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Morgan K, Woollard C, Beinart D, Host LV, Roddy J. Rituximab treatment for systemic sclerosis-associated interstitial lung disease: a case series of 13 patients. Intern Med J 2023; 53:1147-1153. [PMID: 35670218 DOI: 10.1111/imj.15832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Systemic sclerosis (SSc) associated interstitial lung disease (ILD) is a common complication of SSc, with a high mortality, despite current available treatments. Rituximab has shown some promising, although varied, results for the treatment of SSc-ILD. AIMS To determine whether rituximab stabilised or improved pulmonary function at 12 months, in patients with SSc-ILD. METHODS A retrospective analysis of patients with SSc-ILD who progressed despite conventional therapy and received rituximab between 2008 and 2019 was performed at two tertiary centres. Baseline percentage forced vital capacity (FVC) and percentage diffusing capacity of carbon monoxide (DLCO) were compared with 1-year post the first dose of rituximab. Mean and median change in FVC (%) and DLCO (%) were calculated. For those with available data, the FVC (%) and DLCO (%) 2 years and 1 year prior to rituximab were compared with the change 12-months post-rituximab. RESULTS Thirteen patients were included in the analysis. All patients demonstrated stability in their pulmonary function testing at 1-year post-rituximab. The mean FVC (%) was 57.18 (±16.93 standard deviation (SD)) prior to rituximab and 59.75 (±18.83 SD) 12-month post-rituximab, demonstrating an increase of 2.57 (±4.70 SD; P-value 0.07). The mean DLCO (%) increased from 37.10 (±18.41 SD) prior to rituximab to 38.03 (±19.83) post-rituximab. The mean change in DLCO (%) was 0.93 (±5.05 SD; P-value 0.53). In the 2 years preceding rituximab, the mean FVC (%) and DLCO (%) declined by 9.25 and 9.66 respectively. CONCLUSION This case series suggests that rituximab might stabilise pulmonary function tests, and delay deterioration in patients with progressive SSc-ILD. These findings add to the growing body of evidence suggesting a role for rituximab in the treatment of SSc-ILD.
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Affiliation(s)
- Kelly Morgan
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Charlotte Woollard
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Dylan Beinart
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Lauren V Host
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Janet Roddy
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Hanson AL, Sahhar J, Ngian GS, Roddy J, Walker J, Stevens W, Nikpour M, Assassi S, Proudman S, Mayes MD, Kenna TJ, Brown MA. Contribution of HLA and KIR Alleles to Systemic Sclerosis Susceptibility and Immunological and Clinical Disease Subtypes. Front Genet 2022; 13:913196. [PMID: 35754823 PMCID: PMC9214260 DOI: 10.3389/fgene.2022.913196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/03/2022] [Indexed: 01/24/2023] Open
Abstract
Systemic sclerosis (SSc) is an autoinflammatory, fibrotic condition of unknown aetiology. The presence of detectable autoantibodies against diverse nuclear antigens, as well as strong HLA associations with disease, suggest autoimmune involvement, however the links between endogenous and exogenous risk factors and SSc pathology remain undetermined. We have conducted a genetic analysis of HLA inheritance in two independent and meta-analysed cohorts of 1,465 SSc cases and 13,273 controls, including stratified association analyses in clinical and autoantibody positive subgroups of disease. Additionally, we have used patient genotypes to impute gene dosages across the KIR locus, encoding paired activating and inhibitory lymphocyte receptors for Class I HLA ligands, to conduct the largest analysis of KIR-HLA epistatic interactions in SSc to date. We confirm previous Class II HLA associations with SSc risk and report a new Class I association with haplotype HLA-B*44:03-HLA-C*16:01 at genome-wide significance (GWS). We further report statistically significant HLA associations with clinical and serological subtypes of disease through direct case-case comparison, and report a new association of HLA-DRB1*15:01, previously shown to bind topoisomerase-1 derived peptides, with anti-topoisomerase (ATA) positive disease. Finally, we identify genetic epistasis between KIRs and HLA class I ligands, suggesting genetic modulation of lymphocyte activation may further contribute to an individual’s underlying disease risk. Taken together, these findings support future functional investigation into endogenous immunological and environmental stimuli for disrupted immune tolerance in SSc.
