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Behera AK, Sharma P, Tg R, Kumar V, Pati SK, Sinha K. Real-World Clinical Profile and Safety of Nintedanib in Systemic Sclerosis-Associated Interstitial Lung Disease: A Subgroup Analysis of Interstitial Lung Disease Data From an Interstitial Lung Disease (ILD) Specialty Clinic in India. Cureus 2024; 16:e65579. [PMID: 39192903 PMCID: PMC11348947 DOI: 10.7759/cureus.65579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/29/2024] Open
Abstract
INTRODUCTION Systemic sclerosis (SSc) is a multisystem autoimmune disorder characterized by dysregulated innate and adaptive immunity. Interstitial lung disease (ILD) is a common and serious complication of SSc, often leading to significant morbidity and mortality. Consistent demographic characteristics that aid in the early diagnosis of ILD in SSc are lacking. This study aims to identify clinical and demographic parameters associated with ILD in SSc patients and assess the safety and tolerability of nintedanib with other immunosuppressants. MATERIALS AND METHODS This study is a subgroup analysis of data from the ILD clinic at All India Institute of Medical Sciences Raipur, collected between January 2022 and January 2024. We assessed the clinical and demographic profiles, high-resolution computed tomography thorax patterns, autoantibody profiles, lung function, and treatments used in the patients. RESULTS We enrolled 57 patients with SSc-associated ILD. The mean age of the participants was 39.0 ± 11.1 years, with 53 (92.9%) being women. The mean body mass index was 20.4 ± 4.32 kg/m². Dyspnea was the most common symptom, followed by skin tightening and cough. Antinuclear antibody tests were positive in 92.9% of patients, and anti-Scl-70 antibodies were positive in 57.9%. Rheumatoid arthritis-SSc overlap was observed in 15.8% of patients. The mean predicted forced vital capacity was 46.5 ± 19.9%, the mean predicted total lung capacity was 64.5 ± 20.4%, and the mean predicted diffusing capacity for carbon monoxide was 46.2 ± 15.7%. The mean six-minute walk distance was 360.3 ± 81.2 meters, and the mean King's Brief Interstitial Lung Disease score was 63.9 ± 10.7. Common radiological abnormalities included ground-glass opacities in 57.8%, traction bronchiectasis in 43.8%, and honeycombing in 28.07%. The predominant ILD pattern was nonspecific interstitial pneumonia. Patients received a combination of prednisolone (5 mg/day) with mycophenolate mofetil (63.2%), hydroxychloroquine (17.5%), cyclophosphamide (12.3%), and methotrexate (7.02%). Nintedanib, the only antifibrotic used, was administered to 17 (29.8%) patients. CONCLUSIONS ILD is relatively common in SSc, particularly in patients with diffuse cutaneous SSc and those with anti-topoisomerase antibodies. Female patients comprised the predominant population in this study. Patients tolerated mycophenolate mofetil and cyclophosphamide well. Nintedanib was the only antifibrotic used, and all patients tolerated the combination of antifibrotics and immunosuppressants well. Early diagnosis is crucial to slow disease progression and preserve lung function. Our results highlight the need for vigilant screening in high-risk groups and suggest that MMF, cyclophosphamide, and nintedanib can be safely incorporated into treatment regimens, offering a potential strategy to improve patient outcomes.
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Affiliation(s)
- Ajoy K Behera
- Pulmonary Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Pratibha Sharma
- Microbiology, Shri Balaji Institute of Medical Science, Raipur, IND
| | - Ranganath Tg
- Pulmonary Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Vikas Kumar
- Pulmonary Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Saroj K Pati
- Radiodiagnosis, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Kulshreshth Sinha
- Pulmonary Medicine, All India Institute of Medical Sciences, Raipur, Raipur, IND
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Kortelainen S, Käyrä M, Hurme S, Paltta J, Pirilä L, Huhtakangas J. Systemic sclerosis: changes in the incidence rates in the Finnish population during the years 1999-2018. Scand J Rheumatol 2024; 53:29-35. [PMID: 37439450 DOI: 10.1080/03009742.2023.2217620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/22/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE The aim of our study was to examine changes in the incidence of systemic sclerosis (SSc) in Finland using two different classification criteria. METHOD Medical records of patients who had been registered with ICD-10 code M34 from 1999 to 2018 in two university hospitals were reviewed retrospectively. This period was divided into 5 year periods: 1999-2003, 2004-2008, 2009-2013, and 2014-2018. Using American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) 2013 criteria and clinical findings, we reclassified patients into four groups: diffuse SSc, limited SSc, sine SSc, or early SSc. In the same population, we also investigated whether the ACR 1980 criteria were fulfilled. RESULTS In 1999-2018, 246 new patients with SSc and 45 patients with early SSc were identified using ACR/EULAR 2013 criteria. Of these patients, 70 fulfilled the ACR 1980 criteria. Using ACR/EULAR 2013 criteria, the increase in new diagnoses was statistically significant when comparing the fourth period with the first period (p = 0.0012). The increase was due to a rise in limited SSc. Mean annual incidence rates in these groups were 0.9, 1.2, 1.9, and 2.8 per 100 000 inhabitants ≥ 16 years old. An increasing trend was also seen when using ACR 1980 criteria, but this was not statistically significant. CONCLUSION The incidence of SSc increased during the period between 1999-2003 and 2014-2018 using ACR/EULAR 2013, but not using ACR 1980 criteria. The increase was detected within a limited SSc subclass, owing to more sensitive classification criteria.
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Affiliation(s)
- S Kortelainen
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - M Käyrä
- Division of Rheumatology, Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - S Hurme
- Department of Biostatistics, University of Turku, Turku, Finland
| | - J Paltta
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - L Pirilä
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - J Huhtakangas
- Division of Rheumatology, Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
- Cancer Research and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland
- Division of Rheumatology, Department of Internal Medicine, Kuopio University Hospital, Kuopio, Finland
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Shir-az O, Berl A, Mann D, Bilal BS, Levy Y, Shalom A. Treatment of Scleroderma-Related Microstomia Using Hyaluronic Acid: An Interventional Study. Life (Basel) 2023; 13:2176. [PMID: 38004316 PMCID: PMC10671914 DOI: 10.3390/life13112176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Systemic sclerosis (SSc) or scleroderma is a rare, systemic, autoimmune connective tissue disease. It causes increased collagen synthesis, leading to multi-organ sclerosis, including the skin and joints. Patients' overall health and quality of life are harmed dramatically. Involvement of the face and, especially, the oral opening can limit patients' ability to speak and eat, oral hygiene, and cosmetic appearance. Profhilo® (NAHYCO®) is an over-the-counter product consisting of pure hyaluronic acid. It is used to improve skin quality by increasing collagen production and adipocyte vitality. This interventional study evaluated the results of perioral injections of hyaluronic acid in terms of improved skin quality, elasticity, and increased oral opening. Patients diagnosed with SSc received an injection of one syringe of Profhilo® (2 mL of hyaluronic acid) at each of two clinic visits at one-month intervals. The oral opening was measured between the upper and lower central incisors before and after treatment. Quality of life was assessed using the modified Rodnan Skin Score and Health Assessment Questionnaire-Disability Index. A total of 14 patients received the first treatment, and 11 received the second treatment. The mean oral opening increased from 31.6 mm (range 17-50 mm) prior to therapy to 35.8 mm (range 21-56) 2 months following the second injection. Statistical analysis showed that there was a significant increase in the oral opening as observed one week (36.2 mm, p = 0.011), one month (36.2 mm, p = 0.007), and three months (31.6 mm, p = 0.023) after the second injection, at the 5-month follow-up. Treatment of SSc patients' perioral area with Profhilo® can result in significant improvements in oral opening and quality of life.
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Affiliation(s)
- Ofir Shir-az
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba 4428164, Israel; (O.S.-a.); (D.M.); (B.S.B.); (A.S.)
- The Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Ariel Berl
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba 4428164, Israel; (O.S.-a.); (D.M.); (B.S.B.); (A.S.)
- The Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Din Mann
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba 4428164, Israel; (O.S.-a.); (D.M.); (B.S.B.); (A.S.)
