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Wangkaew S, Intum J, Prasertwittayakij N, Euathrongchit J. Elevated baseline serum creatine kinase in Thai early systemic sclerosis patients is associated with high incidence of cardiopulmonary complications and poor survival: an inception cohort study. Clin Rheumatol 2022; 41:3055-3063. [PMID: 35794291 DOI: 10.1007/s10067-022-06272-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Inception cohort data regarding the incidence of cardiopulmonary complications in early systemic sclerosis (SSc) patients comparing those with and without elevated baseline creatine kinase (CK) are limited. This study aimed to compare the incidence of cardiopulmonary complications and survival between the two subgroups. METHODS We used an inception cohort study of early SSc patients seen at the Rheumatology Clinic, Maharaj Nakorn Chiang Mai Hospital, Thailand, from January 2010 to December 2019. All patients were assessed for clinical manifestations and CK levels and underwent echocardiography and HRCT at the study entry and annually thereafter. RESULTS A total of 144 SSc patients (84 female, 115 diffuse cutaneous SSc (DcSSc)) with a mean disease duration of 11.9 ± 9.2 months were enrolled. At cohort entry, their mean ± SD CK levels were 364.3 ± 598.0 U/L. The participants were then divided into two subgroups: (i) 29 SSc with elevated CK (baseline CK ≥ 500 U/L); (ii) 115 SSc with non-elevated CK. At enrollment, the elevated CK group was characterized by a higher proportion of male gender, DcSSc subtype, arthritis, and weakness; shorter disease duration; and higher MRSS compared with non-elevated CK. At the last visit, with a mean ± SD follow-up duration of 6.2 ± 2.7 years, the elevated CK group showed a higher cumulative prevalence of weakness, dysphagia, LVEF < 50%, and suspected myocardial disease; higher incidence of LVEF < 50%, suspected myocardial disease, and ILD; and shorter survival time. CONCLUSION It was found in our study cohort that elevated baseline serum CK in early SSc, of which majority were DcSSc subtype, is associated with more severe clinical presentation, higher incidence of cardiopulmonary complications, and shorter survival time compared with the non-elevated CK subgroup. Key Points • In early SSc patients, elevated baseline serum creatine kinase was confirmed to be associated with a high incidence of cardiac and ILD complications, and poor long-term survival time. • Careful evaluation of baseline serum CK levels in all early-diagnosed SSc patients is crucial in general clinical practice.
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Affiliation(s)
- Suparaporn Wangkaew
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
| | - Jirapath Intum
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Narawudt Prasertwittayakij
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Juntima Euathrongchit
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Spontaneous Pneumo-Mediastinum in a Post-COVID-19 Patient with Systemic Sclerosis. Healthcare (Basel) 2022; 10:healthcare10030529. [PMID: 35327007 PMCID: PMC8953142 DOI: 10.3390/healthcare10030529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 12/14/2022] Open
Abstract
Pulmonary involvement is the most common cause of death among patients with systemic sclerosis (SSc). The current coronavirus disease 2019 (COVID-19) is particularly problematic to manage in SSc patients since they may experience a more severe evolution of COVID-19 due to the pre-existent interstitial lung disease (ILD) and the administration of immunosuppressive treatments. In addition, the remarkable radiological similarities between SSc-ILD and COVID-19 complicate the differential diagnosis between these two entities. Herein, we present the first case of spontaneous pneumo-mediastinum in a post-COVID-19 patient with SSc. In our patient, both smoking and pulmonary fibrosis could lead to cyst formation, which possibly spontaneously broke and caused pneumo-mediastinum. Moreover, megaesophagus perforation due to the smooth muscle atrophy, replacement with fibrosis, and achalasia may extend into the mediastinum or pleural space and has also been described as a rare case of spontaneous pneumo-pericardium. Finally, spontaneous pneumo-mediastinum and pneumothorax have been recently reported as an established complication of severe COVID-19 pneumonia and among COVID-19 long-term complication. This case report underlines that the worsening of respiratory symptoms in SSc patients, especially when recovered from COVID-19, requires further investigations for ruling out other tentative diagnoses besides the evolution of the SSc-ILD.