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Affiliation(s)
- Aimee L Hanson
- Department of Medicine, University of Queensland, Brisbane, QLD, Australia.,Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Joanne Sahhar
- Department of Medicine, Clayton and Monash Health, Monash University, Melbourne, VIC, Australia
| | - Gene-Siew Ngian
- Department of Medicine, Clayton and Monash Health, Monash University, Melbourne, VIC, Australia
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, WA, Australia
| | - Jennifer Walker
- Rheumatology Unit, Flinders Medical Centre, Adelaide, SA, Australia
| | - Wendy Stevens
- Department of Medicine, University of Melbourne, St Vincent's Hospital, Melbourne, VIC, Australia.,Department of Rheumatology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Mandana Nikpour
- Department of Medicine, University of Melbourne, St Vincent's Hospital, Melbourne, VIC, Australia.,Department of Rheumatology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Shervin Assassi
- Division of Rheumatology, University of Texas, Houston, TX, United States
| | - Susanna Proudman
- Rheumtology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Maureen D Mayes
- Division of Rheumatology, University of Texas, Houston, TX, United States
| | - Tony J Kenna
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Matthew A Brown
- Genomics England, Charterhouse Square, London, United Kingdom.,Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
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Morrisroe K, Hansen D, Stevens W, Sahhar J, Ngian GS, Hill C, Roddy J, Walker J, Proudman S, Nikpour M. Gastric antral vascular ectasia in systemic sclerosis: a study of its epidemiology, disease characteristics and impact on survival. Arthritis Res Ther 2022; 24:103. [PMID: 35538587 PMCID: PMC9087964 DOI: 10.1186/s13075-022-02790-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To describe the epidemiology, determinants and survival impact of gastric antral vascular ectasia (GAVE) in systemic sclerosis (SSc). METHODS Consecutive SSc patients prospectively enrolled in the Australian Scleroderma Cohort Study (ASCS) were included. Univariable and multivariable logistic regression were used to determine the associations of GAVE with clinical manifestations and serological parameters. Kaplan-Meier (K-M) survival curves were used to estimate survival. RESULTS The prevalence of GAVE in this SSc cohort of 2039 SSc patients was 10.6% (n = 216) over a median follow-up period of 4.3(1.7-8.4) years. SSc patients with a history of GAVE compared with those without a history of GAVE were older at SSc onset [49.5 (40.0-58.2) vs 46.7 (36.0-56.7) years, p = 0.05]; more likely to have diffuse disease subtype (dcSSc) (35.3% vs 24.1%, p < 0.001); be negative for Scl-70, U1RNP and Scl/PM antibody (4.0% vs 16.1%, p < 0.001, 3.5% vs 7.4%, p = 0.041, 0.0% vs 2.0%, p = 0.042; and respectively) and positive for RNAP III antibody (24.9% vs 8.3%, p < 0.001). Those with GAVE had a worse HRQoL (p = 0.002). Independent determinants of GAVE included the presence of RNAP III antibody (OR 3.46, p < 0.001), absence of Scl-70 antibody (OR 0.23, p = 0.001), presence of GIT dysmotility (OR 1.64, p = 0.004), and digital ulcers; pits; or digital amputation (OR 1.59, p = 0.014). CONCLUSIONS GAVE is an underestimated and underappreciated SSc manifestation of SSc, which occurs with a relatively high frequency. Identifying an at-risk GAVE phenotype, as presented herein, is of practical importance as screening may prove advantageous given GAVE can be easily diagnosed and treated.
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Affiliation(s)
- Kathleen Morrisroe
- Department of Medicine, The University of Melbourne at St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia. .,Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia.
| | - Dylan Hansen
- Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Joanne Sahhar
- Department of Medicine, Monash University, Clayton and Monash Health, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Gene-Siew Ngian
- Department of Medicine, Monash University, Clayton and Monash Health, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Catherine Hill
- Rheumatology Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia.,Rheumatology Unit, The Queen Elizabeth Hospital, Woodville Road, Woodville, SA, 5011, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, Australia
| | - Jennifer Walker
- Rheumatology Unit, Flinders Medical Centre (Adelaide), Flinders Drive, Bedford Park, South Australia, 5042, Australia
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia.,Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
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4
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Scofield RH, Lewis VM, Cavitt J, Kurien BT, Assassi S, Martin J, Gorlova O, Gregersen P, Lee A, Rider LG, O'Hanlon T, Rothwell S, Lilleker J, Kochi Y, Terao C, Igoe A, Stevens W, Sahhar J, Roddy J, Rischmueller M, Lester S, Proudman S, Chen S, Brown MA, Mayes MD, Lamb JA, Miller FW. 47XXY and 47XXX in Scleroderma and Myositis. ACR Open Rheumatol 2022; 4:528-533. [PMID: 35352506 PMCID: PMC9190224 DOI: 10.1002/acr2.11413] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 01/05/2023] Open
Abstract
Objective We undertook this study to examine the X chromosome complement in participants with systemic sclerosis (SSc) as well as idiopathic inflammatory myopathies. Methods The participants met classification criteria for the diseases. All participants underwent single‐nucleotide polymorphism typing. We examined X and Y single‐nucleotide polymorphism heterogeneity to determine the number of X chromosomes. For statistical comparisons, we used χ2 analyses with calculation of 95% confidence intervals. Results Three of seventy men with SSc had 47,XXY (P = 0.0001 compared with control men). Among the 435 women with SSc, none had 47,XXX. Among 709 men with polymyositis or dermatomyositis (PM/DM), seven had 47,XXY (P = 0.0016), whereas among the 1783 women with PM/DM, two had 47,XXX. Of 147 men with inclusion body myositis (IBM), six had 47,XXY, and 1 of the 114 women with IBM had 47,XXX. For each of these myositis disease groups, the excess 47,XXY and/or 47,XXX was significantly higher compared with in controls as well as the known birth rate of Klinefelter syndrome or 47,XXX. Conclusion Klinefelter syndrome (47,XXY) is associated with SSc and idiopathic inflammatory myopathies, similar to other autoimmune diseases with type 1 interferon pathogenesis, namely, systemic lupus erythematosus and Sjögren syndrome.
