of interstitial lung disease in collagen vascular diseases: A systematic review. Eur J Radiol 2019; 112:200-206. [PMID: 30777211 DOI: 10.1016/j.ejrad.2019.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 12/17/2018] [Accepted: 01/21/2019] [Indexed: 02/01/2023]
Abstract
Interstitial lung disease (ILD) is highly prevalent in collagen vascular diseases and reduction of ILD is an important therapeutic target. To that end, reliable quantification of pulmonary disease severity is of great significance. This study systematically reviewed the literature on automated computed tomography (CT) quantification methods for assessing ILD in collagen vascular diseases. PRISMA-DTA guidelines for systematic reviews were used and 19 original research articles up to January 2018 were included based on a MEDLINE/Pubmed and Embase search. Quantitative CT methods were categorized as histogram assessment (12 studies) or pattern/texture recognition (7 studies). R2 for correlation with visual ILD scoring ranged from 0.143 (p < 0.01) to 0.687 (p < 0.0001), for FVC from 0.048 (p < 0.0001) to 0.504 (p < 0.0001) and for DLCO from 0.015 (p = 0.61) to 0.449 (p < 0.0001). Automated CT methods are independent of reader's expertise and are a promising tool in the quantification of ILD in collagen vascular disease patients.
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Affiliation(s)
- Florien S van Royen
- Department of Radiology, Division of Imaging, University Medical Centre Utrecht and Utrecht University, Utrecht, the Netherlands.
| | - Sofia A Moll
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital Utrecht, Utrecht, the Netherlands
| | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Joris M van Montfrans
- Department of Paediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital Utrecht, Utrecht, the Netherlands
| | - Pim A de Jong
- Department of Radiology, Division of Imaging, University Medical Centre Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Firdaus A A Mohamed Hoesein
- Department of Radiology, Division of Imaging, University Medical Centre Utrecht and Utrecht University, Utrecht, the Netherlands
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Cottin V, Brown KK. Interstitial lung disease associated with systemic sclerosis (SSc-ILD). Respir Res 2019; 20:13. [PMID: 30658650 PMCID: PMC6339436 DOI: 10.1186/s12931-019-0980-7] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 01/07/2019] [Indexed: 12/18/2022] Open
Abstract
Background Systemic sclerosis (SSc) is a rare connective tissue disease with a heterogeneous clinical course. Interstitial lung disease (ILD) is a common manifestation of SSc and a leading cause of death. Main body All patients newly diagnosed with SSc should receive a comprehensive clinical evaluation, including assessment of respiratory symptoms, a high-resolution computed tomography (HRCT) scan of the chest, and pulmonary function tests. ILD can develop in any patient with SSc, including those with pulmonary hypertension, but the risk is increased in those with diffuse (rather than limited) cutaneous SSc, those with anti-Scl-70/anti-topoisomerase I antibody, and in the absence of anti-centromere antibody. While it can occur at any time, the risk of developing ILD is greatest early in the course of SSc, so patients should be monitored closely in the first few years after diagnosis. An increased extent of lung fibrosis on HRCT and a low forced vital capacity (FVC) are predictors of early mortality. While not all patients will require treatment, current approaches to the treatment of progressive SSc-ILD focus on immunosuppressant therapies, including cyclophosphamide and mycophenolate mofetil. In patients with severe and/or rapidly progressive disease, both haematopoietic stem cell transplantation (HSCT) and lung transplantation have been successfully used. A number of medications, including the two drugs approved for the treatment of idiopathic pulmonary fibrosis (IPF), are under active investigation as potential new therapies for SSc-ILD. Conclusions Physicians managing patients with SSc should maintain a high level of suspicion and regularly monitor for ILD, particularly in the first few years after diagnosis.
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Affiliation(s)
- Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Claude Bernard University Lyon 1, 28 Avenue du Doyen Lepine, 69677 Lyon Cedex, Lyon, France.
