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Ciaffi J, Liem SIE, Cannegieter S, Ahmed S, Hoekstra EM, Wiland P, Atsumi T, Szücs G, Balbir Gurman A, Czirják L, Zanatta E, Koetter I, Henes JC, Matucci-Cerinic M, Airò P, Ursini F, Huizinga TWJ, De Vries-Bouwstra J, Collaborators E. Untangling the relationship between smoking and systemic sclerosis: an analysis of the EUSTAR cohort. RMD Open 2024; 10:e004101. [PMID: 38772679 DOI: 10.1136/rmdopen-2024-004101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/12/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVES To untangle the association between smoking and systemic sclerosis (SSc). METHODS In the European Scleroderma Trials and Research cohort, the autoantibody status was compared between ever-smokers and never-smokers. Time until disease progression was assessed using Kaplan-Meier curves. Cox models were built to investigate the influence of smoking over 15 years of follow-up. All analyses were performed for the total cohort and stratified for sex and for positivity of anti-centromere (ACA) and anti-topoisomerase antibodies (ATA). RESULTS Overall, 12 314 patients were included in the study. Of these, 10 393 were women (84%), 4637 were ACA-positive (38%), 3919 were ATA-positive (32%) and 4271 (35%) were ever-smokers. In men, but not in women, smoking was associated with mortality (HR 1.63, 95% CI 1.23 to 2.16, p=0.001). Ever-smoking women were at higher risk for skin progression (HR 1.10, 95% CI 1.00 to 1.22, p=0.046) and for 'any organ progression' (HR 1.07, 95% CI 1.00 to 1.13, p=0.036). In women, 34% of never-smokers were ATA-positive compared with 21% of ever-smokers (p<0.001). In the group of ever-smokers, higher exposure rates, reflected by the number of pack-years (OR 0.98, 95% CI 0.97 to 0.99, p<0.001) and by smoking duration (OR 0.96, 95% CI 0.95 to 0.97, p<0.001), were associated with lower frequency of ATA. In ACA-positive patients, the risk of mortality (HR 1.29, 95% CI 1.02 to 1.63, p=0.033), cardiac involvement (HR 1.25, 95% CI 1.03 to 1.43, p=0.001), skin progression (HR 1.21, 95% CI 1.03 to 1.42, p=0.018) and 'any organ progression' (HR 1.14, 95% CI 1.05 to 1.24, p=0.002) was increased among smokers. In ATA-positive smoking patients, mortality (HR 1.40, 95% CI 1.10 to 1.78, p=0.006), skin progression (HR 1.19, 95% CI 1.03 to 1.37, p=0.020) digital ulcers (HR 1.17, 95% CI 1.02 to 1.34, p=0.029) and 'any organ progression' (HR 1.11, 95% CI 1.00 to 1.22, p=0.048) occurred more frequently. CONCLUSIONS Our stratified analysis demonstrates that smoking is associated with an increased risk for mortality in male SSc patients but not in women. Strikingly, smoking is associated with lower prevalence of ATA positivity, in particular in women. In both ATA-positive and ACA-positive patients, smoking is a risk factor for mortality, skin progression and 'any organ progression'.