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Haque A, Kiely DG, Kovacs G, Thompson AAR, Condliffe R. Pulmonary hypertension phenotypes in patients with systemic sclerosis. Eur Respir Rev 2021; 30:30/161/210053. [PMID: 34407977 DOI: 10.1183/16000617.0053-2021] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/04/2021] [Indexed: 01/05/2023] Open
Abstract
Pulmonary hypertension (PH) commonly affects patients with systemic sclerosis (SSc) and is associated with significant morbidity and increased mortality. PH is a heterogenous condition and several different forms can be associated with SSc, including pulmonary arterial hypertension (PAH) resulting from a pulmonary arterial vasculopathy, PH due to left heart disease and PH due to interstitial lung disease. The incidence of pulmonary veno-occlusive disease is also increased. Accurate and early diagnosis to allow optimal treatment is, therefore, essential. Recent changes to diagnostic haemodynamic criteria at the 6th World Symposium on Pulmonary Hypertension have resulted in therapeutic uncertainty regarding patients with borderline pulmonary haemodynamics. Furthermore, the optimal pulmonary vascular resistance threshold for diagnosing PAH and the role of exercise in identifying early disease require further elucidation. In this article we review the epidemiology, diagnosis, outcomes and treatment of the spectrum of pulmonary vascular phenotypes associated with SSc.
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Affiliation(s)
- Ashraful Haque
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Dept of Rheumatology, Royal Hallamshire Hospital, Sheffield, UK.,Both authors contributed equally
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Gabor Kovacs
- Medical University of Graz, Graz, Austria.,Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - A A Roger Thompson
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK .,Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Both authors contributed equally
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Konopka KE, Myers JL. Interstitial lung disease pathology in systemic sclerosis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211032437. [PMID: 34349846 PMCID: PMC8287363 DOI: 10.1177/1759720x211032437] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/25/2021] [Indexed: 12/11/2022] Open
Abstract
Interstitial lung disease is a relatively frequent manifestation of systemic
sclerosis with approximately one-third of patients developing clinical
restrictive lung disease. Fibrotic nonspecific interstitial pneumonia is the
most common cause of diffuse parenchymal lung disease in patients with systemic
sclerosis-associated interstitial lung disease (SSc-ILD), followed by usual
interstitial pneumonia (UIP). Radiographic pleuroparenchymal fibroelastosis-like
changes may accompany other forms of interstitial lung disease, most commonly
UIP. In an appropriate clinical setting with supportive high-resolution computed
tomography findings, lung biopsy is not needed to confirm the presence of
interstitial lung disease and surgical lung biopsies are often reserved for
atypical presentations. In this review, we discuss the histological findings
that define the most common patterns of SSc-ILD and outline other findings
sometimes encountered in lung biopsies obtained from systemic sclerosis
patients, including pulmonary vascular changes, aspiration, chronic pleuritis,
and diffuse alveolar damage.
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Affiliation(s)
- Kristine E Konopka
- Department of Pathology, University of Michigan, Michigan Medicine, 2800 Plymouth Road, Building 35, Ann Arbor, MI 48109, USA
| | - Jeffrey L Myers
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
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Detection, screening, and classification of interstitial lung disease in patients with systemic sclerosis. Curr Opin Rheumatol 2021; 32:497-504. [PMID: 32890027 DOI: 10.1097/bor.0000000000000741] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Interstitial lung disease (ILD) associates with disease burden and reduced life expectancy in systemic sclerosis (SSc). As ILD afflicts around 50% of SSc patients and is often present from early on, there is rationale for early and universal ILD screening. With the approval of the first SSc-ILD therapy last year, there is an increasing need for ILD classifications to assign the right treatment to the right patient. Here, we discuss recent advances on screening, detection, and classification of SSc-ILD. RECENT FINDINGS Although prospective datasets from a nationwide population-based SSc cohort confirm insufficient sensitivity of pulmonary function tests (PFTs) for ILD screening, they provide strong support for lung high resolution computed tomography (HRCT) as the primary tool to detect ILD. Lung ultrasound shows promise as an additional screening tool. Interpreting statements from a new European consensus on SSc-ILD management, we propose an urgent need for integrated SSc classification, grading ILD severity at time of diagnosis and evaluate risk for ILD progression. We discuss advances on potential parameters for such classification, including PFTs, quantitative HRCT analyses, patient-reported outcome measures, functional exercise capacity tests, and soluble biomarkers. SUMMARY Early screening to diagnose ILD is feasible. With new therapies at hand, there is a need for integrated ILD classification including severity grading and risk for progression.