| | - Kevin K Brown
- National Jewish Health, 1400 Jackson Street, Denver, CO, 80206, USA
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Ahmed S, Pattanaik SS, Rai MK, Nath A, Agarwal V. Interstitial lung disease in Systemic sclerosis: insights into pathogenesis and evolving therapies. Mediterr J Rheumatol 2018; 29:140-147. [PMID: 32185315 PMCID: PMC7046043 DOI: 10.31138/mjr.29.3.140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 09/02/2018] [Accepted: 09/13/2018] [Indexed: 01/05/2023] Open
Abstract
Interstitial lung disease (ILD) is a leading cause of mortality in systemic sclerosis (SSc). However, mortality is improving as pathogenesis is being better understood and new therapies emerge. The roles of the inflammasome and NETosis in fibrosis are being elucidated. Epigenetic targets like DNA methylation and microRNA show promise as new targets for anti-fibrotic agents. The IL17-23 pathway has been shown to be active in SSc-ILD. Newer biomarkers are being described like CCL18 and the anti-eIF2B antibody. Hypothesis-free approaches are identifying newer genes like the ALOX5AP and XRCC4 genes. Computer-aided interpretations of CT scans, screening with ultrasonography and magnetic resonance imaging (MRI) are gradually emerging into practice. Imaging can also predict prognosis. A plethora of studies has shown the benefit of immunosuppression in halting ILD progression. Extent of lung involvement and PFT parameters are used to initiate therapy. The best evidence is for cyclophosphamide and mycophenolate. Besides these, corticosteroids and rituximab are being used in cases refractory to the first line drugs. Stem cell transplant is also backed by evidence in SSc. Longer studies on maintenance therapy are awaited. The inflammation in SSc is mostly subclinical and there is great interest in developing anti-fibrotic drugs for SSc-ILD. Perfinidone and nintedanib are under trial. The last resort is lung transplantation.
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Affiliation(s)
- Sakir Ahmed
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sarit Sekhar Pattanaik
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Mohit Kumar Rai
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Alok Nath
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vikas Agarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Silva BRA, Rodrigues RS, Rufino R, Costa CH, Vilela VS, Levy RA, Guimarães ARM, Carvalho ARS, Lopes AJ. Computed tomography trachea volumetry in patients with scleroderma: Association with clinical and functional findings. PLoS One 2018; 13:e0200754. [PMID: 30067820 PMCID: PMC6070209 DOI: 10.1371/journal.pone.0200754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/01/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In scleroderma, excessive collagen production can alter tracheal geometry, and computed tomography (CT) volumetry of this structure may aid in detecting possible abnormalities. The objectives of this study were to quantify the morphological abnormalities in the tracheas of patients with scleroderma and to correlate these findings with data on clinical and pulmonary function. METHODS This was a cross-sectional study in which 28 adults with scleroderma and 27 controls matched by age, gender and body mass index underwent chest CT with posterior segmentation and skeletonization of the images. In addition, all participants underwent pulmonary function tests and clinical evaluation, including the modified Rodnan skin score (mRSS). RESULTS Most patients (71.4%) had interstitial lung disease on CT. Compared to controls, patients with scleroderma showed higher values in the parameters measured by CT trachea volumetry, including area, eccentricity, major diameter, minor diameter, and tortuosity. The tracheal area and equivalent diameter were negatively correlated with the ratio between forced expiratory flow and forced inspiratory flow at 50% of forced vital capacity (FEF50%/FIF50%) (r = -0.44, p = 0.03 and r = -0.46, p = 0.02, respectively). The tracheal tortuosity was negatively correlated with peak expiratory flow (r = -0.51, p = 0.008). The mRSS showed a positive correlation with eccentricity (r = 0.62, p < 0.001) and tracheal tortuosity (r = 0.51, p = 0.007), while the presence of anti-topoisomerase I antibody (ATA) showed a positive correlation with tracheal tortuosity (r = 0.45, p = 0.03). CONCLUSIONS In a sample composed predominantly of scleroderma patients with associated interstitial lung disease, there were abnormalities in tracheal geometry, including greater eccentricity, diameter and tortuosity. In these patients, abnormalities in the geometry of the trachea were associated with functional markers of obstruction. In addition, tracheal tortuosity was correlated with cutaneous involvement and the presence of ATA.