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Affiliation(s)
- Jacopo Ciaffi
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Sophie I E Liem
- Department of Rheumatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Suzanne Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Department of Internal Medicine, Division of Thrombosis and Haemostasis, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Saad Ahmed
- Department of Rheumatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Eva M Hoekstra
- Department of Rheumatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Gabriella Szücs
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Alexandra Balbir Gurman
- Rheumatology Department, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - László Czirják
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Pécs, Hungary
| | - Elisabetta Zanatta
- Department of Medicine-DIMED, Unit of Rheumatology, Padova University Hospital, Padova, Italy
| | - Ina Koetter
- Medical Department 4, Rheumatology, Immunology, Nephrology, Asklepios Klinik Altona, Hamburg, Germany
| | - Joerg C Henes
- Internal Medicine II - Oncology, haematology, clinical immunology and rheumatology, University Hospital and Faculty of Medicine, University of Tübingen, Tubingen, Germany
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Airò
- Rheumatology and Clinical Immunology Service, Spedali Civili di Brescia, Brescia, Italy
| | - Francesco Ursini
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - Jeska De Vries-Bouwstra
- Department of Rheumatology, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
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Campochiaro C, Hoffmann-Vold AM, Avouac J, Henes J, de Vries-Bouwstra J, Smith V, Siegert E, Airò P, Oksel F, Pellerito R, Vanthuyne M, Pozzi MR, Inanc M, Sibilia J, Gabrielli A, Distler O, Allanore Y. Sex influence on outcomes of patients with systemic sclerosis-associated interstitial lung disease: a EUSTAR database analysis. Rheumatology (Oxford) 2023; 62:2483-2491. [PMID: 36413079 DOI: 10.1093/rheumatology/keac660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/08/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE Interstitial lung disease (ILD) is the leading cause of morbidity and mortality in systemic sclerosis (SSc) patients. We aimed to investigate the impact of sex on SSc-ILD. METHODS EUSTAR SSc patients with radiologically confirmed ILD and available percentage predicted forced vital capacity (%pFVC) were included. Demographics and disease features were recorded. A change in %pFVC over 12 months (s.d. 6) (cohort 1) was classified into stable (≤4%), mild (5-9%) and large progression (≥10%). In those with 2-year longitudinal %pFVC (cohort 2), the %pFVC change at each 12-month (s.d. 6) interval was calculated. Logistic regression analyses [odds ratio (OR) and 95% CI] and Cox proportional hazards models adjusted for age and %pFVC were applied. RESULTS A total of 1136 male and 5253 female SSc-ILD patients were identified. Males were significantly younger, had a shorter disease duration, had a higher prevalence of CRP elevation and frequently had diffuse cutaneous involvement. In cohort 1 (1655 females and 390 males), a higher percentage of males had stable ILD (74.4% vs 69.4%, P = 0.056). In multivariable analysis, disease duration and %pFVC [OR 0.99 (95% CI 0.98, 0.99) and OR 0.97 (95% CI 0.95, 0.99), respectively] in males and age, %pFVC and anti-centromere [OR 1.02 (95% CI 1.00, 1.04), OR 0.97 (95% CI 0.96, 0.98) and OR 0.39 (95% CI 0.245, 0.63), respectively] in females were associated with large progression. The 1-year mortality rate was higher in males (5.1% vs 2.5%, P = 0.013). In cohort 2 (849 females and 209 males), a higher percentage of females showed periods of large progression (11.7% vs 7.7%, P = 0.023), the percentage of patients with none, one or two periods of worsening was not different. The overall death rate was 30.9% for males and 20.4% in females (P < 0.001). In the survival analysis, male sex was a predictor of mortality [OR 1.95 (95% CI 1.66, 2.28)]. CONCLUSIONS Male SSc-ILD patients have a poorer prognosis and sex-specific predictors exist in SSc-ILD.
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Affiliation(s)
- Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Jerome Avouac
- Service de Rheumatologie, Cochin Hospital, APHP, Universite Paris Descartes, Paris, France
| | - Jörg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-Inflammatory Diseases and Department of Internal Medicine II (Haematology, Oncology, Immunology and Rheumatology), University Hospital Tuebingen, Tuebingen, Germany
| | | | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité-Universitatsmedizin Berlin, Berlin, Germany
| | - Paolo Airò
- Rheumatology and Clinical Immunology Department, Spedali Civili, Brescia, Italy
| | - Fahrettin Oksel
- Department of Internal Medicine, Division of Rheumatology, Ege University, Faculty of Medicine, Izmir, Turkey
| | | | - Marie Vanthuyne
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | | | - Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Jean Sibilia