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Affiliation(s)
- R Hal Scofield
- Oklahoma Medical Research Foundation, College of Medicine, University of Oklahoma Health Sciences Center, and Oklahoma City US Department of Veterans Affairs Medical Center, Oklahoma City
| | - Valerie M Lewis
- Oklahoma Medical Research Foundation, College of Medicine, University of Oklahoma Health Sciences Center, and Oklahoma City US Department of Veterans Affairs Medical Center, Oklahoma City
| | - Joshua Cavitt
- Oklahoma Medical Research Foundation, College of Medicine, University of Oklahoma Health Sciences Center, and Oklahoma City US Department of Veterans Affairs Medical Center, Oklahoma City
| | - Biji T Kurien
- Oklahoma Medical Research Foundation, College of Medicine, University of Oklahoma Health Sciences Center, and Oklahoma City US Department of Veterans Affairs Medical Center, Oklahoma City
| | - Shervin Assassi
- University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA
| | - Javier Martin
- Instituto de Parasitología y Biomedicina López-Neyra, Consejo Superior de Investigaciones Científicas, PTS, Granada, Spain
| | - Olga Gorlova
- Geisel School of Medicine, Dartmouth College and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Peter Gregersen
- Robert S. Boas Center for Genomics and Human Genetics, Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Annette Lee
- Robert S. Boas Center for Genomics and Human Genetics, Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Lisa G Rider
- National Institute of Environmental Health Science, National Institutes of Health, Bethesda, Maryland, USA
| | - Terrance O'Hanlon
- National Institute of Environmental Health Science, National Institutes of Health, Bethesda, Maryland, USA
| | | | - James Lilleker
- School of Biological Sciences, The University of Manchester, Manchester, UK, and Salford Royal National Health Service Foundation Trust, Salford, UK
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- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Yuta Kochi
- Tokyo, Japan, and RIKEN Center for Integrative Medical Sciences, Tokyo Medical and Dental University, Yokohama, Japan
| | - Chikacshi Terao
- RIKEN Center for Integrative Medical Sciences, Yokohama, Japan, and Shizuoka General Hospital and School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Ann Igoe
- Oklahoma Medical Research Foundation, Oklahoma City
| | - Wendy Stevens
- St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Joanne Sahhar
- Monash Medical Centre, Melbourne, Victoria, Australia
| | - Janet Roddy
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Maureen Rischmueller
- The Queen Elizabeth Hospital and University of Adelaide, Woodville, South Australia, Australia
| | - Sue Lester
- The Queen Elizabeth Hospital and University of Adelaide, Woodville, South Australia, Australia
| | | | - Sixia Chen
- College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Matthew A Brown
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Maureen D Mayes
- University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA
| | | | - Frederick W Miller
- National Institute of Environmental Health Science, National Institutes of Health, Bethesda, Maryland, USA
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5
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Yap FH, Olsson-White D, Roddy J, Cook NJ, Langlands DR, Manners PJ, Carroll GJ. Long-term Clinical Outcomes in Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis Syndrome. Mayo Clin Proc Innov Qual Outcomes 2021; 5:574-582. [PMID: 34195549 PMCID: PMC8240170 DOI: 10.1016/j.mayocpiqo.2021.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To assess the outcome of empirical therapeutic interventions for synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. Methods The clinical features and treatment outcomes of a cohort of 21 patients diagnosed with SAPHO in Western Australia were reviewed retrospectively. Results All 21 patients met published diagnostic criteria; 20 (95%) were Caucasian, and the median age was 47 years. The median follow-up was 6 years (range, 2 to 32 years). Three patients (14%) received no treatment; 18 (86%) required conventional synthetic disease-modifying antirheumatic drug (DMARDs). Thirteen (62%) had an initial good response to methotrexate; 8 relapsed and progressed to biologic DMARDs (bDMARDs) during a period of 14 years. Of the 13 recipients on a tumor necrosis factor inhibitor, 11 (85%) continued treatment for a median of 4 years (range, 1 to 14 years), whereas none of 3 recipients of interleukin 17/23 continued treatment (median, 4 months). Higher Physician Global Assessment scores (better outcomes) were observed in bDMARD recipients (mean, 7.06±2.24 [SD]) compared with non-bDMARD recipients (mean, 5.63±2.50; P=.1672) after a median of 3 years of therapy. Conclusion This study describes the broad range of clinical manifestations in SAPHO, variable courses over time, and inconsistent outcomes with diverse empirical therapies. Moderately good long-term treatment outcomes were observed in most recipients of tumor necrosis factor inhibitor. Poorer outcomes were observed with bisphosphonates and interleukin 17/23 axis inhibitors; however, low numbers preclude robust comparison. Suboptimal treatment may be associated with poorer clinical outcomes and greater skeletal damage. Trial Registration Australian and New Zealand Clinical Trials Registry: ACTRN12619000445178
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Key Words
- CRP, C-reactive protein
- DMARD, disease-modifying antirheumatic drug
- IL, interleukin
- MTX, methotrexate
- PGA, Physician Global Assessment
- PPP, palmoplantar pustulosis
- SAPHO, synovitis, acne, pustulosis, hyperostosis, and osteitis
- TNF, tumor necrosis factor
- bDMARD, biologic disease-modifying antirheumatic drug
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Affiliation(s)
- Francis H.X. Yap
- PathWest, QEII Medical Centre, Nedlands, Western Australia, Australia
| | - Deborah Olsson-White
- Department of Rheumatology, QEII Medical Centre, Nedlands, Western Australia, Australia
- Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Janet Roddy
- Department of Rheumatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Nicola J. Cook
- Western Rheumatology, Wyllie Arthritis Foundation, Shenton Park, Western Australia, Australia
| | - D. Robert Langlands
- Department of Rheumatology, QEII Medical Centre, Nedlands, Western Australia, Australia
| | - Prue J. Manners
- Faculty of Health and Medical Sciences, University of Western Australia, Nedlands, Western Australia, Australia