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Affiliation(s)
- Bruno Rangel Antunes Silva
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rogério Rufino
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cláudia Henrique Costa
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Veronica Silva Vilela
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roger Abramino Levy
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alan Ranieri Medeiros Guimarães
- Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alysson Roncally Silva Carvalho
- Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Pulmonary Engineering, Biomedical Engineering Programme, Alberto Luiz Coimbra Institute of Post-Graduation and Research in Engineering, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Xia X, Dai C, Yu H, Huang X, Chen A, Tan Y, Wang L. Asiatic acid prevents the development of interstitial lung disease in a hypochlorous acid-induced mouse model of scleroderma. Oncol Lett 2018; 15:8711-8716. [PMID: 29805609 DOI: 10.3892/ol.2018.8412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 02/15/2018] [Indexed: 12/15/2022] Open
Abstract
Interstitial lung disease is the most common complication of systemic sclerosis (SSc) and is associated with a high rate of mortality. Due to the complex pathogenesis of SSc, the therapies currently available remain limited. In the present study, the effect of asiatic acid (AA) on SSc-associated pulmonary fibrosis (PF) and its association with the transforming growth factor-β1 (TGF-β1)/Smad2/3 signaling pathway were evaluated. A hypochlorous acid (HOCl)-induced model of SSc was used to evaluate the therapeutic effect of AA on PF in SSc, where AA was administered to SSc mice by gavage. PF was alleviated in the AA-treated SSc mice groups when examined under light microscopy. In addition, there was a decrease in histopathological progression and collagen in the lungs. AA significantly reduced expression of type I collagen in the lungs of mice with SSc. It also significantly suppressed α-smooth muscle actin expression, which attenuated the conversion of fibroblasts into muscle fibroblasts. These AA-associated antifibrosis and anti-immune effects were mediated through the significant downregulation of advanced oxidation protein product, E-selectin, and anti-DNA topoisomerase-1 autoantibody levels in the serum. Furthermore, the expression levels of TGF-β1 and the phosphorylated-Smad2/3/Smad2/3 ratios in AA-treated SSc mice were similar to the control. The presence of pulmonary inflammation and fibrosis was confirmed in the HOCl-induced SSc mice and the results demonstrated that selective inhibition of reactive oxygen species prevented PF. By focusing on the classical TGF-β1/Smad2/3 signaling pathway, a mechanism of action of AA was identified to be associated with the inhibition of Smad2/3 activation through negative regulation of Smad2/3 phosphorylation.
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Affiliation(s)
- Xiaoru Xia
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Caijun Dai
- Department of Respiratory Medicine, Jinhua Municipal Central Hospital, Zhejiang University Jinhua Hospital, Jinhua, Zhejiang 321000, P.R. China
| | - Hua Yu
- Department of Geriatric Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Xiaoying Huang
- Department of Pulmonary Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Ali Chen
- Department of Pulmonary Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yingxia Tan
- Central Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Liangxing Wang
- Department of Pulmonary Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
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Kafaja S, Clements PJ, Wilhalme H, Tseng CH, Furst DE, Kim GH, Goldin J, Volkmann ER, Roth MD, Tashkin DP, Khanna D. Reliability and minimal clinically important differences of forced vital capacity: Results from the Scleroderma Lung Studies (SLS-I and SLS-II). Am J Respir Crit Care Med 2018; 197:644-652. [PMID: 29099620 PMCID: PMC6008871 DOI: 10.1164/rccm.201709-1845oc] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/02/2017] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To assess the reliability and the minimal clinically important differences (MCID) for FVC% predicted in the Scleroderma Lung Study I and II. METHODS Using data from SLS I and II (N=300), we evaluated the test-retest reliability for FVC% predicted (FVC%; screening vs. baseline) using intra-class correlation (ICC). MCID estimates at 12 months were calculated in the pooled cohort (SLS-I and II) using 2 anchors: Transition Dyspnea Index (≥change of 1.5 units for improvement and worsening, respectively) and the SF-36 Health Transition question: "Compared to one year ago, how would you rate your health in general now?", where "somewhat better" or "somewhat worse" were defined as the MCID estimates. We next assessed the association of MCID estimates for improvement and worsening of FVC% with patient reported outcomes (PROs) and computer-assisted quantitation of extent of fibrosis (QLF) and of total ILD (QILD) on HRCT. RESULTS Reliability of FVC%, assessed at a mean of 34 days, was 0.93 for the pooled cohort. The MCID estimates for the pooled cohort at 12 months for FVC% improvement ranged from 3.0 % to 5.3% and for worsening from -3.0% to -3.3%. FVC% improvement by ≥MCID was associated with either statistically significant or numerical improvements in some PROs, QILD, and QLF, while FVC% worsening ≥MCID was associated with statistically significant or numerical worsening of PROs, QILD, and QLF. CONCLUSION FVC% has acceptable test-retest reliability, and we have provided the MCID estimates for FVC% in SSc-ILD based changes at 12 months from baseline in two clinical trials. Clinical trial registration available at www.clinicaltrials.gov, IDs NCT00004563 and NCT00883129.