- Service de Rheumatologie, RESO: Centre de Reference des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest, Hôpital De Hautepierre, Strasbourg, France
| | - Armando Gabrielli
- Department of Clinical and Molecular Sciences, Universita' Politecnica Delle Marche, Ancona, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Yannick Allanore
- Service de Rheumatologie, Cochin Hospital, APHP, Universite Paris Descartes, Paris, France
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Trang A, Kambhatla S, Manadan A. Risk Factors for Respiratory Failure in Patients Hospitalized With Systemic Sclerosis: An Analysis of the National Inpatient Sample. Cureus 2023; 15:e35797. [PMID: 37025705 PMCID: PMC10072985 DOI: 10.7759/cureus.35797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/07/2023] Open
Abstract
Background Systemic sclerosis (SSc) patients are at high risk for respiratory failure due to the progression of their disease. Investigating factors predictive of impending respiratory failure in this patient population can be used to improve hospital outcomes. Here, we investigate risk factors associated with developing respiratory failure in patients hospitalized with a diagnosis of SSc in the United States using a large, multi-year, population-based dataset. Methodology This retrospective study was conducted on SSc hospitalizations from 2016 to 2019 with and without a principal diagnosis of respiratory failure from the United States National Inpatient Sample database. A multivariate logistic regression analysis was performed to calculate adjusted odds ratios (ORadj) for respiratory failure. Results There were 3,930 SSc hospitalizations with a principal diagnosis of respiratory failure and 94,910 SSc hospitalizations without a diagnosis of respiratory failure. Among SSc hospitalizations, multivariable analysis showed that the following were associated with a principal diagnosis of respiratory failure: Charlson comorbidity index (ORadj = 1.05), heart failure (ORadj = 1.81), interstitial lung disease (ILD) (ORadj = 3.62), pneumonia (ORadj = 3.40), pulmonary hypertension (ORadj = 3.59), and smoking (ORadj = 1.42). Conclusions This analysis represents the largest sample to date in assessing risk factors for respiratory failure among SSc inpatients. Charlson comorbidity index, heart failure, ILD, pulmonary hypertension, smoking, and pneumonia were associated with higher odds of inpatient respiratory failure. Patients with respiratory failure had higher in-hospital mortality compared to those without it. Outpatient optimization and inpatient recognition of these risk factors can lead to improved hospitalization outcomes for SSc patients.
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Bruni C, Occhipinti M, Pienn M, Camiciottoli G, Bartolucci M, Bosello SL, Payer C, Bálint Z, Larici AR, Tottoli A, Tofani L, De Lorenzis E, Lepri G, Bellando-Randone S, Spinella A, Giuggioli D, Masini F, Cuomo G, Lavorini F, Colagrande S, Olschewski H, Matucci-Cerinic M. Lung vascular changes as biomarkers of severity in systemic sclerosis-associated interstitial lung disease. Rheumatology (Oxford) 2023; 62:696-706. [PMID: 35708639 DOI: 10.1093/rheumatology/keac311] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/21/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES It has recently become possible to assess lung vascular and parenchymal changes quantitatively in thoracic CT images using automated software tools. We investigated the vessel parameters of patients with SSc, quantified by CT imaging, and correlated them with interstitial lung disease (ILD) features. METHODS SSc patients undergoing standard of care pulmonary function testing and CT evaluation were retrospectively evaluated. CT images were analysed for ILD patterns and total pulmonary vascular volume (PVV) extents with Imbio lung texture analysis. Vascular analysis (volumes, numbers and densities of vessels, separating arteries and veins) was performed with an in-house developed software. A threshold of 5% ILD extent was chosen to define the presence of ILD, and commonly used cut-offs of lung function were adopted. RESULTS A total of 79 patients [52 women, 40 ILD, mean age 56.2 (s.d. 14.2) years, total ILD extent 9.5 (10.7)%, PVV/lung volume % 2.8%] were enrolled. Vascular parameters for total and separated PVV significantly correlated with functional parameters and ILD pattern extents. SSc-associated ILD (SSc-ILD) patients presented with an increased number and volume of arterial vessels, in particular those between 2 and 4 mm of diameter, and with a higher density of arteries and veins of <6 mm in diameter. Considering radiological and functional criteria concomitantly, as well as the descriptive trends from the longitudinal evaluations, the normalized PVVs, vessel numbers and densities increased progressively with the increase/worsening of ILD extent and functional impairment. CONCLUSION In SSc patients CT vessel parameters increase in parallel with ILD extent and functional impairment, and may represent a biomarker of SSc-ILD severity.