| | - Graeme J. Carroll
- Department of Rheumatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- Correspondence: Address to Graeme J. Carroll, MD, FRACP, Department of Rheumatology, Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch, Western Australia 6150, Australia
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6
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Lee A, Patterson KA, Tan DJ, Wilson ME, Proudman SM, Stevens W, Nikpour M, Sahhar J, Ngian GS, Roddy J, Roberts-Thomson PJ, Walker JG. Anti-Ro52/TRIM21 is independently associated with pulmonary arterial hypertension and mortality in a cohort of systemic sclerosis patients. Scand J Rheumatol 2021; 50:469-474. [PMID: 33851896 DOI: 10.1080/03009742.2021.1887927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: We undertook a comprehensive cross-sectional analysis of a multicentred Australian cohort of systemic sclerosis (SSc) patients to evaluate the associations of anti-Ro52/TRIM21 with SSc pulmonary involvement.Method: The study included 596 patients from the Australian Scleroderma Cohort Study database whose anti-Ro52/TRIM21 status was known. Anti-Ro52/TRIM21 was measured via line immunoassay. Data on demographic variables, autoantibody profiles, presence of interstitial lung disease (ILD), presence of pulmonary arterial hypertension (PAH), oxygen saturation, Six-Minute Walk Test distance, Borg dyspnoea score, and lung function tests were extracted. SPSS software was used to examine associations using univariate and multivariate analyses.Results: Anti-Ro52/TRIM21 was present in 34.4% of SSc patients. In the cross-sectional analysis, anti-Ro52/TRIM21 was independently associated with PAH [odds ratio 1.75, 95% confidence interval (CI) 1.05-2.90], but not ILD or other surrogate measures of pulmonary involvement such as average patient oxygen saturation. The antibody, however, was also associated with a higher forced vital capacity/diffusing capacity of the lung for carbon monoxide ratio. Prospectively, anti-Ro52/TRIM21 was also associated with an increased risk of death in patients with SSc (hazard ratio 1.62, 95% CI 1.11-2.35), independent of confounding factors. The primary cause of death appeared to be related to PAH and/or ILD, and anti-Ro52/TRIM21 was associated with PAH-related complications.Conclusion: Anti-Ro52/TRIM21 was independently associated with PAH and mortality in SSc patients. Future longitudinal studies are recommended to investigate the timing and pathogenic mechanisms of this autoantibody in PAH.
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Affiliation(s)
- Ays Lee
- Departments of Rheumatology and Immunology, Flinders Medical Centre, Bedford Park, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, Australia.,Department of Immunology, SA Pathology, Flinders Medical Centre, Bedford Park, Australia
| | - K A Patterson
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - D J Tan
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - M E Wilson
- Department of Rheumatology, St Vincent's Hospital (Melbourne), Fitzroy, Australia
| | - S M Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - W Stevens
- Department of Rheumatology, St Vincent's Hospital (Melbourne), Fitzroy, Australia
| | - M Nikpour
- Department of Rheumatology, St Vincent's Hospital (Melbourne), Fitzroy, Australia.,Department of Medicine, The University of Melbourne, Fitzroy, Australia
| | - J Sahhar
- Department of Rheumatology, Monash Health, Clayton, Australia.,Department of Medicine, Monash University, Clayton, Australia
| | - G-S Ngian
- Department of Rheumatology, Monash Health, Clayton, Australia.,Department of Medicine, Monash University, Clayton, Australia
| | - J Roddy
- Department of Rheumatology, Fiona Stanley Hospital, Murdoch, Australia
| | - P J Roberts-Thomson
- Departments of Rheumatology and Immunology, Flinders Medical Centre, Bedford Park, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, Australia.,Department of Immunology, SA Pathology, Flinders Medical Centre, Bedford Park, Australia
| | - J G Walker
- Departments of Rheumatology and Immunology, Flinders Medical Centre, Bedford Park, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, Australia
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7
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Morrisroe K, Hansen D, Huq M, Stevens W, Sahhar J, Ngian GS, Ferdowsi N, Hill C, Roddy J, Walker J, Proudman S, Nikpour M. Incidence, Risk Factors, and Outcomes of Cancer in Systemic Sclerosis. Arthritis Care Res (Hoboken) 2020; 72:1625-1635. [PMID: 31539207 DOI: 10.1002/acr.24076] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 09/17/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To quantify the burden of cancer in systemic sclerosis (SSc). METHODS Standardized incidence ratios (SIRs) and standardized mortality ratios relative to the general Australian population were derived. Cox proportional hazards regression was used to estimate survival in patients with SSc with cancer compared to patients without. Determinants of cancer were identified using logistic regression. Health care cost was quantified through cross-jurisdictional data linkage. RESULTS This SSc cohort of 1,727 had a cancer incidence of 1.3% per year and a prevalence of 14.2%, with a SIR of 2.15 (95% confidence interval [95% CI] 1.84-2.49). The most common cancers were breast, melanoma, hematologic, and lung. Anti-RNA polymerase III (RNAP) antibody was associated with an increased risk of cancer (odds ratio [OR] 2.9, P = 0.044), diagnosed within 5 years of SSc disease onset. Calcium channel blockers were associated with a higher risk of overall cancer (OR 1.47, P = 0.016), breast cancer (OR 1.61, P = 0.051), and melanoma (OR 2.01, P = 0.042). Interstitial lung disease (ILD) was associated with lung cancer (OR 2.83, P = 0.031). Incident SSc cancer patients had >2-fold increased mortality compared to patients with SSc without cancer (hazard ratio 2.85 [95% CI 1.51-5.37], P = 0.001). Patients with SSc and cancer utilized more health care than those without cancer, with an excess annual health care cost of $1,496 Australian (P < 0.001). CONCLUSION SSc carries an increased risk of developing cancer, particularly lung cancer associated with ILD, and breast cancer and melanoma occurring close to SSc disease onset in association with RNAP antibodies. Compared to those patients without cancer, patients with SSc and cancer had higher mortality and an increased health care cost, with an annual excess per patient cost of $1,496 Australian (P < 0.001).