- The Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Biader Samih Bilal
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba 4428164, Israel; (O.S.-a.); (D.M.); (B.S.B.); (A.S.)
- The Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Yair Levy
- The Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Department of Internal Medicine E, Meir Medical Center, Kfar Saba 4428164, Israel
| | - Avshalom Shalom
- Department of Plastic Surgery, Meir Medical Center, Kfar Saba 4428164, Israel; (O.S.-a.); (D.M.); (B.S.B.); (A.S.)
- The Tel Aviv Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
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Bogatkevich GS, Atanelishvili I, Bogatkevich AM, Silver RM. Critical Role of LMCD1 in Promoting Profibrotic Characteristics of Lung Myofibroblasts in Experimental and Scleroderma-Associated Lung Fibrosis. Arthritis Rheumatol 2023; 75:438-448. [PMID: 36103378 PMCID: PMC9998340 DOI: 10.1002/art.42344] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 07/15/2022] [Accepted: 08/31/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Interstitial lung disease (ILD) is a serious complication and leading cause of mortality in patients with systemic sclerosis (SSc). In this study, we explored the role of LIM and cysteine-rich domains protein 1 (LMCD1) as a novel factor in the pathogenesis of SSc-related ILD (SSc-ILD). METHODS The expression and effects of LMCD1 were studied in lung tissue samples and fibroblasts from SSc-ILD patients and control subjects as well as in lung tissue samples from animal models. RESULTS LMCD1 was consistently elevated in lung tissue samples and in fibroblasts isolated from SSc-ILD patients as compared to controls. Additionally, LMCD1 was found to be highly expressed in the lung in the fibroblast-specific protein (FSP)-driven, constitutively active transforming growth factor β receptor type I (TGFβR1) transgenic mouse model of ILD and the bleomycin-induced mouse model of ILD. In lung fibroblasts from SSc-ILD patients, LMCD1 is an essential factor for the TGFβ-induced generation of type I collagen, fibronectin, and α-smooth muscle actin (α-SMA). Depletion of LMCD1 by small interfering RNA reduced the expression of extracellular matrix proteins and lowered transcriptional activity and expression of α-SMA, as well as decreased the proliferation and contractile activity of SSc-ILD lung fibroblasts. In dense fibrotic areas of affected lung tissue, lung LMCD1 colocalized with α-SMA. In cultured scleroderma lung fibroblasts, LMCD1 colocalized and interacted with serum response factor which mediates LMCD1-induced contractile activity of lung fibroblasts. CONCLUSION Our study identifies LMCD1 as a profibrotic molecule contributing to the activation of myofibroblasts and the persistent fibroproliferation observed in SSc-ILD. Thus, LMCD1 may be a potential novel therapeutic target for patients with SSc-ILD.
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Affiliation(s)
- Galina S Bogatkevich
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, Charleston
| | - Ilia Atanelishvili
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, Charleston
| | - Andrew M Bogatkevich
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, and College of Charleston (BSc Student), Charleston, South Carolina
| | - Richard M Silver
- Division of Rheumatology and Immunology, Department of Medicine, Medical University of South Carolina, Charleston
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Total Facial Autologous Fat Grafting for Treating Skin Manifestations in Scleroderma. LIFE (BASEL, SWITZERLAND) 2022; 12:life12121997. [PMID: 36556362 PMCID: PMC9783901 DOI: 10.3390/life12121997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
Systemic sclerosis (SSc) or scleroderma, is a rare, systemic autoimmune connective tissue disease that can cause fibrosis of cutaneous tissue and visceral organs. Facial involvement can have a deleterious effect on patients' function, cosmetic appearance and quality of life. This study describes our experience and results with total facial autologous fat grafting for treating scleroderma. It includes 14 women and 3 men with SSc, at an average age of 51.3 years who underwent 32 autologous fat grafting surgeries between 2017-2022. The surgical technique is further described and demographic and surgical data, including preoperative and postoperative measurements were analyzed. Patients who had multiple surgeries ultimately received grafts with twice the volume of fat than in the first procedure. The oral opening increased an average of 33%. All patients reported improvement in quality of life and were very satisfied with the aesthetic outcomes. The use of autologous fat grafting to treat SSc patients successfully increased oral openings and improved facial manifestations. The procedure is reproducible, safe and leads to improvement in facial manifestations and patients' quality of life. It can be repeated over time to preserve or enhance the results.
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Abstract
PURPOSE OF REVIEW Systemic sclerosis (SSc) is a chronic rheumatic disease that is characterized by immune activation, vasculopathy and fibrosis of the skin and internal organs. It has been proposed that premature onset of ageing pathways and associated senescent changes in cells contribute to the clinical and pathological features of SSc. The aim of this review is to critically review recent insights into the involvement of cellular senescence in SSc. RECENT FINDINGS Cellular senescence plays a critical role in SSc pathogenesis, particularly involving endothelial cells and fibroblasts. Immunosenescence could also contribute to SSc pathogenesis by direct alteration of cellular functions or indirect promotion of defective immune surveillance. Molecular studies have shed some light on how cellular senescence contributes to fibrosis. Recent and planned proof-of-concept trials using senotherapeutics showed promising results in fibrotic diseases, including SSc. SUMMARY There is increasing evidence implicating cellular senescence in SSc. The mechanisms underlying premature cellular senescence in SSc, and its potential role in pathogenesis, merit further investigation. Emerging drugs targeting senescence-related pathways might be potential therapeutic options for SSc.
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Affiliation(s)
- Pei-Suen Tsou
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
| | - Bo Shi
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - John Varga
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
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Natural polysaccharides as potential anti-fibrotic agents: A review of their progress. Life Sci 2022; 308:120953. [PMID: 36103957 DOI: 10.1016/j.lfs.2022.120953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/24/2022]
Abstract
Fibrosis, as a common disease which could be found in nearly all organs, is normally initiated by organic injury and eventually ended in cellular dysfunction and organ failure. Currently, effective and safe therapeutic strategies targeting fibrogenesis still in highly demand. Natural polysaccharides derived from natural resources possess promising anti-fibrosis potential, with no deleterious side effects. Based on the etiology and pathogenesis of fibrosis, this review summarizes the intervention effects and mechanisms of natural polysaccharides in the prevention and treatment of fibrosis. Natural polysaccharides are able to regulate each phase of the fibrogenic response, including primary injury to organs, activation of effector cells, the elaboration of extracellular matrix (ECM) and dynamic deposition. In addition, polysaccharides significantly reduce fibrosis levels in multiple organs including heart, lung, liver and kidney. The investigation of the pathogenesis of fibrosis indicates that mechanisms including the inhibition of TGF-β/Smad, NF-κB, HMGB1/TLR4, cAMP/PKA signaling pathways, MMPs/TIMPs system as well as microRNAs are promising therapeutic targets. Natural polysaccharides can target these mediators or pathways to alleviate fibrosis. The information reviewed here offer new insights into the understanding the protective role of natural polysaccharides against fibrosis, help design further experimental studies related to polysaccharides and fibrotic responses, and shed light on a potential treatment for fibrosis.