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Affiliation(s)
- Cosimo Bruni
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.,Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Michael Pienn
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Gianna Camiciottoli
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence.,Department of CardioThoracoVascular, Careggi University Hospital, Florence
| | | | - Silvia Laura Bosello
- Department of Rheumatology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Roma, Italy
| | - Christian Payer
- Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria
| | - Zoltán Bálint
- Faculty of Physics, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Anna Rita Larici
- Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore.,Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome
| | - Alessandra Tottoli
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Lorenzo Tofani
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.,Department of Statistics, Computer Science, Applications, University of Florence, Florence
| | - Enrico De Lorenzis
- Department of Rheumatology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Roma, Italy
| | - Gemma Lepri
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Silvia Bellando-Randone
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Amelia Spinella
- Scleroderma Unit, Rheumatology Unit, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria di Modena, Modena
| | - Dilia Giuggioli
- Scleroderma Unit, Rheumatology Unit, Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria di Modena, Modena
| | - Francesco Masini
- Department of Medicine of Precision, University of Campania L. Vanvitelli, Naples
| | - Giovanna Cuomo
- Department of Medicine of Precision, University of Campania L. Vanvitelli, Naples
| | - Federico Lavorini
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence.,Department of CardioThoracoVascular, Careggi University Hospital, Florence
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, Careggi University Hospital, University of Florence, Florence, Italy
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.,Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Deptartment of Experimental and Clinical Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
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Kiss F, Farkas N, Nagy G, Minier T, Kumánovics G, Faludi R, Czirják L, Varjú C. Minimal Clinically Important Differences (MCID) for the Functional Assessment of Chronic Illness Therapy Fatigue Scale in Patients with Systemic Sclerosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:771. [PMID: 36613093 PMCID: PMC9819291 DOI: 10.3390/ijerph20010771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: Systemic sclerosis (SSc) is characterized by significant fatigue, causing diminished quality of life (QoL). The aim of this study was to examine fatigue levels and their associations with clinical factors and determine the minimal clinically important difference (MCID) value for the Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-FS). (2) Methods: A total of 160 SSc patients and 62 individuals without SSc were followed-up over a 12-month period by measuring the FACIT-FS and the Visual Analogue Scale and the Short Form 36 Vitality Score analyzing changes in exhaustion. (3) Results: Fatigue was strongly correlated with HRQoL, level of pain, emotional disorders, physical capability and functionality. The MCID values for FACIT-FS were calculated as -3 for deterioration and +4 for improvement after a 12-month follow-up. The predictors of improvement of fatigue from baseline parameters were the significant disease activity, the patients' poorer functionality and the short disease duration. Patients with scleroderma-related interstitial lung disease at baseline had approximately tripled risks for worsening fatigue. The independent influential factors regarding the changing of FACIT-FS were improving or worsening in the same direction in reference to physical condition, gastrointestinal and emotional factors. (4) Conclusions: Fatigue is a multi-dimensional symptom, which is strongly correlated to HRQoL. MCID values of FACIT-FS can be useful tools in monitoring the changes of HRQoL in clinical trials and in daily practice among patients with SSc.