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Affiliation(s)
- Kathleen Morrisroe
- The University of Melbourne at St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Dylan Hansen
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Molla Huq
- The University of Melbourne at St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Wendy Stevens
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Joanne Sahhar
- Monash University and Clayton and Monash Health, Clayton, Victoria, Australia
| | - Gene-Siew Ngian
- Monash University and Clayton and Monash Health, Clayton, Victoria, Australia
| | - Nava Ferdowsi
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Catherine Hill
- Queen Elizabeth Hospital, Woodville, and Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Janet Roddy
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Jennifer Walker
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Susanna Proudman
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Mandana Nikpour
- The University of Melbourne at St Vincent's Hospital, Melbourne, Victoria, Australia
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8
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Ross L, Stevens W, Wilson M, Strickland G, Walker J, Sahhar J, Ngian GS, Roddy J, Major G, Proudman S, Baron M, Nikpour M. Can Patient-Reported Symptoms Be Used to Measure Disease Activity in Systemic Sclerosis? Arthritis Care Res (Hoboken) 2020; 72:1459-1465. [PMID: 31421031 DOI: 10.1002/acr.24053] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/13/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To evaluate the association between patient-reported symptoms and changes in disease activity over time in systemic sclerosis (SSc). METHODS Using data from 1,636 patients enrolled in the Australian Scleroderma Cohort Study, we used generalized estimating equations to determine the relationship between patient-reported worsening of Raynaud's phenomenon (RP), skin involvement, and breathlessness in the month preceding each study visit and features of disease activity in the corresponding organ systems. The associations between the following parameters were analyzed: patient-reported worsening RP and the presence of new-onset digital pitting and digital ulcers; patient-reported worsening skin involvement and increasing modified Rodnan skin thickness score (MRSS); new areas of skin involvement and new-onset joint contractures; patient-reported worsening breathlessness and deteriorating respiratory functions test (RFT) results, indicated by a 10% decrease in forced vital capacity (FVC) and a 15% decrease in diffusing capacity for carbon monoxide (DLco), new-onset interstitial lung disease (ILD), and new-onset pulmonary arterial hypertension (PAH). RESULTS We found a significant association between patient-reported worsening RP and the presence of digital ulcers (odds ratio [OR] 1.53 [95% confidence interval (95% CI) 0.60-0.93]), patient-reported worsening skin involvement and increasing MRSS (OR 2.10 [95% CI 1.54-2.86]), and worsening patient breathlessness and deteriorating RFTs (FVC OR 2.12 [95% CI 1.70-2.65]; DLco OR 1.97 [95% CI 1.34-2.02]), new-onset ILD (OR 1.91 [95% CI 1.40-2.61]), and new-onset PAH (OR 5.08 [95% CI 3.59-7.19]). CONCLUSION These results demonstrate that patient-reported symptoms are associated with clinically meaningful changes in disease activity in patients with SSc. This suggests that when objective measures of change in disease status are unavailable, patient-reported symptoms could be used to indicate a change in SSc disease activity.
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Affiliation(s)
- Laura Ross
- St. Vincent's Hospital Melbourne and the University of Melbourne, Fitzroy, Victoria, Australia
| | - Wendy Stevens
- St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Michelle Wilson
- St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | | | - Jennifer Walker
- Flinders Medical Centre, Bedford Park, South Australia, Australia, and Royal Adelaide Hospital and Flinders University, Adelaide, South Australia, Australia
| | - Joanne Sahhar
- Monash Health and Monash University, Clayton, Victoria, Australia
| | - Gene-Siew Ngian
- Monash Health and Monash University, Clayton, Victoria, Australia
| | - Janet Roddy
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Gabor Major
- Royal Newcastle Centre, New Lambton Heights, New South Wales, Australia
| | - Susanna Proudman
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Murray Baron
- Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
| | - Mandana Nikpour
- St. Vincent's Hospital Melbourne and the University of Melbourne, Fitzroy, Victoria, Australia
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9
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Patel S, Morrisroe K, Proudman S, Hansen D, Sahhar J, Sim MR, Ngian GS, Walker J, Strickland G, Wilson M, Ferdowsi N, Major G, Roddy J, Stevens W, Nikpour M, Nikpour M, Proudman S, Stevens W, Sahhar J, Cooley H, Croyle L, Ferdowsi N, Hill C, Host L, Major G, Morrisroe K, Ngian GS, Rischmueller M, Roddy J, Strickland G, Tay T, Tymms K, Walker J, Youssef P. Occupational silica exposure in an Australian systemic sclerosis cohort. Rheumatology (Oxford) 2020; 59:3900-3905. [DOI: 10.1093/rheumatology/keaa446] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/01/2020] [Indexed: 12/13/2022] Open
Abstract
Abstract
Objective
To determine the frequency of self-reported occupational exposure to silica in SSc patients enrolled in the Australian Scleroderma Cohort Study, and to compare the disease characteristics of the silica-exposed patients with those of the non-exposed patients.