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Perelas A, Silver RM, Arrossi AV, Highland KB. Systemic sclerosis-associated interstitial lung disease. THE LANCET RESPIRATORY MEDICINE 2020; 8:304-320. [PMID: 32113575 DOI: 10.1016/s2213-2600(19)30480-1] [Citation(s) in RCA: 184] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/19/2019] [Accepted: 12/19/2019] [Indexed: 12/15/2022]
Abstract
Systemic sclerosis is an autoimmune connective tissue disease, which is characterised by immune dysregulation and progressive fibrosis that typically affects the skin, with variable internal organ involvement. It is a rare condition that affects mostly young and middle-aged women, resulting in disproportionate morbidity and mortality. Currently, interstitial lung disease is the most common cause of death among patients with systemic sclerosis, with a prevalence of up to 30% and a 10-year mortality of up to 40%. Interstitial lung disease is more common among African Americans and in people with the diffuse cutaneous form of systemic sclerosis or anti-topoisomerase 1 antibodies. Systemic sclerosis-associated interstitial lung disease most commonly presents with dyspnoea, cough, and a non-specific interstitial pneumonia pattern on CT scan, with a minority of cases fulfilling the criteria for usual interstitial pneumonia. The standard therapy has traditionally been combinations of immunosuppressants, particularly mycophenolate mofetil or cyclophosphamide. These immunosuppressants can be supplemented by targeted biological and antifibrotic therapies, whereas autologous haematopoietic stem-cell transplantation and lung transplantation are reserved for refractory cases.
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Affiliation(s)
- Apostolos Perelas
- Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Richard M Silver
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, SC, USA
| | - Andrea V Arrossi
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
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Abstract
Systemic sclerosis (SSc) is a rare disease characterized by widespread collagen deposition resulting in fibrosis. Although skin involvement is the most common manifestation and also the one that determines the classification of disease, mortality in SSc is usually a result of respiratory compromise in the form of interstitial lung disease (ILD) or pulmonary hypertension (PH). Clinically significant ILD is seen in up to 40% of patients and PH in up to 20%. Treatment with either cyclophosphamide or mycophenolate has been shown to delay disease progression, whereas rituximab and lung transplantation are reserved for refractory cases.
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Tanaka N, Kunihiro Y, Kubo M, Kawano R, Oishi K, Ueda K, Gondo T. HRCT findings of collagen vascular disease-related interstitial pneumonia (CVD-IP): a comparative study among individual underlying diseases. Clin Radiol 2018; 73:833.e1-833.e10. [DOI: 10.1016/j.crad.2018.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/23/2018] [Indexed: 01/14/2023]
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Yamaguchi K, Yamaguchi A, Kashiwagi C, Sawada Y, Taguchi K, Umetsu K, Oshima K, Uchida M, Suzuki M, Kono S, Takemura M, Masubuchi H, Kitahara S, Hara K, Maeno T, Motegi SI, Muro Y, Sakairi T, Hisada T, Kurabayashi M. Differential clinical features of patients with clinically amyopathic dermatomyositis who have circulating anti-MDA5 autoantibodies with or without myositis-associated autoantibodies. Respir Med 2018; 140:1-5. [PMID: 29957268 DOI: 10.1016/j.rmed.2018.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 03/26/2018] [Accepted: 05/13/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Anti-melanoma differentiation-associated gene 5 (MDA5) autoantibodies have been identified as myositis-specific autoantibodies that are often associated with clinically amyopathic dermatomyositis (CADM) and a poor prognosis due to rapidly progressive interstitial lung disease (RP-ILD) in East Asian patients. Besides anti-MDA5 autoantibodies, patients with CADM may have myositis-associated autoantibodies (MAAs), which characterize other connective tissue diseases such as rheumatoid arthritis and Sjögren's syndrome. However, the clinical significance of the coexistence of anti-MDA5 autoantibodies and MAAs in patients with CADM remains unclear. METHODS We retrospectively analyzed 24 patients with CADM who had anti-MDA5 autoantibodies. Their clinical phenotypes including laboratory test results, high-resolution lung computed tomography data, response to therapy, and prognosis were compared between those who were positive and negative for MAAs, such as antinuclear antibody (ANA), anti-cyclic citrullinated peptide (CCP), anti-SSA, and anti-SSB antibodies. RESULTS Among 24 patients, 9 (37.5%) additionally had at least one of the MAAs examined in this study: 1 patient was positive for ANA, 5 for anti-CCP, 5 for either anti-SSA or anti-SSB, 1 for anti-cardiolipin, and 1 for anti-Scl-70. Although all anti-MDA5-positive patients with CADM had ILD, the MAA-positive patients showed a lower risk of developing RP-ILD (p = 0.03), a more favorable response to combination therapy of corticosteroids and immunosuppressive agents, and a lower mortality rate than patients with no MAAs (p = 0.03). CONCLUSIONS Our data suggest that anti-MDA5-positive patients with CADM who also have MAAs have a better prognosis than those without MAAs; thus, anti-MDA5 autoantibodies by themselves may not be strong predictors of worse clinical outcomes in patients with CADM. Coexistent MAAs could be biomarkers for a favorable prognosis in anti-MDA5-positive patients with CADM.