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Padem N, Wright H, Fuleihan R, Garabedian E, Suez D, Cunningham-Rundles C, Marsh RA, Khojah A. Rheumatologic diseases in patients with inborn errors of immunity in the USIDNET registry. Clin Rheumatol 2022; 41:2197-2203. [PMID: 35099673 DOI: 10.1007/s10067-021-06044-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/10/2021] [Accepted: 12/28/2021] [Indexed: 02/08/2023]
Abstract
There is a gap in clinical knowledge regarding associations between specific inborn errors of immunity (IEIs) and rheumatologic diseases. This study reports the frequency of rheumatologic conditions in a large cohort of patients with IEI using the USIDNET (United States Immunodeficiency Network) registry. We used the USIDNET registry to conduct the analysis. We included all IEI patients within the registry for whom a diagnosed rheumatologic disease was reported. The total number of patients with IEI in our query was 5058. Among those, 278 (5.49%) patients had a diagnosis of rheumatologic disease. This cohort included 172 (61.8%) female and 106 (38.2%) male patients. Rheumatologic complications were highest in the interferonopathies (66.6%), autoimmune lymphoproliferative syndrome (ALPS) (13.7%), and immunoglobulin G subclass deficiency (IgGSD) (11.11%). Additionally, disease patterns were noted to be different in various IEI disease groups. Inflammatory myopathies were the most common rheumatologic condition in patients with X-linked agammaglobulinemia (1.65%), Sjogren's syndrome was the most common rheumatologic disease reported in ALPS patients (6.85%), and systemic lupus erythematosus was the most common rheumatologic disease in patients with chronic mucocutaneous candidiasis (CMC) (7.41%). Rheumatoid arthritis (RA) report rate was highest in patients with IgGSD (3.70%), specific antibody deficiency (SAD) (3.66%), and ALPS (2.74%). This study reports that rheumatologic diseases are frequently observed in patients with IEI. The frequency of different rheumatologic conditions was variable based on the underlying diagnosis. Clinicians caring for patients with IEI should be vigilant to monitor for rheumatologic complications. Key Points • The rates of reported rheumatologic diseases in the USIDNET registry are different in individual IEIs. • Further studies are needed to guide clinicians for detecting rheumatologic conditions earlier in patients with IEI.
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Affiliation(s)
- N Padem
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, 705 Riley Hospital Dr, ROC 4270, Indianapolis, IN, 46202, USA.
| | - H Wright
- United States Immunodeficiency Network, Towson, MD, USA
| | - R Fuleihan
- Division of Allergy, Immunology and Rheumatology, Columbia University Irving Medical Center, New York, NY, USA
| | - E Garabedian
- Division of Intramural Research, National Human Genome Research Institute, NIH, Bethesda, MD, USA
| | - D Suez
- Allergy, Asthma & Immunology Clinic, PA, Irving, TX, USA
| | - C Cunningham-Rundles
- Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - R A Marsh
- Department of Pediatrics, University of Cincinnati, Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - A Khojah
- Department of Pediatrics, College of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
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Coffey CM, Radwan YA, Sandhu AS, Crowson CS, Bauer PR, Matteson EL, Makol A. Epidemiology and Trends in Survival of Systemic Sclerosis in Olmsted County (1980-2018): A Population-based Study. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2022; 6:264-270. [PMID: 35295789 DOI: 10.1177/23971983211026853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background/Purpose To update the epidemiology of systemic sclerosis (SSc) and evaluate the performance of the ACR/EULAR 2013 vs. 1980 ARA classification criteria in a U.S. population-based cohort. Methods An inception cohort of patients with incident SSc from January 1, 1980, through December 31, 2018, in Olmsted County, Minnesota, was identified based on comprehensive individual medical record review. Incidence and prevalence rates were age- and sex-adjusted to the 2010 US white population. Survival rates were compared with expected rates in the general population. Fulfillment of 1980 and 2013 classification criteria was ascertained. Results A total of 85 incident cases of SSc (91% female, mean age 55.4 ± 16 y) and 49 prevalent cases on Jan 1, 2015 were identified. The overall age- and sex-adjusted annual incidence was 25 (95% CI 20-31) per million population, with no change in incidence over time. The age- and sex-adjusted prevalence was 436 (95% CI: 313-558) per 1,000,000 population. 77 (91%) patients fulfilled the 2013 classification criteria, and 38 (45%) fulfilled the 1980 criteria. Mortality among patients with SSc was significantly higher in comparison to the general population, with a standardized mortality ratio of 2.48 (95% CI:1.76-3.39) and no evidence of improvement over time. Conclusions SSc developed in 25 persons/million/year with no change over the 39-year study period. The 2013 classification criteria perform significantly better than the 1980 criteria but failed to classify 9% of patients. SSc portends a 2.5-fold higher risk of mortality than the general population, with no evidence of improved survival over time.
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Affiliation(s)
- Caitrin M Coffey
- Division of Rheumatology, Mayo Clinic College of Medicine and Research, Rochester, MN, USA
| | - Yasser A Radwan
- Department of Internal Medicine, Michigan State University, Lansing, MI, USA
| | - Avneek S Sandhu
- Department of Internal Medicine, Kettering Medical Center, Kettering, OH, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic College of Medicine and Research, Rochester, MN, USA.,Department of Quantitative Heath Sciences, Mayo Clinic College of Medicine and Research, Rochester, MN, USA
| | - Philippe R Bauer
- Division of Pulmonary and Critical Care, Mayo Clinic College of Medicine and Research, Rochester, MN, USA
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Research, Rochester, MN, USA.,Department of Quantitative Heath Sciences, Mayo Clinic College of Medicine and Research, Rochester, MN, USA
| | - Ashima Makol
- Division of Rheumatology, Mayo Clinic College of Medicine and Research, Rochester, MN, USA
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Knarborg M, Hyldgaard C, Bendstrup E, Davidsen JR, Løkke A, Shaker SB, Hilberg O. Incidence, prevalence and regional distribution of systemic sclerosis and related interstitial lung Disease: A nationwide retrospective cohort study. Chron Respir Dis 2022; 19:14799731221125559. [PMID: 36123773 PMCID: PMC9500307 DOI: 10.1177/14799731221125559] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate incidence and prevalence of Systemic Sclerosis (SSc) and association with interstitial lung disease (SSc-ILD) in a nationwide population-based study. Methods Patients with an incident diagnosis of SSc in 2000–2016 were identified in the Danish National Patient Registry and categorised based on diagnosis of ILD. Incidence- and prevalence proportions were calculated based on the annual population estimates. A cox proportional hazards model was used to evaluate the association between age, sex, region and marital status and presence of ILD. Results In total, 1869 patients with SSc were identified; 275 patients (14.7%) had SSc-ILD. The majority of patients were females (75.5%). The percentage of males was higher in SSc-ILD than in SSc alone (30.9% and 23.4%, p = 0.008). Median time from SSc to ILD diagnosis was 1.4 years (range 0–14.2). ILD was diagnosed from ≤4 years before to ≥7 years after SSc. Development of ILD was associated with male gender (HR 1.75, 95% CI 1.15–2.66), age 41–50 (HR 1.81, 95% CI 1.07–3.05) and residency in the North Denmark Region (HR 1.95, 9 5% CI 1.12–3.40). Mean annual incidence proportion of SSc was 2.9/100,000 and mean annual prevalence proportion was 16.8/100,000. The incidence remained stable, but prevalence proportion increased from 14.1 – 16.5/100,000 in 2000–2008 to 17.9–19.2/100,000 in 2009–2016. Conclusion The prevalence of SSc increased during the study period, while the incidence remained stable. The prevalence of SSc-ILD was 14.7% and thus less frequent than expected. Male sex and age between 41 and 50 years were associated with ILD.
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Affiliation(s)
- Malene Knarborg
- Department of Medicine, 371420Lillebaelt Hospital, Vejle, Denmark.,Department of Regional Health Research, 6174University of Southern Denmark, Odense, Denmark
| | - Charlotte Hyldgaard
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, 53179Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, 11297Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, 1006Aarhus University, Aarhus, Denmark
| | - Jesper R Davidsen
- South Danish Center for Interstitial Lung Diseases (SCILS), Department of Respiratory Medicine, 11286Odense University Hospital, Odense, Denmark.,Odense Respiratory Research Unit (ODIN), Department of Clinical Research, 6174University of Southern Denmark, Odense, Denmark
| | - Anders Løkke
- Department of Medicine, 371420Lillebaelt Hospital, Vejle, Denmark.,Department of Regional Health Research, 6174University of Southern Denmark, Odense, Denmark
| | - Saher B Shaker
- Department of Respiratory Medicine, 53147Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Ole Hilberg
- Department of Medicine, 371420Lillebaelt Hospital, Vejle, Denmark.,Department of Regional Health Research, 6174University of Southern Denmark, Odense, Denmark
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Bairkdar M, Rossides M, Westerlind H, Hesselstrand R, Arkema EV, Holmqvist M. Incidence and prevalence of systemic sclerosis globally: a comprehensive systematic review and meta-analysis. Rheumatology (Oxford) 2021; 60:3121-3133. [PMID: 33630060 PMCID: PMC8516513 DOI: 10.1093/rheumatology/keab190] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/14/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We aimed to conduct a systematic review and meta-analysis on the incidence and prevalence of SSc covering the entire literature. METHODS This study followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement of 2009. We conducted a systematic search in MEDLINE, Web of Science and Embase to identify articles reporting incidence and/or prevalence of SSc. Two authors conducted the search, reviewed articles for inclusion and extracted relevant data. We used random-effects models to estimate the pooled prevalence and incidence of SSc and performed subgroup analyses by sex, case definition and region to investigate heterogeneity. We explored the association between calendar period and reported estimates using meta-regression. RESULTS Among 6983 unique records identified, we included 61 studies of prevalence and 39 studies of incidence in the systematic review. The overall pooled prevalence of SSc was 17.6 (95% CI 15.1, 20.5) per 100 000 and the overall pooled incidence rate of SSc was 1.4 (95% CI 1.1, 1.9) per 100 000 person-years. We observed significant regional variations in reported estimates; studies conducted in North America reported considerably higher estimates than other regions. The pooled incidence and prevalence in women were five times higher than in men. More recent studies reported higher estimates than older ones. CONCLUSION In this comprehensive review of the incidence and prevalence of SSc across the world, there was large heterogeneity among estimates, which should be taken into consideration when interpreting the results.