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Affiliation(s)
- Franciska Kiss
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
| | - Nelli Farkas
- Institute of Bioanalysis, Medical School, University of Pécs, H-7624 Pécs, Hungary
| | - Gabriella Nagy
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
| | - Tünde Minier
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
| | - Gábor Kumánovics
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
| | - Réka Faludi
- Heart Institute, Medical School, University of Pécs, H-7624 Pécs, Hungary
| | - László Czirják
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
| | - Cecília Varjú
- Department of Rheumatology and Immunology, Medical School, University of Pécs, H-7632 Pécs, Hungary
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Clinical and radiological features of lung disorders related to connective-tissue diseases: a pictorial essay. Insights Imaging 2022; 13:108. [PMID: 35767157 PMCID: PMC9243214 DOI: 10.1186/s13244-022-01243-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/28/2022] [Indexed: 11/10/2022] Open
Abstract
Connective tissue diseases (CTDs) include a spectrum of disorders that affect the connective tissue of the human body; they include autoimmune disorders characterized by immune-mediated chronic inflammation and the development of fibrosis. Lung involvement can be misdiagnosed, since pulmonary alterations preceded osteo-articular manifestations only in 20% of cases and they have no clear clinical findings in the early phases. All pulmonary structures may be interested: pulmonary interstitium, airways, pleura and respiratory muscles. Among these autoimmune disorders, rheumatoid arthritis (RA) is characterized by usual interstitial pneumonia (UIP), pulmonary nodules and airway disease with air-trapping, whereas non-specific interstitial pneumonia (NSIP), pulmonary hypertension and esophageal dilatation are frequently revealed in systemic sclerosis (SSc). NSIP and organizing pneumonia (OP) may be found in patients having polymyositis (PM) and dermatomyositis (DM); in some cases, perilobular consolidations and reverse halo-sign areas may be observed. Systemic lupus erythematosus (SLE) is characterized by serositis, acute lupus pneumonitis and alveolar hemorrhage. In the Sjögren syndrome (SS), the most frequent pattern encountered on HRCT images is represented by NSIP; UIP and lymphocytic interstitial pneumonia (LIP) are reported with a lower frequency. Finally, fibrotic NSIP may be the interstitial disease observed in patients having mixed connective tissue diseases (MCTD). This pictorial review therefore aims to provide clinical features and imaging findings associated with autoimmune CTDs, in order to help radiologists, pneumologists and rheumatologists in their diagnoses and management.
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Allanore Y, Constans J, Godard D, de Pouvourville G, Bouee S, Jeanbat V, Teissier C, Le Lay K, Chollet J, Hachulla E. Quality of life in SSc-ILD patients: Understanding the impact of the ILD and the needs of the SSc-ILD patients and their need for caregivers in France. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2022; 7:49-56. [PMID: 35386942 PMCID: PMC8922678 DOI: 10.1177/23971983211013979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/03/2021] [Indexed: 02/03/2023]
Abstract
Objectives The objectives of this study were to describe the impact of systemic sclerosis associated interstitial lung disease, on quality of life, to estimate the correlation between quality of life and severity of lung disease and to assess the impact of interstitial lung disease on caregivers. Methods Seven investigators included systemic sclerosis associated interstitial lung disease patients from December 2019 to April 2020. Sociodemographics and clinical data were collected. Patients reported outcomes and questionnaires were used with 1 generic patients reported outcome (EQ-5D-5L), 1 specific PRO (Brief Interstitial Lung Disease) and 2 self-reported questionnaires on impact of SSc complications and impact on caregivers. The correlation between forced vital capacity and EQ-5D-5L score was estimated with a multivariate linear regression model adjusted on several covariates. Results In all, 89 patients were included. 26.4% were males, mean age was 58.2 ± 14.5 years. Mean EQ-5D-5L score = 0.79 ± 0.22 (median = 0.85). Mean EQ-5D-5L visual analog scale score = 60.8 ± 20.4 (median = 61.5). Mean King's Brief Interstitial Lung Disease score = 58.4 ± 12.7 (median = 58.0). After adjustment on covariates, a significant correlation between forced vital capacity and EQ-5D-5L score was found with an increase of 0.003 of the EQ-5D-5L score for a 1% increase of FVC (p = 0.0096). No significant correlation between forced vital capacity and the EQ-VAS and King's Brief Interstitial Lung Disease score were found. The impact of SSc on other organs was significantly correlated with EQ- 5D-5L score, respectively, for the impact scores on the lung system (p = 0.0003), heart system (p = 0.0182), Raynaud's syndrome (p = 0.0015), digestive system (p = 0.0032), joints/muscles (p = 0.0003), skin (p < 0.0001), kidney (p = 0.0052) and gastro-oesophageal reflux (p = 0.0063). Significant correlations between King's Brief Interstitial Lung Disease score and lung system (p < 0.0001), heart system (p < 0.0001), digital ulcers (p = 0.058), digestive system (p < 0.0001), kidney (p = 0.0004), skin (p = 0.0499) and gastro-oesophageal reflux (p = 0.0033) scores were found 68.5% of patients reported their need for a caregiver to help them in their daily life activities. Conclusion Our study highlighted the strong burden of systemic sclerosis associated interstitial lung disease` for patients, especially with an impact on quality of life, on other organs manifestations and need for caregivers in their daily life.