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Affiliation(s)
- Koichi Yamaguchi
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Japan.
| | - Aya Yamaguchi
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Japan
| | - Chiharu Kashiwagi
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Japan
| | - Yuri Sawada
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Japan
| | - Kohei Taguchi
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Japan
| | - Kazue Umetsu
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Japan
| | - Kazuma Oshima
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Japan
| | - Megumi Uchida
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Japan
| | - Masafumi Suzuki
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Japan
| | - Shunichi Kono
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Japan
| | - Masao Takemura
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Japan
| | - Hiroaki Masubuchi
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Japan
| | - Shinsuke Kitahara
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Japan
| | - Kenichiro Hara
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Japan
| | - Toshitaka Maeno
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Japan
| | - Sei-Ichiro Motegi
- Department of Dermatology, Gunma University Graduate School of Medicine, Japan
| | - Yoshinao Muro
- Department of Dermatology, Nagoya University Graduate School of Medicine, Japan
| | - Toru Sakairi
- Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Japan
| | - Takeshi Hisada
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Japan
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CT Features of the Usual Interstitial Pneumonia Pattern: Differentiating Connective Tissue Disease-Associated Interstitial Lung Disease From Idiopathic Pulmonary Fibrosis. AJR Am J Roentgenol 2017; 210:307-313. [PMID: 29140119 DOI: 10.2214/ajr.17.18384] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE A substantial proportion of cases of usual interstitial pneumonia (UIP) are due to connective tissue disease (CTD)-associated interstitial lung disease (ILD). The purpose of this study was to determine whether specific CT findings can help differentiate a UIP pattern of CTD-ILD from a UIP pattern of idiopathic pulmonary fibrosis (IPF) and whether these signs are associated with survival. MATERIALS AND METHODS Adults visiting an ILD clinic from 2006 to 2015 enrolled in a research registry with a multidisciplinary diagnosis of CTD-ILD or IPF and a UIP pattern at high-resolution CT were included in the study. In these subjects with CT findings of UIP due to either IPF or CTD-ILD, three CT findings anecdotally associated with CTD-ILD were assessed for diagnostic accuracy: the "straight-edge" sign, the "exuberant honeycombing" sign, and the "anterior upper lobe" sign. Survival assessments were performed with univariate and multivariable techniques. RESULTS The subjects included 63 patients who had CTD-ILD and 133 patients who had IPF with a UIP pattern at CT. All three CT signs were significantly more common in subjects with CTD-ILD than those with IPF (prevalence, 22.2-25.4% for CTD-ILD, 6.0-12.8% for IPF; p = 0.028 to < 0.001). The highest specificity (94.0%) and sensitivity (25.4%) were seen for the straight-edge sign. No CT sign was associated with survival in multivariable analysis. CONCLUSION Although UIP is usually associated with IPF, the index of suspicion for CTD-ILD should be raised in the care of patients with any of the three CT signs. A thorough workup for CTD-ILD should be pursued, including referral to the rheumatology department.
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Lee JY, Jin SM, Lee BJ, Chung DH, Jang BG, Park HS, Lee SM, Yim JJ, Yang SC, Yoo CG, Han SK, Shim YS, Kim YW. Treatment response and long term follow-up results of nonspecific interstitial pneumonia. J Korean Med Sci 2012; 27:661-7. [PMID: 22690098 PMCID: PMC3369453 DOI: 10.3346/jkms.2012.27.6.661] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 03/13/2012] [Indexed: 11/20/2022] Open
Abstract
The purpose of this study was to investigate the long-term clinical course of non-specific interstitial pneumonia (NSIP) and to determine which factors are associated with a response to steroid therapy and relapse. Thirty-five patients with pathologically proven NSIP were included. Clinical, radiological, and laboratory data were reviewed retrospectively. The male-to-female ratio was 7:28 (median age, 52 yr). Thirty (86%) patients responded to steroid therapy, and the median follow-up was 55.2 months (range, 15.9-102.0 months). Five patients (14%) showed sustained disease progression and three died despite treatment. In the five with sustained disease progression, NSIP was associated with various systemic conditions, and the seropositivity of fluorescent antinuclear antibody was significantly associated with a poor response to steroids (P = 0.028). The rate of relapse was 25%, but all relapsed patients improved after re-treatment. The initial dose of steroids was significantly low in the relapse group (P = 0.020). In conclusion, progression is associated with various systemic conditions in patients who show progression. A low dose of initial steroids is significantly associated with relapse.