Method
Data collected over a 12-year period from 1670 SSc patients were analysed. We compared the demographic and clinical characteristics of those who reported occupational silica exposure with those who did not. A subgroup analysis of male patients was performed, as well as a multivariable analysis of correlates of silica exposure.
Results
Overall, 126 (7.5%) of the cohort reported occupational silica exposure. These individuals were more likely to be male (73 of 231, i.e. 31.6% males exposed) and to have worked in mining and construction industries. Those who reported silica exposure were younger at the onset of SSc skin involvement [odds ratio (OR) 0.9, P = 0.02], of male gender (OR 14.9, P < 0.001), have joint contractures (OR 1.8, P = 0.05) and have higher physical disability as defined by scleroderma HAQ (OR 1.4, P = 0.01).
Conclusion
The highest percentage of silica exposure was found in males. These patients were more likely to have the presence of certain clinical manifestations and Scl-70 antibody, which is known to confer a poor prognosis. These findings support the association between occupational silica exposure and the subsequent development of SSc. Further investigation is required to describe the range of clinical manifestations and disease course, including prognosis and treatment response, in those diagnosed with occupationally induced SSc compared with idiopathic SSc.
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Affiliation(s)
- Shreeya Patel
- Department of Rheumatology, St Vincent’s Hospital Melbourne, Melbourne, Victoria
| | - Kathleen Morrisroe
- Department of Rheumatology, St Vincent’s Hospital Melbourne, Melbourne, Victoria
- Department of Medicine, The University of Melbourne at St Vincent’s Hospital (Melbourne), Fitzroy, Victoria
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia
| | - Dylan Hansen
- Department of Rheumatology, St Vincent’s Hospital Melbourne, Melbourne, Victoria
| | - Joanne Sahhar
- Department of Rheumatology, Monash Health
- Department of Medicine, Monash University
| | - Malcolm R Sim
- Centre for Occupational & Environmental Health, Monash University, Melbourne, Victoria
| | - Gene-Siew Ngian
- Department of Rheumatology, Monash Health
- Department of Medicine, Monash University
| | | | - Gemma Strickland
- Department of Rheumatology, St Vincent’s Hospital Melbourne, Melbourne, Victoria
| | - Michelle Wilson
- Department of Rheumatology, St Vincent’s Hospital Melbourne, Melbourne, Victoria
| | - Nava Ferdowsi
- Department of Rheumatology, St Vincent’s Hospital Melbourne, Melbourne, Victoria
| | - Gabor Major
- Department of Rheumatology, Bone and Joiny Institute, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales
| | - Janet Roddy
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent’s Hospital Melbourne, Melbourne, Victoria
| | - Mandana Nikpour
- Department of Rheumatology, St Vincent’s Hospital Melbourne, Melbourne, Victoria
- Department of Medicine, The University of Melbourne at St Vincent’s Hospital (Melbourne), Fitzroy, Victoria
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10
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Ross L, Stevens W, Wilson M, Huq M, Strickland G, Walker J, Sahhar J, Ngian GS, Roddy J, Youssef P, Proudman S, Nikpour M. Performance of the 2017 EUSTAR activity index in an scleroderma cohort. Clin Rheumatol 2020; 39:3701-3705. [PMID: 32696281 DOI: 10.1007/s10067-020-05126-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 11/28/2022]
Abstract
Assessment of disease activity in systemic sclerosis (SSc) is limited by the absence of a fully validated, multisystem measure of disease activity. The European Scleroderma Trials and Research Group (EUSTAR) SSc activity index (EScSG-AI) was recently revised, and a validation study within the EUSTAR cohort was performed. In this study, we evaluated the performance of the revised EScSG-AI in an external Australian cohort. The association between the EScSG-AI and the physician global assessment of disease activity (PhGA), both collected prospectively at each annual visit over up to 12 years follow-up, was evaluated using Pearson's correlation coefficient and Cohen's kappa coefficient. Generalized linear modelling and time-dependent Cox regression analysis were performed to determine the association of disease activity measured by the EScSG-AI and the summed Medsger Severity Scale (MSS) and death, respectively. There was a moderate correlation between EScSG-AI and PhGA scores (r 0.42, p < 0.001) and moderate association between rising EScSG-AI and summed MSS (r 0.60, p < 0.001). High disease activity, measured by the EScSG-AI at any time during follow-up, was associated with a hazard ratio of 2.07 (95% CI 1.51-2.79) for mortality. The EScSG-AI has a moderate correlation with physician-assessed SSc disease activity. This suggests that the criterion and construct validity of the EScSG-AI are yet to be demonstrated in an external cohort of SSc patients. Key Points •There remains no gold standard measure of SSc disease activity. •The revised 2017 EUSTAR SSc disease activity index shows moderate correlation with physician-rated global disease activity. •Significant work remains to develop a validated multisystem measure of disease activity in SSc.