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Affiliation(s)
- Yannick Allanore
- Rheumatology, Cochin Hospital, Université de Paris, Paris, France
| | | | | | | | - Stephane Bouee
- Real World Evidence, CEMKA, Bourg La Reine, France,Stephane Bouee, Real World Evidence, CEMKA, 92340 Bourg La Reine, France.
| | | | | | | | | | - Eric Hachulla
- Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286–INFINITE–Institute for Translational Research in Inflammation, Lille, France
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Lee A, Patterson KA, Tan DJ, Wilson ME, Proudman SM, Stevens W, Nikpour M, Sahhar J, Ngian GS, Roddy J, Roberts-Thomson PJ, Walker JG. Anti-Ro52/TRIM21 is independently associated with pulmonary arterial hypertension and mortality in a cohort of systemic sclerosis patients. Scand J Rheumatol 2021; 50:469-474. [PMID: 33851896 DOI: 10.1080/03009742.2021.1887927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: We undertook a comprehensive cross-sectional analysis of a multicentred Australian cohort of systemic sclerosis (SSc) patients to evaluate the associations of anti-Ro52/TRIM21 with SSc pulmonary involvement.Method: The study included 596 patients from the Australian Scleroderma Cohort Study database whose anti-Ro52/TRIM21 status was known. Anti-Ro52/TRIM21 was measured via line immunoassay. Data on demographic variables, autoantibody profiles, presence of interstitial lung disease (ILD), presence of pulmonary arterial hypertension (PAH), oxygen saturation, Six-Minute Walk Test distance, Borg dyspnoea score, and lung function tests were extracted. SPSS software was used to examine associations using univariate and multivariate analyses.Results: Anti-Ro52/TRIM21 was present in 34.4% of SSc patients. In the cross-sectional analysis, anti-Ro52/TRIM21 was independently associated with PAH [odds ratio 1.75, 95% confidence interval (CI) 1.05-2.90], but not ILD or other surrogate measures of pulmonary involvement such as average patient oxygen saturation. The antibody, however, was also associated with a higher forced vital capacity/diffusing capacity of the lung for carbon monoxide ratio. Prospectively, anti-Ro52/TRIM21 was also associated with an increased risk of death in patients with SSc (hazard ratio 1.62, 95% CI 1.11-2.35), independent of confounding factors. The primary cause of death appeared to be related to PAH and/or ILD, and anti-Ro52/TRIM21 was associated with PAH-related complications.Conclusion: Anti-Ro52/TRIM21 was independently associated with PAH and mortality in SSc patients. Future longitudinal studies are recommended to investigate the timing and pathogenic mechanisms of this autoantibody in PAH.
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Affiliation(s)
- Ays Lee
- Departments of Rheumatology and Immunology, Flinders Medical Centre, Bedford Park, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, Australia.,Department of Immunology, SA Pathology, Flinders Medical Centre, Bedford Park, Australia
| | - K A Patterson
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - D J Tan
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - M E Wilson
- Department of Rheumatology, St Vincent's Hospital (Melbourne), Fitzroy, Australia
| | - S M Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - W Stevens
- Department of Rheumatology, St Vincent's Hospital (Melbourne), Fitzroy, Australia
| | - M Nikpour
- Department of Rheumatology, St Vincent's Hospital (Melbourne), Fitzroy, Australia.,Department of Medicine, The University of Melbourne, Fitzroy, Australia
| | - J Sahhar
- Department of Rheumatology, Monash Health, Clayton, Australia.,Department of Medicine, Monash University, Clayton, Australia
| | - G-S Ngian
- Department of Rheumatology, Monash Health, Clayton, Australia.,Department of Medicine, Monash University, Clayton, Australia
| | - J Roddy
- Department of Rheumatology, Fiona Stanley Hospital, Murdoch, Australia
| | - P J Roberts-Thomson
- Departments of Rheumatology and Immunology, Flinders Medical Centre, Bedford Park, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, Australia.,Department of Immunology, SA Pathology, Flinders Medical Centre, Bedford Park, Australia
| | - J G Walker
- Departments of Rheumatology and Immunology, Flinders Medical Centre, Bedford Park, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, Australia
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9