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Affiliation(s)
- Majd Bairkdar
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Marios Rossides
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Helga Westerlind
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Roger Hesselstrand
- Section for Rheumatology, Department of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund
| | - Elizabeth V Arkema
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm
| | - Marie Holmqvist
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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12
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Li Q, Wallace L, Patnaik P, Alves M, Gahlemann M, Kohlbrenner V, Raabe C, Wang JR, Garry EM. Disease frequency, patient characteristics, comorbidity outcomes and immunosuppressive therapy in systemic sclerosis and systemic sclerosis-associated interstitial lung disease: a US cohort study. Rheumatology (Oxford) 2021; 60:1915-1925. [PMID: 33155024 PMCID: PMC8023990 DOI: 10.1093/rheumatology/keaa547] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/29/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To investigate prevalence estimates and incidence rates (IRs) for SSc and SSc-associated interstitial lung disease (SSc-ILD) cohorts and describe patient characteristics, immunosuppressive therapy (IST) and comorbid outcomes among incident SSc and SSc-ILD cohorts. METHODS Data were obtained from the US IBM MarketScan (2008-2017) claims database using algorithms developed with expert consultation. For the SSc cohort, newly diagnosed patients (aged ≥18 years) had one or more diagnostic claim for SSc. For the SSc-ILD cohort, patients had an additional ILD claim. Sensitivity analyses using two or more claims or alternative ILD diagnostic codes were also conducted. RESULTS When requiring one or more diagnostic claim, the prevalence of SSc and SSc-ILD per 100 000 persons was 72.1 and 19.0. The IR for SSc and SSc-ILD per 100 000 person-years was 18.3 and 4.3. Sensitivity analyses requiring two or more claims yielded much lower prevalence (SSc: 41.5; SSc-ILD: 13.3) and IR (SSc: 8.8; SSc-ILD: 1.6) estimates. Patients with SSc-ILD were older, with increased comorbidities and diagnostic procedures at baseline. MTX and MMF were the most common ISTs; 12.7% of the SSc-ILD cohort received therapy at baseline vs 8.2% for SSc. A total of 42.5% and 45.0% of the SSc and SSc-ILD cohorts, respectively, started a stable IST regimen and 21.7% and 19.4% of these had an escalation. Skin disorders were the most common comorbid outcome in both cohorts during follow-up. CONCLUSIONS SSc, with or without associated ILD, is a rare disease in the US. Newly diagnosed patients with SSc-ILD had received more IST and had more comorbidities compared with newly diagnosed SSc.
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Affiliation(s)
- Qiang Li
- Department of Epidemiology, Boehringer Ingelheim (China) Investment Co. Ltd., Beijing, China
| | - Laura Wallace
- Global Epidemiology and Real World Evidence, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Padmaja Patnaik
- Global Epidemiology and Real World Evidence, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Margarida Alves
- Inflammation Medicine, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | | | - Veronika Kohlbrenner
- Global Epidemiology and Real World Evidence, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA
| | - Christina Raabe
- Inflammation Medicine, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
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13
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Pope JE, Quansah K, Hassan S, Seung SJ, Flavin J, Kolb M. Systemic Sclerosis and Associated Interstitial Lung Disease in Ontario, Canada: An Examination of Prevalence and Survival Over 10 Years. J Rheumatol 2021; 48:1427-1434. [PMID: 33795325 DOI: 10.3899/jrheum.201049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is a rare autoimmune disease. Pulmonary complications of SSc are some of the leading causes of morbidity and mortality. The objective of this study was to determine prevalence and survival estimates of SSc and SSc with interstitial lung disease (SSc-ILD) in the Canadian province of Ontario using administrative data over 10 years. METHODS Using International Classification of Diseases, 10th revision codes adapted for Canada (ICD-10-CA), adult patients diagnosed with SSc and SSc-ILD between April 1, 2008, and March 31, 2018, were identified from the National Ambulatory Care Reporting System and the Discharge Abstract Database administrative databases. SSc was identified first, and ILD was included if presence occurred after SSc diagnosis. Prevalence estimates were determined for both SSc and SSc-ILD. For survival rates, Kaplan-Meier survival curves were generated. RESULTS At the start of the 2017/18 fiscal year (final year of the cohort), there were 2114 prevalent SSc cases for a cumulative prevalence of 19.1 per 100,000 persons, as well as 257 prevalent cases of SSc-ILD that generated a prevalence of 2.3 cases per 100,000 persons. Mean ages were 57 and 58 years with 84% and 80% females for patients with SSc and SSc-ILD, respectively. One-, 5-, and 10-year survival rates were 85.0%, 64.5%, and 44.9% for the SSc group and 77.1%, 44.4%, and 22.0% for the SSc-ILD group, respectively. CONCLUSION To our knowledge, this study provides the first population-based estimates of SSc and SSc-ILD in Canada for prevalence and survival. Results confirm that the prevalence estimates of SSc-ILD fall within the Canadian threshold for rare disease. It also demonstrates the poor survival in SSc, especially when ILD is also present.
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Affiliation(s)
- Janet E Pope
- J.E. Pope, MD, Schulich School of Medicine and Dentistry, Western University, St. Joseph Health Care, London;
| | - Kobina Quansah
- K. Quansah, MSc, Boehringer Ingelheim (Canada) Ltd., Burlington
| | - Shazia Hassan
- S. Hassan, HBSc, S.J. Seung, HBSc, HOPE Research Centre, Sunnybrook Research Institute, Toronto
| | - Soo Jin Seung
- S. Hassan, HBSc, S.J. Seung, HBSc, HOPE Research Centre, Sunnybrook Research Institute, Toronto
| | - Jason Flavin
- J. Flavin, MA, Boehringer Ingelheim International Gmbh
| | - Martin Kolb
- M. Kolb, MD, PhD, Department of Respiratory Medicine, Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
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Alhendi FJ, Werth VP, Sollecito TP, Stoopler ET. Systemic sclerosis: Update for oral health care providers. SPECIAL CARE IN DENTISTRY 2021; 40:418-430. [PMID: 33448431 DOI: 10.1111/scd.12492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/22/2022]
Abstract
Systemic sclerosis (SSc), also known as scleroderma, is an autoimmune disease of unknown origin characterized by an uncontrolled inflammatory process resulting in fibrosis of the skin, internal organs and vasculopathy. Manifestations of SSc are heterogenous and can include pulmonary, cardiac, neural, renal, muscular, cutaneous and orofacial complications. Recent scientific advances have led to a better understanding of disease etiopathogenesis and the development of a new classification system. Therapeutic management is often multidisciplinary and targeted toward the affected organs. Oral health care providers (OHCPs) should be familiar with SSc, particularly as it relates to its impact on the orofacial region and modifications to delivery of oral health care for patients with this condition.