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Affiliation(s)
- Laura Ross
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, Australia.,Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Michelle Wilson
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Molla Huq
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, Australia
| | - Gemma Strickland
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Jennifer Walker
- Rheumatology Unit, Flinders Medical Centre, Adelaide, Australia
| | - Joanne Sahhar
- Department of Rheumatology, Monash Health & Monash University, Melbourne, Australia.,Department of Medicine, Monash Health & Monash University, Melbourne, Australia
| | - Gene-Siew Ngian
- Department of Rheumatology, Monash Health & Monash University, Melbourne, Australia.,Department of Medicine, Monash Health & Monash University, Melbourne, Australia
| | - Janet Roddy
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Australia
| | - Peter Youssef
- Department of Rheumatology, Royal Prince Alfred Hospital, Sydney, Australia.,Department of Medicine, University of Sydney, Sydney, Australia
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, Melbourne, Australia. .,Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia.
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11
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Fairley JL, Hansen D, Proudman S, Sahhar J, Ngian GS, Walker J, Strickland G, Wilson M, Morrisroe K, Ferdowsi N, Major G, Roddy J, Stevens W, Nikpour M. Clinical Features of Systemic Sclerosis-Mixed Connective Tissue Disease and Systemic Sclerosis Overlap Syndromes. Arthritis Care Res (Hoboken) 2020; 73:732-741. [PMID: 32058672 DOI: 10.1002/acr.24167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/04/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To describe the clinical characteristics and outcomes of systemic sclerosis-mixed connective tissue disease (SSc-MCTD) and SSc overlap syndrome. METHODS We included patients from the Australian Scleroderma Cohort Study who met American College of Rheumatology/European Alliance of Associations for Rheumatology criteria for SSc. Three mutually exclusive groups were created: SSc-MCTD, SSc overlap, and SSc only. Univariate comparison of clinical features was performed by analysis of variance or chi-square test. Survival analysis was performed using Kaplan-Meier (KM) curves and Cox proportional hazards regression models. RESULTS Of 1,728 patients, 97 (5.6%) had SSc-MCTD, and 126 (7.3%) had SSc overlap. Those with MCTD-SSc were more commonly Asian (18.3% versus 10.1% in SSc overlap, and 3.6% in SSc only; P < 0.0001) and younger at disease onset (38.4 years versus 46.5 or 46.8 years, P < 0.0001). Those with SSc-MCTD or SSc overlap were more likely to have limited cutaneous SSc. All 3 groups had similar frequency of interstitial lung disease (ILD), although pulmonary arterial hypertension (PAH) was less common in SSc overlap. Synovitis and myositis were more common in SSc overlap and SSc-MCTD than in SSc only. KM curves showed better survival in SSc-MCTD than SSc overlap or SSc only (P = 0.011), but this was not significant after adjustment for sex and age at disease onset. SSc-specific antibodies were survival prognostic markers, with antinuclear antibody centromere or anti-RNP conferring better survival than anti-Scl-70 or anti-RNA polymerase III (P = 0.005). Patients with SSc-MCTD and SSc overlap had lower mortality following diagnosis of ILD and PAH than patients with SSc only. CONCLUSION This study provides insights into the clinical characteristics of patients with SSc-MCTD, SSc overlap, and SSc only and shows that anti-RNP antibodies are associated with better survival than anti-Scl-70 and anti-RNA polymerase III antibodies.
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Affiliation(s)
- Jessica L Fairley
- The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Dylan Hansen
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Susanna Proudman
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Joanne Sahhar
- Monash Health and Monash University, Melbourne, Victoria, Australia
| | - Gene-Siew Ngian
- Monash Health and Monash University, Melbourne, Victoria, Australia
| | - Jenny Walker
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Gemma Strickland
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Michelle Wilson
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | | | - Nava Ferdowsi
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Gabor Major
- Royal Newcastle Centre John Hunter Hospital and University of Newcastle, Newcastle, New South Wales, Australia
| | - Janet Roddy
- Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Wendy Stevens
- St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Mandana Nikpour
- St. Vincent's Hospital Melbourne, Melbourne, and The University of Melbourne at St Vincent's Hospital (Melbourne), Fitzroy, Victoria, Australia
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12
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Morrisroe K, Stevens W, Sahhar J, Ngian GS, Ferdowsi N, Hill CL, Roddy J, Walker J, Proudman S, Nikpour M. Digital ulcers in systemic sclerosis: their epidemiology, clinical characteristics, and associated clinical and economic burden. Arthritis Res Ther 2019; 21:299. [PMID: 31870459 PMCID: PMC6929369 DOI: 10.1186/s13075-019-2080-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 12/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine the frequency and clinical characteristics of systemic sclerosis-related digital ulcers, and associated direct health care costs, quality of life, and survival. METHODS Digital ulcers (DUs) were defined as an area with a visually discernible depth and a loss of continuity of epithelial coverage. DU severity was calculated based on the physician reported highest number of new DUs at clinical review (mild = 1-5 DUs, moderate 6-10 DUs, severe > 10 DUs). Healthcare use was captured through data linkage, wherein SSc clinical data captured prospectively in a dedicated clinical database were linked with health services databases to capture hospital admissions, emergency department (ED) presentations and ambulatory care (MBS) utilization and cost for the period 2008-2015. Healthcare cost determinants were estimated using logistic regression. RESULTS Among 1085 SSc patients, 48.6% experienced a DU over a mean follow-up of 5.2 ± 2.5 years. Those who developed DUs were more likely to have diffuse disease subtype (34.9% vs 18.2%, p < 0.001), anti-Scl-70 antibody (18.9% vs 9.3%, p < 0.001), and a younger age at SSc onset (43.6 ± 13.9 vs 48.8 ± 14.0 years, p < 0.001) in addition to reduced health-related quality of life (HRQoL) measured by the SF-36 but without a significant impact on survival. SSc patients with a history of a DU utilized significantly more healthcare resources per annum than those without a DU, including hospitalizations, ED presentation, and ambulatory care services. Total healthcare services, excluding medications, were associated with an annual excess cost per DU patient of AUD$12,474 (8574-25,677), p < 0.001, driven by hospital admission and ED presentation costs. CONCLUSION DUs place a large burden on the patient and healthcare system through reduced HRQoL and increased healthcare resource utilization and associated cost.