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Ruaro B, Confalonieri M, Matucci-Cerinic M, Salton F, Confalonieri P, Santagiuliana M, Citton GM, Baratella E, Bruni C. The Treatment of Lung Involvement in Systemic Sclerosis. Pharmaceuticals (Basel) 2021; 14:154. [PMID: 33668530 PMCID: PMC7918752 DOI: 10.3390/ph14020154] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 12/17/2022] Open
Abstract
Systemic sclerosis (SSc) patients are often affected by interstitial lung disease (ILD) and, although there have been recent treatment advances, it remains the leading cause of death among SSc, with a 10-year mortality up to 40%. African Americans and subjects with diffuse cutaneous SSc or anti-topoisomerase 1 antibodies are most commonly affected. Currently, early ILD diagnosis can be made, and it is pivotal to improve the prognosis. The diagnostic mainstay test for SSc-ILD is high-resolution computed tomography for the morphology and pulmonary function tests for the functional aspects. Treatment planning and intensity are guided by the disease severity and risk of progression. Traditionally, therapy has depended on combinations of immunosuppressants, particularly cyclophosphamide and mycophenolate mofetil, which can be supplemented by targeted biological and antifibrotic therapies. Benefits have been observed in trials on hematopoietic autologous stem cell transplantation for patients with progressive SSc, whilst lung transplantation is reserved for refractory SSc-ILD cases. Herein, recent advances in SSc-ILD treatment will be explored.
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Affiliation(s)
- Barbara Ruaro
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste TS, Italy; (M.C.); (F.S.); (P.C.); (M.S.); (G.M.C.)
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste TS, Italy; (M.C.); (F.S.); (P.C.); (M.S.); (G.M.C.)
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Firenze, 50121 Firenze FI, Italy; (M.M.-C.); (C.B.)
| | - Francesco Salton
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste TS, Italy; (M.C.); (F.S.); (P.C.); (M.S.); (G.M.C.)
| | - Paola Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste TS, Italy; (M.C.); (F.S.); (P.C.); (M.S.); (G.M.C.)
| | - Mario Santagiuliana
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste TS, Italy; (M.C.); (F.S.); (P.C.); (M.S.); (G.M.C.)
| | - Gloria Maria Citton
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste TS, Italy; (M.C.); (F.S.); (P.C.); (M.S.); (G.M.C.)
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34127 Trieste TS, Italy;
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Firenze, 50121 Firenze FI, Italy; (M.M.-C.); (C.B.)
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10
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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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11
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Volkmann ER. Natural History of Systemic Sclerosis-Related Interstitial Lung Disease: How to Identify a Progressive Fibrosing Phenotype. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2019; 5:31-40. [PMID: 33693056 DOI: 10.1177/2397198319889549] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The natural history of interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) is highly variable. Historical observational studies have demonstrated that the greatest decline in lung function in SSc occurs early in the course of the disease; however, not all patients experience a decline in lung function even in the absence of treatment. Furthermore, among patients who do experience a decline in lung function, the rate of decline can be either rapid or slow. The most common clinical phenotypes of SSc-ILD therefore: (i) Rapid Progressors, (ii) Gradual Progressors, (iii) Stabilizers and (iv) Improvers. This review summarizes the features of SSc-ILD patients who are more likely to experience rapid progression of ILD, as well as those who are more likely not to experience ILD progression. Understanding the clinical, biological and radiographic factors that consistently predict ILD-related outcomes in SSc is central to our ability to recognize those patients who are at heightened risk for ILD progression. With new options available for treating patients with SSc-ILD, it is more important than ever to accurately identify patients who may derive the most benefit from aggressive SSc-ILD therapy. Early therapeutic intervention in patients with this progressive fibrosing phenotype may ultimately improve morbidity and mortality outcomes in patients with SSc-ILD.