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Affiliation(s)
- Fatmah J Alhendi
- Department of Oral Medicine, Penn Dental Medicine, Philadelphia, Pennsylvania
| | - Victoria P Werth
- Department of Dermatology, Philadelphia V.A. Hospital, Hospital of the University of Pennsylvania and the Veteran's Administration Medical Center, Philadelphia, Pennsylvania
| | - Thomas P Sollecito
- Department of Oral Medicine, Penn Dental Medicine, Philadelphia, Pennsylvania
| | - Eric T Stoopler
- Department of Oral Medicine, Penn Dental Medicine, Philadelphia, Pennsylvania
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15
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Wu M, Xu H, Liu J, Tan X, Wan S, Guo M, Long Y, Xu Y. Metformin and Fibrosis: A Review of Existing Evidence and Mechanisms. J Diabetes Res 2021; 2021:6673525. [PMID: 34007848 PMCID: PMC8102119 DOI: 10.1155/2021/6673525] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 12/16/2022] Open
Abstract
Fibrosis is a physiological response to organ injury and is characterized by the excessive deposition of connective tissue components in an organ, which results in the disruption of physiological architecture and organ remodeling, ultimately leading to organ failure and death. Fibrosis in the lung, kidney, and liver accounts for a substantial proportion of the global burden of disability and mortality. To date, there are no effective therapeutic strategies for controlling fibrosis. A class of metabolically targeted chemicals, such as adenosine monophosphate-activated protein kinase (AMPK) activators and peroxisome proliferator-activated receptor (PPAR) agonists, shows strong potential in fighting fibrosis. Metformin, which is a potent AMPK activator and is the only recommended first-line drug for the treatment of type 2 diabetes, has emerged as a promising method of fibrosis reduction or reversion. In this review, we first summarize the key experimental and clinical studies that have specifically investigated the effects of metformin on organ fibrosis. Then, we discuss the mechanisms involved in mediating the antifibrotic effects of metformin in depth.
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Affiliation(s)
- Maoyan Wu
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China 646000
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, Sichuan, China 646000
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China 646000
| | - Huiwen Xu
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China 646000
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, Sichuan, China 646000
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China 646000
| | - Jingyu Liu
- Southwest Medical University, Luzhou, Sichuan, China 646000
| | - Xiaozhen Tan
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, Sichuan, China 646000
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China 646000
| | - Shengrong Wan
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China 646000
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, Sichuan, China 646000
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China 646000
| | - Man Guo
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, Sichuan, China 646000
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China 646000
| | - Yang Long
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China 646000
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, Sichuan, China 646000
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China 646000
| | - Yong Xu
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China 646000
- Cardiovascular and Metabolic Diseases Key Laboratory of Luzhou, Luzhou, Sichuan, China 646000
- Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan, China 646000
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Fan Y, Bender S, Shi W, Zoz D. Incidence and prevalence of systemic sclerosis and systemic sclerosis with interstitial lung disease in the United States. J Manag Care Spec Pharm 2020; 26:1539-1547. [PMID: 32996805 PMCID: PMC10391172 DOI: 10.18553/jmcp.2020.20136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although systemic sclerosis (SSc) with interstitial lung disease (SSc-ILD) is a serious condition and incurs a substantial clinical burden, the epidemiology has not been well characterized. OBJECTIVE To estimate the incidence and prevalence of SSc and SSc-ILD among commercially insured adults in the United States. METHODS Adults with medical claims between 2011 and 2016 for SSc or SSc-ILD with and without high-resolution computed tomography scans were identified from the Optum Clinformatics Data Mart. Incidence and prevalence were calculated as rates per 100,000 person-years and 100,000 people, respectively. The crude and age- and sex-adjusted prevalence and incidence of SSc and SSc-ILD were estimated and stratified by year and geography. Sensitivity analyses were conducted based on different cohort identification algorithms. RESULTS Overall, the crude incidence rates of SSc and SSc-ILD were 16.4 and 1.2 per 100,000 person-years, respectively, and the crude prevalence was 24.4 and 6.9 per 100,000 people, respectively. Patient characteristics were generally similar between the SSc and SSc-ILD groups. Mean age range was 59.2-59.9 years and 61.8-62.9 years in the SSc and SSc-ILD groups, respectively. SSc had an age- and sex-adjusted incidence rate of 15.1 per 100,000 person-years and an adjusted prevalence of 25.9 per 100,000 people. The adjusted incidence rate of SSc-ILD was 1.1 per 100,000 person-years and the adjusted prevalence was 7.3 per 100,000 people. CONCLUSIONS This study provides current estimates of the national incidence and prevalence of SSc and SSc-ILD, which have not been previously well characterized. Further research in the future may help to support health management strategies and resource allocation for adults with SSc and SSc-ILD in the United States. DISCLOSURES This work was supported by Boehringer Ingelheim Pharmaceuticals, Inc. (BIPI), which reviewed the manuscript for medical and scientific accuracy, as well as intellectual property considerations. All authors are employed by BIPI and did not receive direct compensation related to the development of the manuscript.
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Affiliation(s)
- Yanni Fan
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT
| | - Shaun Bender
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT
| | - Weizhi Shi
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT
| | - Donald Zoz
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT
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17
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Structure-based virtual screening to identify novel carnitine acetyltransferase activators. J Mol Graph Model 2020; 100:107692. [PMID: 32759041 DOI: 10.1016/j.jmgm.2020.107692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/28/2020] [Accepted: 07/06/2020] [Indexed: 12/22/2022]
Abstract
Carnitine acetyltransferase (CAT) is an attractive therapeutic target against fibrosis. We have identified few CAT activators through structure-based virtual screening followed by molecular dynamics simulations for assessment of the binding mode. A set of 10,000 drug-like molecules properly filtered from an initial chemical library of 13 M commercially available compounds were docked into the active site. Virtual hits were selected for in vitro experimental testing to validate the computational findings and the stability of the predicted complexes was evaluated by molecular dynamics simulations. Applied protocol led to the identification of three hit compounds showing promising activity, which can serve as potential scaffolds for further structural optimization. This is the first report of successful discovery of CAT activators through the use of structure-based virtual screening.
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Gale SL, Trinh H, Mathew N, Jahreis A, Lin CJF, Sarsour K. Characterizing Disease Manifestations and Treatment Patterns Among Adults with Systemic Sclerosis: A Retrospective Analysis of a US Healthcare Claims Population. Rheumatol Ther 2020; 7:89-99. [PMID: 31734871 PMCID: PMC7021840 DOI: 10.1007/s40744-019-00181-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Real-world use of immunomodulating therapy (IMT) in patients with systemic sclerosis (SSc) was investigated for the first time in a descriptive, retrospective cohort analysis of claims made in a healthcare insurance database to characterize treatment patterns and their alignment with SSc disease manifestations. METHODS Treatment patterns and disease manifestations, symptoms, complications, and comorbidities were assessed in patients with SSc enrolled in a US healthcare claims database who received treatment between January 2006 and December 2013 and for whom data were available 6 months before and 12 months after SSc diagnosis. RESULTS Among 7812 eligible patients, 6852 received treatments of interest for SSc and 2404 (30.8%) received IMT during the first year after SSc diagnosis. In the first year after diagnosis, the most common claims were for antibiotics (61.7%), opioids (50.6%), glucocorticoids (46.5%), and proton pump inhibitors (35.4%); the most common organs involved with complications among patients with SSc were lung (30.5%), heart (17.4%), and gastrointestinal tract (22.4%); the most common signs or symptoms were musculoskeletal (16.1%) and fatigue (10.5%); 1035 patients (15.1%) had infections and 14 (0.2%) had malignancies. Among patients who received IMT, 43.8% received at least hydroxychloroquine and 21.1% received at least methotrexate; 460 patients switched to a second IMT, 23.0% to at least methotrexate and 22.8% to at least mycophenolate mofetil. The most common comorbidities reported with first IMT were in lung (11.8%), overlap syndrome (8.4%), heart (5.3%), and gastrointestinal (6.8%) categories. CONCLUSION One-third of patients with SSc in the healthcare claims population received IMTs during the first year after diagnosis. However, patients who received IMTs had disease manifestations similar to those of the overall SSc healthcare claims population.