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Affiliation(s)
- Suzanne Kafaja
- UCLA Medical Center, David Geffen School of Medicine at UCLA, Medicine, Los Angeles, California, United States ;
| | - Philip J Clements
- UCLA Medical Center, David Geffen School of Medicine at UCLA, Medicine, Los Angeles, California, United States ;
| | - Holly Wilhalme
- UCLA Medical Center, David Geffen School of Medicine at UCLA, Medicine, Los Angeles, California, United States ;
| | - Chi-Hong Tseng
- UCLA Medical Center, David Geffen School of Medicine at UCLA, Medicine, Los Angeles, California, United States ;
| | - Daniel E Furst
- UCLA Medical Center, David Geffen School of Medicine at UCLA, Medicine, Los Angeles, California, United States ;
| | - Grace Hyun Kim
- UCLA, Radiological Science, Los Angeles, California, United States ;
| | - Jonathan Goldin
- UCLA School Of Medicine, Los Angeles, California, United States ;
| | - Elizabeth R Volkmann
- University of California Los Angeles David Geffen School of Medicine, 12222, Department of Medicine, Los Angeles, California, United States ;
| | - Michael D Roth
- UCLA School of Medicine, Department of Medicine, Los Angeles, California, United States ;
| | - Donald P Tashkin
- UCLA School Of Medicine, Los Angeles, California, United States ;
| | - Dinesh Khanna
- University of Michigan, Ann Arbor, Michigan, United States ;
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George PM, Wells AU. Disease staging and sub setting of interstitial lung disease associated with systemic sclerosis: impact on therapy. Expert Rev Clin Immunol 2018; 14:127-135. [DOI: 10.1080/1744666x.2018.1427064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Peter M. George
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Athol U. Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
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Barnes H, Holland AE, Westall GP, Goh NSL, Glaspole IN. Cyclophosphamide for connective tissue disease-associated interstitial lung disease. Cochrane Database Syst Rev 2018; 1:CD010908. [PMID: 29297205 PMCID: PMC6491200 DOI: 10.1002/14651858.cd010908.pub2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Approximately one-third of individuals with interstitial lung disease (ILD) have associated connective tissue disease (CTD). The connective tissue disorders most commonly associated with ILD include scleroderma/systemic sclerosis (SSc), rheumatoid arthritis, polymyositis/dermatomyositis, and Sjögren's syndrome. Although many people with CTD-ILD do not develop progressive lung disease, a significant proportion do progress, leading to reduced physical function, decreased quality of life, and death. ILD is now the major cause of death amongst individuals with systemic sclerosis.Cyclophosphamide is a highly potent immunosuppressant that has demonstrated efficacy in inducing and maintaining remission in autoimmune and inflammatory illnesses. However this comes with potential toxicities, including nausea, haemorrhagic cystitis, bladder cancer, bone marrow suppression, increased risk of opportunistic infections, and haematological and solid organ malignancies.Decision-making in the treatment of individuals with CTD-ILD is difficult; the clinician needs to identify those who will develop progressive disease, and to weigh up the balance between a high level of need for therapy in a severely unwell patient population against the potential for adverse effects from highly toxic therapy, for which only relatively limited data on efficacy can be found. Similarly, it is not clear whether histological subtype, disease duration, or disease extent can be used to predict treatment responsiveness. OBJECTIVES To assess the efficacy and adverse effects of cyclophosphamide in the treatment of individuals with CTD-ILD. SEARCH METHODS We performed searches on CENTRAL, MEDLINE, Embase, CINAHL, and Web of Science up to May 2017. We handsearched review articles, clinical trial registries, and reference lists of retrieved articles. SELECTION CRITERIA We included randomised controlled parallel-group trials that compared cyclophosphamide in any form, used individually or concomitantly with other immunomodulating therapies, versus non-cyclophosphamide-containing therapies for at least six months, with follow-up of at least 12 months from the start of treatment. DATA COLLECTION AND ANALYSIS We imported studies identified by the search into a reference manager database. We retrieved the full-text versions of relevant