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Affiliation(s)
- Elizabeth R Volkmann
- University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, USA
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12
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Volkmann ER, Tashkin DP, Kuwana M, Li N, Roth MD, Charles J, Hant FN, Bogatkevich GS, Akter T, Kim G, Goldin J, Khanna D, Clements PJ, Furst DE, Elashoff RM, Silver RM, Assassi S. Progression of Interstitial Lung Disease in Systemic Sclerosis: The Importance of Pneumoproteins Krebs von den Lungen 6 and CCL18. Arthritis Rheumatol 2019; 71:2059-2067. [PMID: 31233287 PMCID: PMC6883123 DOI: 10.1002/art.41020] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/18/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To investigate the relationship between Krebs von den Lungen 6 (KL-6) and CCL18 levels and the severity and progression of systemic sclerosis (SSc)-related interstitial lung disease (ILD). METHODS Patients enrolled in the Scleroderma Lung Study II (cyclophosphamide [CYC] versus mycophenolate mofetil [MMF]) were included. Baseline and 12-month plasma samples were analyzed by enzyme-linked immunosorbent assay to assess CCL18 and KL-6 levels. The forced vital capacity (FVC) and the diffusing capacity for carbon monoxide (DLco) were measured every 3 months. Joint models were created to investigate the relationship between baseline CCL18 and KL-6 levels and the course of the FVC and DLco over 1 year according to treatment arm. RESULTS Baseline KL-6 and CCL18 levels each correlated with the extent of radiographic fibrosis. Levels of both CCL18 and KL-6 declined significantly at 1 year. In both treatment arms (n = 71 for CYC, n = 62 for MMF), a higher baseline KL-6 level predicted progression of ILD based on the course of FVC (P = 0.024 for CYC; P = 0.005 for MMF) and DLco (P < 0.001 for CYC; P = 0.004 for MMF) over 1 year. A higher baseline CCL18 level predicted progression of ILD based on the course of the FVC (P < 0.001 for CYC; P = 0.007 for MMF) and DLco (P = 0.001 for CYC; P < 0.001 for MMF) over 1 year, as well as mortality (P = 0.0008 for CYC arm only). CONCLUSION In a rigorously conducted clinical trial for SSc-related ILD, KL-6 and CCL18 levels correlated with ILD severity and declined with immunosuppression. Patients with higher baseline KL-6 and CCL18 levels were more likely to experience disease progression despite treatment. KL-6 and CCL18 levels could be used to identify patients with a progressive ILD phenotype who may benefit from a more aggressive initial treatment approach.
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Affiliation(s)
- Elizabeth R. Volkmann
- Department of Medicine, University of California, Los
Angeles, David Geffen School of Medicine; USA
| | - Donald P. Tashkin
- Department of Medicine, University of California, Los
Angeles, David Geffen School of Medicine; USA
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical
School, Tokyo; Japan
| | - Ning Li
- Department of Biomathematics, University of California, Los
Angeles; USA
| | - Michael D. Roth
- Department of Medicine, University of California, Los
Angeles, David Geffen School of Medicine; USA
| | - Julio Charles
- University of Texas McGovern Medical School, Houston;
USA
| | - Faye N. Hant
- Department of Medicine, Medical University of South
Carolina; Charleston, USA
| | | | - Tanjina Akter
- Department of Medicine, Medical University of South
Carolina; Charleston, USA
| | - Grace Kim
- Department of Radiology, University of California, Los
Angeles, David Geffen School of Medicine; Los Angeles, USA
- Department of Biostatistics, University of California, Los
Angeles, Fielding School of Public Health Los Angeles, USA
| | - Jonathan Goldin
- Department of Biostatistics, University of California, Los
Angeles, Fielding School of Public Health Los Angeles, USA
| | - Dinesh Khanna
- Department of Medicine, University of Michigan Medical
School; Ann Arbor, USA
| | - Philip J. Clements
- Department of Medicine, University of California, Los
Angeles, David Geffen School of Medicine; USA
| | - Daniel E. Furst
- Department of Medicine, University of California, Los
Angeles, David Geffen School of Medicine; USA
- Department of Medicine, University of Washington; Seattle,
USA
- Department of Rheumatology, University of Florence;
Florence, Italy
| | - Robert M. Elashoff
- Department of Biomathematics, University of California, Los
Angeles; USA
| | - Richard M. Silver
- Department of Medicine, Medical University of South
Carolina; Charleston, USA
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