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19
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Reed DN, Hall DL, Cottle JH, Frimenko K, Horton CK, Abu Sharkh F, Beckett R, Hernandez B, Mabe H, Mansour ST, Rodriguez SA, Weprin B, Yarborough LE. Dental management of scleroderma patients using pentoxifylline plus vitamin E with and without TheraBite ® to reduce trismus: Two case reports and brief review of literature. Clin Case Rep 2020; 8:247-253. [PMID: 32128166 PMCID: PMC7044382 DOI: 10.1002/ccr3.2572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/30/2019] [Accepted: 09/04/2019] [Indexed: 11/23/2022] Open
Abstract
To provide evidence supporting the off label use of pentoxifylline and vitamin E especially by dentists with TheraByte to reduce trismus in scleroderma patients.
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Affiliation(s)
- Daniel N. Reed
- GPROhio State University College of DentistryColumbusOHUSA
| | - David L. Hall
- GPROhio State University College of DentistryColumbusOHUSA
| | | | | | | | | | - Rachel Beckett
- GPROhio State University College of DentistryColumbusOHUSA
| | | | - Hannah Mabe
- GPROhio State University College of DentistryColumbusOHUSA
| | | | | | - Bradley Weprin
- GPROhio State University College of DentistryColumbusOHUSA
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20
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Zhong L, Pope M, Shen Y, Hernandez JJ, Wu L. Prevalence and incidence of systemic sclerosis: A systematic review and meta‐analysis. Int J Rheum Dis 2019; 22:2096-2107. [DOI: 10.1111/1756-185x.13716] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/12/2019] [Accepted: 09/09/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Lixian Zhong
- Irma Lerma Rangel College of Pharmacy Texas A&M University College Station TX USA
| | - Melinda Pope
- Irma Lerma Rangel College of Pharmacy Texas A&M University College Station TX USA
| | - Ye Shen
- College of Public Health University of Georgia Athens Georgia
| | - Jose J. Hernandez
- Irma Lerma Rangel College of Pharmacy Texas A&M University College Station TX USA
| | - Lin Wu
- Research & Learning Services Health Sciences Library University of Tennessee Health Science Center Memphis TN USA
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21
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Pecher AC, Kettemann F, Asteriti E, Schmid H, Duerr-Stoerzer S, Keppeler H, Henes JC, Klein R, Hinterleitner C, Secker KA, Schneidawind C, Kanz L, Schneidawind D. Invariant natural killer T cells are functionally impaired in patients with systemic sclerosis. Arthritis Res Ther 2019; 21:212. [PMID: 31615552 PMCID: PMC6792213 DOI: 10.1186/s13075-019-1991-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 09/05/2019] [Indexed: 12/12/2022] Open
Abstract
Background Systemic sclerosis (SSc) is a potentially fatal autoimmune disease that leads to extensive fibrosis of the skin and internal organs. Invariant natural killer T (iNKT) cells are potent immunoregulatory T lymphocytes being able to orchestrate dysregulated immune responses. The purpose of this study was to evaluate numbers and function of iNKT cells in patients with SSc and to analyze their correlation with disease parameters. Methods Human iNKT cells from 88 patients with SSc and 33 healthy controls were analyzed by flow cytometry. Their proliferative capacity and cytokine production were investigated following activation with CD1d ligand α-galactosylceramide (α-GalCer). Results We observed an absolute and relative decrease of iNKT cells in patients with SSc compared with healthy controls. Interestingly, the subtype of SSc, disease severity, or treatment with immunosuppressive drugs did not affect iNKT cell numbers. However, T helper (Th) cell immune polarization was biased towards a Th17 immunophenotype in SSc patients. Moreover, iNKT cells from patients with SSc showed a significantly decreased expansion capacity upon stimulation with α-GalCer. Conclusion iNKT cells are deficient and functionally impaired in patients with SSc. Therefore, adoptive transfer strategies using culture-expanded iNKT cells could be a novel approach to treat SSc patients.
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Affiliation(s)
- Ann-Christin Pecher
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Felix Kettemann
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Elisa Asteriti
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Hannes Schmid
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Silke Duerr-Stoerzer
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Hildegard Keppeler
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Joerg Christoph Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Reinhild Klein
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Clemens Hinterleitner
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Kathy-Ann Secker
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Corina Schneidawind
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany.
| | - Lothar Kanz
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
| | - Dominik Schneidawind
- Department of Hematology, Oncology, Immunology, Rheumatology, Pulmonology, University Hospital Tuebingen, Otfried-Mueller-Strasse 10, 72076, Tuebingen, Germany
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Abstract
Fibrosis is the abnormal deposition of extracellular matrix, which can lead to organ dysfunction, morbidity, and death. The disease burden caused by fibrosis is substantial, and there are currently no therapies that can prevent or reverse fibrosis. Metabolic alterations are increasingly recognized as an important pathogenic process that underlies fibrosis across many organ types. As a result, metabolically targeted therapies could become important strategies for fibrosis reduction. Indeed, some of the pathways targeted by antifibrotic drugs in development - such as the activation of transforming growth factor-β and the deposition of extracellular matrix - have metabolic implications. This Review summarizes the evidence to date and describes novel opportunities for the discovery and development of drugs for metabolic reprogramming, their associated challenges, and their utility in reducing fibrosis. Fibrotic therapies are potentially relevant to numerous common diseases such as cirrhosis, non-alcoholic steatohepatitis, chronic renal disease, heart failure, diabetes, idiopathic pulmonary fibrosis, and scleroderma.
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Abstract
Rheumatological diseases (RDs) represent a diverse group of diseases that are inherited or related to environmental factors. RDs frequently affect the gastrointestinal (GI) tract, and gastroenterologists are often asked to evaluate patients with symptoms thought to represent an underlying or coexisting RD. GI manifestations of RDs vary based on the organ involved as well as the extent and duration of involvement. Although most manifestations of RD are nonspecific and not life-threatening, the chronicity and severity of symptoms can be debilitating and may lead to serious injury. This narrative review discusses the most common RD encountered by gastroenterologists: systemic lupus erythematosus, systemic sclerosis (scleroderma), dermatomyositis/polymyositis, rheumatoid arthritis, Sjögren syndrome, overlap syndromes, mixed connective tissue disease, Ehlers-Danlos syndromes, and other vasculitides. Each section begins with a brief overview of the condition, followed by a discussion of the etiopathophysiology, physical examination findings, GI manifestations, diagnostic tools (i.e., serologic, imaging, endoscopic, and functional), and treatment options.
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Bergamasco A, Hartmann N, Wallace L, Verpillat P. Epidemiology of systemic sclerosis and systemic sclerosis-associated interstitial lung disease. Clin Epidemiol 2019; 11:257-273. [PMID: 31114386 PMCID: PMC6497473 DOI: 10.2147/clep.s191418] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/21/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Interstitial lung disease (ILD) is one of the leading causes of mortality in patients with systemic sclerosis (SSc). To further understand this patient population, we present the first systematic review on the epidemiology of SSc and SSc-associated ILD (SSc-ILD). Methods: Bibliographic databases and web sources were searched for studies including patients with SSc and SSc-ILD in Europe and North America (United States and Canada). The systematic review was limited to publications in English, German, French, Spanish, Italian, and Portuguese, published between January 1, 2000 and February 29, 2016. For all publications included in the review, the methodologic quality was assessed. For each dimension and region, data availability in terms of quantity and consistency of reported findings was evaluated. Results: Fifty publications reporting epidemiologic data (prevalence, incidence, demographic profile, and survival and mortality) were included; 39 included patients with SSc and 16 included patients with SSc-ILD. The reported prevalence of SSc was 7.2–33.9 and 13.5–44.3 per 100,000 individuals in Europe and North America, respectively. Annual incidence estimates were 0.6–2.3 and 1.4–5.6 per 100,000 individuals in Europe and North America, respectively. Associated ILD was present in ~35% of the patients in Europe and ~52% of the patients in North America. In Europe, a study estimated the prevalence and annual incidence of SSc-ILD at 1.7–4.2 and 0.1–0.4 per 100,000 individuals, respectively. In both Europe and North America, SSc-ILD was diagnosed at a slightly older age than SSc, with both presentations of the disease affecting 2–3 times more women than men. Ten-year survival in patients with SSc was reported at 65–73% in Europe and 54–82% in North America, with cardiorespiratory manifestations (including ILD) associated with poor prognosis. Conclusion: This systematic review confirms that SSc and SSc-ILD are rare, with geographic variation in prevalence and incidence.