studies, and two review authors independently extracted data. Primary outcomes were change in lung function (change in forced vital capacity (FVC) % predicted and diffusing capacity of the lung for carbon monoxide (DLCO) % predicted), adverse events, and health-related quality of life measures. Secondary outcomes included all-cause mortality, dyspnoea, cough, and functional exercise testing. When appropriate, we performed meta-analyses and subgroup analyses by severity of lung function, connective tissue disease diagnosis, and radiological pattern of fibrosis. We assessed the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and created 'Summary of findings' tables. MAIN RESULTS We included in the analysis four trials with 495 participants (most with systemic sclerosis). We formed two separate comparisons: cyclophosphamide versus placebo (two trials, 195 participants) and cyclophosphamide versus mycophenolate (two trials, 300 participants). We found evidence to be of low quality, as dropout rates were high in the intervention groups, and as we noted a wide confidence interval around the effect with small differences, which affected the precision of results.The data demonstrates significant improvement in lung function with cyclophosphamide compared with placebo (post-treatment FVC % mean difference (MD) 2.83, 95% confidence interval (CI) 0.80 to 4.87; P = 0.006) but no significant difference in post-treatment DLCO (% MD -1.68, 95% CI -4.37 to 1.02; P = 0.22; two trials, 182 participants).Risk of adverse effects was increased in the cyclophosphamide treatment groups compared with the placebo groups, in particular, haematuria, leukopenia, and nausea, leading to a higher rate of withdrawal from cyclophosphamide treatment. The data demonstrates statistically significant improvement in one-measure of quality of life in one trial favouring cyclophosphamide over placebo and clinically and statistically significant improvement in breathlessness in one trial favouring cyclophosphamide compared with placebo, with no significant impact on mortality.Trialists reported no significant impact on lung function when cyclophosphamide was used compared with mycophenolate at 12 months (FVC % MD -0.82, 95% CI -3.95 to 2.31; P = 0.61; two trials, 149 participants; DLCO % MD -1.41, 95% CI -10.40 to 7.58; P = 0.76; two trials, 149 participants).Risk of side effects was increased with cyclophosphamide versus mycophenolate, in particular, leukopenia and thrombocytopenia.The data demonstrates no significant impact on health-related quality of life, all-cause mortality, dyspnoea, or cough severity in the cyclophosphamide group compared with the mycophenolate group. No trials reported outcomes associated with functional exercise tests.We performed subgroup analysis to determine whether severity of lung function, connective tissue disease diagnosis, or radiological pattern had any impact on outcomes. One trial reported that cyclophosphamide protected against decreased FVC in individuals with worse fibrosis scores, and also showed that cyclophosphamide may be more effective in those with worse lung function. No association could be made between connective tissue disease diagnosis and outcomes. AUTHORS' CONCLUSIONS This review, which is based on studies of varying methodological quality, demonstrates that overall, in this population, small benefit may be derived from the use of cyclophosphamide in terms of mean difference in % FVC when compared with placebo, but not of the difference in % DLCO, or when compared with mycophenolate. Modest clinical improvement in dyspnoea may be noted with the use of cyclophosphamide. Clinical practice guidelines should advise clinicians to consider individual patient characteristics and to expect only modest benefit at best in preserving FVC. Clinicians should carefully monitor for adverse effects during treatment and in the years thereafter.Further studies are required to examine the use of cyclophosphamide; they should be adequately powered to compare outcomes within different subgroups, specifically, stratified for extent of pulmonary infiltrates on high-resolution computed tomography (HRCT) and skin involvement in SSc. Studies on other forms of connective tissue disease are needed. Researchers may consider comparing cyclophosphamide (a potent immunosuppressant) versus antifibrotic agents, or comparing both versus placebo, in particular, for those with evidence of rapidly progressive fibrotic disease, who may benefit the most.