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Affiliation(s)
- Ji Yeon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Man Jin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Byoung Jun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Doo Hyun Chung
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Bo-Gun Jang
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Heae Surng Park
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seok-Chul Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Koo Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Soo Shim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young Whan Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
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Interstitial Lung Disease in Myositis: Clinical Subsets, Biomarkers, and Treatment. Curr Rheumatol Rep 2012; 14:264-74. [DOI: 10.1007/s11926-012-0246-6] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nonspecific interstitial pneumonia: prognostic significance of high-resolution computed tomography in 59 patients. J Comput Assist Tomogr 2011; 35:583-9. [PMID: 21926853 DOI: 10.1097/rct.0b013e31822a5883] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To retrospectively analyze the prognostic implications of high-resolution computed tomography (HRCT) findings for patients with biopsy-proven nonspecific interstitial pneumonia (NSIP). METHODS Fifty-nine patients with NSIP (25 idiopathic NSIP, 34 collagen-vascular disease-associated NSIP) were included. Two chest radiologists independently evaluated the extent, presence, and distribution of various HRCT findings. Cox hazards analysis was used to evaluate the relationship between HRCT findings and prognosis. RESULTS The 5-year survival rate was 83% and the 10-year survival rate was 66%. Univariate analysis revealed that the extent of areas with ground-glass attenuation without traction bronchi-bronchiolectasis and that of airs-pace consolidation were associated with favorable outcome, whereas that of intralobular reticular opacities was associated with worse prognosis. Multivariate analysis showed that the extent of air-space consolidation was an independent factor of favorable outcome. CONCLUSION In NSIP, the extent of areas with ground-glass attenuation without traction bronchi-bronchiolectasis, air-space consolidation, and intralobular reticular opacities correlate with survival.
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Current world literature. Curr Opin Rheumatol 2010; 22:704-12. [PMID: 20881793 DOI: 10.1097/bor.0b013e3283404094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Saketkoo LA, Ascherman DP, Cottin V, Christopher-Stine L, Danoff SK, Oddis CV. Interstitial Lung Disease in Idiopathic Inflammatory Myopathy. Curr Rheumatol Rev 2010; 6:108-119. [PMID: 21941374 PMCID: PMC3092635 DOI: 10.2174/157339710791330740] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The lung is one of the most common extra-muscular targets in idiopathic inflammatory myopathies (IIM) and interstitial lung disease (ILD) is a prevalent and often devastating manifestation of IIM. IIM-associated ILD (IIM-ILD) contributes to nearly 80% of the mortality in IIM with a reported prevalence of 65% of newly diagnosed IIM cases. Although ILD frequently accompanies clinical and laboratory findings of myositis, overt signs of muscle disease may be absent in the setting of significant lung disease. Understanding the varied scope of presentation of these diseases is essential to providing optimal patient care. This review will provide an in depth examination of ILD in IIM both from a rheumatologic and pulmonary perspective and will discuss the scope of disease, presenting features, genetic associations, pathogenesis, diagnosis, radiographic and histopathologic findings, along with biomarker assessment and a rationale for therapeutic intervention.
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Affiliation(s)
- Lesley Ann Saketkoo
- Louisiana State University Health Sciences Center, Department of Medicine, Division of Rheumatology, New Orleans, LA, USA
- University Cancer Institute, Section of Rheumatology, Boynton Beach, FL, USA
| | - Dana P. Ascherman
- University of Pittsburgh School of Medicine, Division of Rheumatology and Clinical Immunology, Pittsburgh, PA, USA
| | - Vincent Cottin
- Hospices Civils de Lyon, Université de Lyon, Centre de référence des maladies orphelines pulmonaires, Service de pneumologie, UMR 754 INRA-ENVL-UCBL-IFR128, Hôpital Louis Pradel, Lyon, France
| | - Lisa Christopher-Stine
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sonye K. Danoff
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chester V. Oddis
- University of Pittsburgh School of Medicine, Division of Rheumatology and Clinical Immunology, Pittsburgh, PA, USA
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