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Affiliation(s)
| | - Nadine Hartmann
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Laura Wallace
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CO, USA
| | - Patrice Verpillat
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
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Ingegnoli F, Ughi N, Mihai C. Update on the epidemiology, risk factors, and disease outcomes of systemic sclerosis. Best Pract Res Clin Rheumatol 2018; 32:223-240. [DOI: 10.1016/j.berh.2018.08.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/22/2018] [Accepted: 07/26/2018] [Indexed: 12/12/2022]
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Abstract
PURPOSE OF REVIEW Premature activation of aging-associated molecular mechanisms is emerging as an important contributor to many diseases, including scleroderma. Among central regulators of the aging process are a group of histone deacetylases called sirtuins (SIRTs). Recent findings implicate these molecules as pathophysiological players in scleroderma skin and lung fibrosis. The goal of this article is to review recent studies on the involvement of SIRTs in scleroderma from the perspective of aging-related molecular mechanisms. RECENT FINDINGS Despite a degree of controversy in this rapidly developing field, the majority of data suggest that SIRT levels are decreased in tissues from patients with scleroderma compared to healthy controls as well as in animal models of scleroderma. Molecular studies reveal several mechanisms through which declining SIRT levels contribute to fibrosis, with the most attention given to modulation of the TGF-β signaling pathway. Activation of SIRTs in cell culture and in animal models elicits antifibrotic effects. Declining SIRT levels and activity are emerging as pathophysiological contributors to scleroderma. Restoration of SIRTs may be therapeutic in patients with scleroderma.
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Suliman S, Al Harash A, Roberts WN, Perez RL, Roman J. Scleroderma-related interstitial lung disease. Respir Med Case Rep 2017; 22:109-112. [PMID: 28761806 PMCID: PMC5524221 DOI: 10.1016/j.rmcr.2017.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 01/01/2023] Open
Abstract
Scleroderma-related interstitial lung disease (SSc-ILD) is a pulmonary fibrosing disorder characterized by systemic inflammation and progressive scarring of the lungs that leads to respiratory failure. Although certain immunosuppressive therapies may slow disease progression, current treatment strategies are not curative; consequently, SSc-ILD continues to be a major cause of morbidity and mortality. We present four cases of SSc-ILD that emphasize the importance of early screening and detection, close follow-up, and aggressive management. We also highlight the need for well-conducted clinical trials designed to identify new and effective treatments.
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Affiliation(s)
- Sally Suliman
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Louisville Health Sciences Center, Louisville, KY, USA
| | - Abdalhamid Al Harash
- Division of Rheumatology, University of Louisville Health Sciences Center, Louisville, KY, USA
| | - William Neil Roberts
- Division of Rheumatology, University of Louisville Health Sciences Center, Louisville, KY, USA
| | - Rafael L Perez
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Louisville Health Sciences Center, Louisville, KY, USA.,Robley Rex VA Medical Center, Louisville, KY, USA
| | - Jesse Roman
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Louisville Health Sciences Center, Louisville, KY, USA.,Robley Rex VA Medical Center, Louisville, KY, USA
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Wyman AE, Noor Z, Fishelevich R, Lockatell V, Shah NG, Todd NW, Atamas SP. Sirtuin 7 is decreased in pulmonary fibrosis and regulates the fibrotic phenotype of lung fibroblasts. Am J Physiol Lung Cell Mol Physiol 2017; 312:L945-L958. [PMID: 28385812 DOI: 10.1152/ajplung.00473.2016] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 03/08/2017] [Accepted: 03/29/2017] [Indexed: 01/10/2023] Open
Abstract
Pulmonary fibrosis is a severe condition with no cure and limited therapeutic options. A better understanding of its pathophysiology is needed. Recent studies have suggested that pulmonary fibrosis may be driven by accelerated aging-related mechanisms. Sirtuins (SIRTs), particularly SIRT1, SIRT3, and SIRT6, are well-known mediators of aging; however, limited data exist on the contribution of sirtuins to lung fibrosis. We assessed the mRNA and protein levels of all seven known sirtuins in primary lung fibroblasts from patients with idiopathic pulmonary fibrosis (IPF) and systemic sclerosis-associated interstitial lung disease (SSc-ILD) in comparison with lung fibroblasts from healthy controls. These unbiased tests revealed a tendency for all sirtuins to be expressed at lower levels in fibroblasts from patients compared with controls, but the greatest decrease was observed with SIRT7. Similarly, SIRT7 was decreased in lung tissues of bleomycin-challenged mice. Inhibition of SIRT7 with siRNA in cultured lung fibroblasts resulted in an increase in collagen and α-smooth muscle actin (α-SMA). Reciprocally, overexpression of SIRT7 resulted in lower basal and TGF-β-induced levels of COL1A1, COL1A2, COL3A1, and α-SMA mRNAs, as well as collagen and α-SMA proteins. Induced changes in SIRT7 had no effect on endogenous TGF-β mRNA levels or latent TGF-β activation, but overexpression of SIRT7 reduced the levels of Smad3 mRNA and protein. In conclusion, the decline in SIRT7 in lung fibroblasts has a profibrotic effect, which is mediated by changes in Smad3 levels.
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Affiliation(s)
- Anne E Wyman
- Geriatric Research Education and Clinical Center, Veterans Affairs Maryland Health Care Center, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland; .,Research Service, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland; and.,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Zahid Noor
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rita Fishelevich
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Virginia Lockatell
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nirav G Shah
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nevins W Todd
- Research Service, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland; and.,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sergei P Atamas
- Research Service, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland; and.,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Horimoto AMC, Matos ENN, Costa MRD, Takahashi F, Rezende MC, Kanomata LB, Locatelli EPP, Finotti LT, Maegawa FKM, Rondon RMR, Machado NP, Couto FMAATD, Figueiredo TPAD, Ovidio RA, Costa IPD. Incidence and prevalence of systemic sclerosis in Campo Grande, State of Mato Grosso do Sul, Brazil. REVISTA BRASILEIRA DE REUMATOLOGIA 2017; 57:107-114. [PMID: 28343614 DOI: 10.1016/j.rbre.2016.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 05/02/2016] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Systemic sclerosis is an autoimmune disease which shows extreme heterogeneity in its clinical presentation and that follows a variable and unpredictable course. Although some discrepancies in the incidence and prevalence rates between geographical regions may reflect methodological differences in the definition and verification of cases, they may also reflect true local differences. OBJECTIVES To determine the prevalence and incidence of systemic sclerosis in the city of Campo Grande, state capital of Mato Grosso do Sul (MS), Brazil, during the period from January to December 2014. METHODS All health care services of the city of Campo Grande - MS with attending in the specialty of Rheumatology were invited to participate in the study through a standardized form of clinical and socio-demographic assessment. Physicians of any specialty could report a suspected case of systemic sclerosis, but necessarily the definitive diagnosis should be established by a rheumatologist, in order to warrant the standardization of diagnostic criteria and exclusion of other diseases resembling systemic sclerosis. At the end of the study, 15 rheumatologists reported that they attended patients with systemic sclerosis and sent the completed forms containing epidemiological data of patients. RESULTS The incidence rate of systemic sclerosis in Campo Grande for the year 2014 was 11.9 per million inhabitants and the prevalence rate was 105.6 per million inhabitants. Systemic sclerosis patients were mostly women, white, with a mean age of 50.58 years, showing the limited form of the disease with a mean duration of the disease of 8.19 years. Regarding laboratory tests, 94.4% were positive for antinuclear antibody, 41.6% for anti-centromere antibody and 19.1% for anti-Scl70; anti-RNA Polymerase III was performed in 37 patients, with 16.2% positive. CONCLUSIONS The city of Campo Grande, the state capital of MS, presented a lower incidence/prevalence of systemic sclerosis in comparison with those numbers found in US studies and close to European studies' data.