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Affiliation(s)
- Hayley Barnes
- The Alfred HospitalDepartment of Allergy, Immunology and Respiratory MedicineCommercial RdMelbourneAustralia3004
| | - Anne E Holland
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe UniversityDiscipline of PhysiotherapyMelbourneVictoriaAustralia3086
- The Alfred HospitalDepartment of PhysiotherapyMelbourneVictoriaAustralia3181
- Austin HealthInstitute for Breathing and SleepMelbourneAustralia
| | - Glen P Westall
- The Alfred HospitalDepartment of Allergy, Immunology and Respiratory MedicineCommercial RdMelbourneAustralia3004
| | - Nicole SL Goh
- The Alfred HospitalDepartment of Allergy, Immunology and Respiratory MedicineCommercial RdMelbourneAustralia3004
| | - Ian N Glaspole
- The Alfred HospitalDepartment of Allergy, Immunology and Respiratory MedicineCommercial RdMelbourneAustralia3004
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Molberg Ø, Hoffmann-Vold AM. Interstitial lung disease in systemic sclerosis: progress in screening and early diagnosis. Curr Opin Rheumatol 2017; 28:613-8. [PMID: 27387267 DOI: 10.1097/bor.0000000000000323] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Interstitial lung disease (ILD) is the major determinant of morbidity and mortality in systemic sclerosis (SSc). In highly selected SSc patients, it was recently shown that stem cell therapy early in the disease course improved survival and reduced the extent of ILD, providing a rationale for early ILD detection strategies in this disease. Here, we review recent progress on ILD screening and early diagnosis in SSc. RECENT FINDINGS Two studies showed that over 60% of unselected SSc cases with ILD by high-resolution computer tomography (HRCT) had normal range pulmonary function tests (PFTs); indicating poor performance of PFTs for ILD screening purposes. Serial, paired HRCT and PFT analyses indicated that screening by HRCT at baseline predicted risk for lung fibrosis development, progression rate of fibrosis and PFT decline. Analyses of circulating biomarkers, like CCL18, and nonradiating lung imaging modalities, like ultrasound and MRI, showed promise as tools for early ILD detection; but further work is needed. SUMMARY Prospective cohort data indicated poor performance of PFT as a stand-alone method for ILD screening. Lung HRCT appeared promising, but radiation is an issue. Promising biomarker data indicate the possibility of new ILD screening algorithms in SSc.
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Affiliation(s)
- Øyvind Molberg
- aDepartment of Rheumatology, Oslo University Hospital (OUH) bInstitute of Clinical Medicine, University of Oslo, Oslo, Norway
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Wangkaew S, Euathrongchit J, Wattanawittawas P, Kasitanon N. Correlation of delta high-resolution computed tomography (HRCT) score with delta clinical variables in early systemic sclerosis (SSc) patients. Quant Imaging Med Surg 2016; 6:381-390. [PMID: 27709074 DOI: 10.21037/qims.2016.08.08] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The correlation of changes (delta: Δ) of high-resolution computed tomography (HRCT) score with the Δ of other clinical variables has not been well studied. The purpose of this study was to determine the correlation of Δ HRCT score with Δ percent predicted forced vital capacity (%pFVC), Δ modified Rodnan Skin Score (mRSS), Δ erythrocyte sedimentation rate (ESR), and Δ percent of oxygen saturation at room air (%SpO2) in patients with early systemic sclerosis (SSc). METHODS We used an inception cohort of early-SSc patients seen at the Rheumatology Clinic, Chiang Mai University, Thailand, between January 2010 and June 2014. All patients underwent HRCT at study entry and every 12 months thereafter. Thirty-one SSc patients who underwent pulmonary function test (PFT) within 12 weeks of their corresponding HRCT at baseline and last visit were identified. The extent of ground glass (GG), lung fibrosis (Fib), bronchiectasis (B), and honeycombing (HC) was scored, and then aggregated to produce a total (t) HRCT score. RESULTS Mean ± SD age and disease duration from non-Raynaud's phenomenon (NRP) to undergo HRCT at baseline were 52.2±8.8 years and 11.7±7.1 months, respectively. Seventeen (54.8%) patients were female and 20 (64.5%) were classified as dcSSc. The mean ± SD interval between the two HRCT tests was 16.0±7.2 months. The Δ HRCT scores [total fibrosis scores (t-Fib), total bronchiectasis scores (t-B), and total HRCT score (t-HRCT) scores] and Δ mRSS, but not Δ %pFVC, showed significant change over the observation period. We found significant correlation of Δ total honeycombing scores (t-HC) with Δ ESR (r=-0.44, P<0.05), and Δ t-Fib with Δ %SpO2 (r=-0.38, P<0.05). However, no significant correlation of any Δ HRCT scores with Δ %pFVC and Δ mRSS were observed. CONCLUSIONS In this study, the changes in the HRCT scores were greater than %pFVC; this, along with their correlations with the changes in ESR and %SpO2, suggest that HRCT scores are a useful and sensitive method for monitoring disease progression in early SSc-related ILD (SSc-ILD).
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Affiliation(s)
- Suparaporn Wangkaew
- Division of Rheumatology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Juntima Euathrongchit
- Division of Diagnostic Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Nuntana Kasitanon
- Division of Rheumatology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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