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Affiliation(s)
- Alex Magno Coelho Horimoto
- Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil; Hospital Regional de Mato Grosso do Sul, Serviço de Reumatologia, Campo Grande, MS, Brazil; Universidade Federal de Mato Grosso do Sul (UFMS), Hospital Universitário, Serviço de Reumatologia, Campo Grande, MS, Brazil.
| | - Erica Naomi Naka Matos
- Universidade Federal de Mato Grosso do Sul (UFMS), Hospital Universitário, Serviço de Reumatologia, Campo Grande, MS, Brazil; Universidade de Brasília (UnB), Brasília, DF, Brazil; Prefeitura Municipal de Campo Grande, Ambulatório de Especialidades Médicas, Campo Grande, MS, Brazil
| | - Márcio Reis da Costa
- Universidade Federal de Mato Grosso do Sul (UFMS), Hospital Universitário, Serviço de Reumatologia, Campo Grande, MS, Brazil
| | - Fernanda Takahashi
- Prefeitura Municipal de Campo Grande, Ambulatório de Especialidades Médicas, Campo Grande, MS, Brazil; Universidade Anhanguera (Uniderp), Faculdade de Medicina, Ambulatório de Especialidades Médicas, Campo Grande, MS, Brazil
| | | | - Letícia Barrios Kanomata
- Caixa de Assistência aos Servidores do Mato Grosso do Sul (CASSEMS), Ambulatório de Especialidades Médicas, Coxim, MS, Brazil
| | | | - Leandro Tavares Finotti
- Universidade Federal de Mato Grosso do Sul (UFMS), Hospital Universitário, Serviço de Reumatologia, Campo Grande, MS, Brazil; Prefeitura Municipal de Campo Grande, Ambulatório de Especialidades Médicas, Campo Grande, MS, Brazil
| | | | | | - Natália Pereira Machado
- Universidade Federal de Mato Grosso do Sul (UFMS), Hospital Universitário, Serviço de Reumatologia, Campo Grande, MS, Brazil; Universidade Anhanguera (Uniderp), Faculdade de Medicina, Ambulatório de Especialidades Médicas, Campo Grande, MS, Brazil; Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | | | - Raphael Antonio Ovidio
- Universidade Federal da Grande Dourados (UFGD), Hospital Universitário, Serviço de Reumatologia, Dourados, MS, Brazil
| | - Izaias Pereira da Costa
- Universidade Federal de Mato Grosso do Sul (UFMS), Hospital Universitário, Serviço de Reumatologia, Campo Grande, MS, Brazil; Universidade de São Paulo (USP), São Paulo, SP, Brazil
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30
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Horimoto AMC, Matos ENN, Costa MRD, Takahashi F, Rezende MC, Kanomata LB, Locatelli EPP, Finotti LT, Maegawa FKM, Rondon RMR, Machado NP, Couto FMAATD, Figueiredo TPAD, Ovidio RA, Costa IPD. Incidência e prevalência de esclerose sistêmica em Campo Grande, Estado de Mato Grosso do Sul, Brasil. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2016.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Abstract
PURPOSE OF REVIEW Systemic sclerosis (SSc) is an autoimmune disease with fibrosis seen in multiple organs. Although not traditionally regarded as a disease of aging, SSc-associated fibrosis shares many of the hallmarks of aging seen in other age-related fibrotic disorders. Here, we review the current literature of the potential role of aging and age-related cellular processes in the development of SSc and fibrosis. RECENT FINDINGS Accumulating evidence supports a role for immune dysregulation, epigenetic modifications, cellular senescence, mitochondrial dysregulation and impaired autophagy in fibrosis that occurs in aging and SSc. SUMMARY Cellular alterations linked to aging may promote the development and/or progression of SSc-associated fibrosis.
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Elfving P, Marjoniemi O, Niinisalo H, Kononoff A, Arstila L, Savolainen E, Rutanen J, Kaipiainen-Seppänen O. Estimating the incidence of connective tissue diseases and vasculitides in a defined population in Northern Savo area in 2010. Rheumatol Int 2016; 36:917-24. [DOI: 10.1007/s00296-016-3474-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/23/2016] [Indexed: 11/24/2022]
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Gill L, Zarbo A, Isedeh P, Jacobsen G, Lim HW, Hamzavi I. Comorbid autoimmune diseases in patients with vitiligo: A cross-sectional study. J Am Acad Dermatol 2015; 74:295-302. [PMID: 26518171 DOI: 10.1016/j.jaad.2015.08.063] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 08/21/2015] [Accepted: 08/23/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Few large-scale studies have quantified the burden of comorbid autoimmune diseases in patients with vitiligo. OBJECTIVE We sought to determine the prevalence of comorbid autoimmune diseases in patients with vitiligo. METHODS We conducted a manual chart review on a cohort of 1873 patients with vitiligo seen between January 2002 and October 2012 at the Henry Ford Health System in Detroit, MI. Patients were excluded if they had fewer than 2 dermatology notes (N = 595) or if they were never given a diagnosis of vitiligo by a dermatologist (N = 180). RESULTS Of 1098 patients with vitiligo, nearly 20% had at least 1 comorbid autoimmune disease. Compared with the general US population, we found a higher prevalence of thyroid disease (12.9%, P < .001), alopecia areata (3.8%, P < .001), inflammatory bowel disease (0.9%, P = .046), pernicious anemia (0.5%, P = .007), systemic lupus erythematosus (0.3%, P = .048), Guillain-Barre syndrome (0.3%, P < .001), discoid lupus (0.2%, P = .003), linear morphea (0.2%, P < .001), myasthenia gravis (0.2%, P = .002), and Sjögren syndrome (0.2%, P = .011). LIMITATIONS The study lacked a control group. This was a single-institution study with possible selection bias, and thus the findings may not be representative of the overall population of patients with vitiligo. CONCLUSIONS We observed a high prevalence of comorbid autoimmune diseases in patients with vitiligo and report several new associations.
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Affiliation(s)
- Liza Gill
- College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Allison Zarbo
- Wayne State University School of Medicine, Detroit, Michigan
| | - Prescilia Isedeh
- Vitiligo Research and Treatment Center, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Gordon Jacobsen
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
| | - Henry W Lim
- Vitiligo Research and Treatment Center, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Iltefat Hamzavi
- Vitiligo Research and Treatment Center, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.
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FURST DANIELE, FERNANDES ANCILLAW, IORGA SERBANR, GRETH WARREN, BANCROFT TIM. Annual Medical Costs and Healthcare Resource Use in Patients with Systemic Sclerosis in an Insured Population. J Rheumatol 2012; 39:2303-9. [DOI: 10.3899/jrheum.120600] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.Systemic sclerosis (SSc) is a chronic autoimmune disease. The objective of our study was to estimate the medical costs and healthcare resource use of subjects with SSc in a large US managed care plan.Methods.Subjects at least 18 years of age and with claims-based evidence of SSc (ICD-9-CM code 710.1x) were identified from a health plan database from 2003 through 2008. Subjects were matched to unaffected controls, based on index date, age, sex, geographic region, time on insurance, and comorbidity score. Costs and resource use were identified during the 12-month postindex period. A generalized linear model (GLM) was used to estimate costs, controlling for demographic and clinical characteristics.Results.In this study, 1648 subjects with SSc were matched to 4944 controls. Mean overall annual medical costs were higher among SSc subjects than controls ($17,365 vs $5,508; p < 0.001). A GLM model supported these results. Evidence of lung disease, gastrointestinal bleeding, or renal disease increased costs (all p < 0.001). Compared to controls, significantly higher proportions of SSc subjects had postindex ambulatory visits, emergency department visits, and inpatient hospital stays (all p < 0.001).Conclusion.Our findings suggest that the medical costs and resource use associated with treating SSc are high (compared to matched controls), and as expected, subjects with serious disease complications experience the highest costs.
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