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Affiliation(s)
- Kathleen Morrisroe
- Department of Medicine, The University of Melbourne at St. Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia.,Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Joanne Sahhar
- Department of Medicine, Monash University, Clayton and Monash Health, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Gene-Siew Ngian
- Department of Medicine, Monash University, Clayton and Monash Health, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Nava Ferdowsi
- Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Catherine L Hill
- Rheumatology Unit, Royal Adelaide Hospital, North Terrace, SA, 5000, Australia.,Rheumatology Unit, The Queen Elizabeth Hospital, Woodville Road, Woodville, SA, 5011, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, Australia
| | - Jennifer Walker
- Rheumatology Unit, Flinders Medical Centre (Adelaide), Flinders Drive, Bedford Park, South Australia, 5042, Australia
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, North Terrace, SA, 5000, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St. Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia. .,Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia.
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13
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Morrisroe K, Stevens W, Sahhar J, Ngian GS, Ferdowsi N, Hansen D, Patel S, Hill CL, Roddy J, Walker J, Proudman S, Nikpour M. The economic burden of systemic sclerosis related pulmonary arterial hypertension in Australia. BMC Pulm Med 2019; 19:226. [PMID: 31775705 PMCID: PMC6881974 DOI: 10.1186/s12890-019-0989-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/13/2019] [Indexed: 11/23/2022] Open
Abstract
Background To quantify the financial cost of pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc). Methods Healthcare use was captured through data linkage, wherein clinical data for SSc patients enrolled in the Australian Scleroderma Cohort Study were linked with hospital, emergency department (ED) and ambulatory care databases (MBS) for the period 2008–2015. PAH was diagnosed on right heart catheter according to international criteria. Determinants of healthcare cost were estimated using logistic regression. Results Total median (25th–75th) healthcare cost per patient (including hospital, ED and MBS cost but excluding medication cost) for our cohort during 2008–2015 was AUD$37,685 (18,144-78,811) with an annual per patient healthcare cost of AUD$7506 (5273-10,654). Total healthcare cost was higher for SSc-PAH patients compared with those without PAH with a total cost per patient of AUD$70,034 (37,222-110,814) vs AUD$34,325 (16,093 – 69,957), p < 0.001 respectively with an annual excess healthcare cost per PAH patient of AUD$2463 (1973-1885), p < 0.001. The cost of SSc-PAH occurs early post PAH diagnosis with 89.4% utilizing a healthcare service within the first 12 months post PAH diagnosis with an associated cost per patient of AUD$4125 (0–15,666). PAH severity was the main significant determinant of increased healthcare cost (OR 2.5, p = 0.03) in our PAH cohort. Conclusions Despite SSc-PAH being a low prevalence disease, it is associated with significant healthcare resource utilization and associated economic burden, predominantly driven by the severity of PAH.
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Affiliation(s)
- Kathleen Morrisroe
- Department of Medicine, The University of Melbourne at St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia.,Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Joanne Sahhar
- Department of Medicine, Monash University, Clayton and Monash Health, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Gene-Siew Ngian
- Department of Medicine, Monash University, Clayton and Monash Health, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Nava Ferdowsi
- Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Dylan Hansen
- Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Shreeya Patel
- Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Catherine L Hill
- Rheumatology Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia.,Rheumatology Unit, The Queen Elizabeth Hospital, Woodville Road, Woodville, SA, 5011, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, Australia
| | - Jennifer Walker
- Rheumatology Unit, Flinders Medical Centre (Adelaide), Flinders Drive, Bedford Park, South Australia, 5042, Australia
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia. .,Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia.
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14
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Morrisroe K, Stevens W, Sahhar J, Ngian GS, Ferdowsi N, Hansen D, Patel S, Hill CL, Roddy J, Walker J, Proudman S, Nikpour M. The clinical and economic burden of systemic sclerosis related interstitial lung disease. Rheumatology (Oxford) 2019; 59:1878-1888. [DOI: 10.1093/rheumatology/kez532] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/03/2019] [Indexed: 12/14/2022] Open
Abstract
Abstract
Objective
To quantify the burden of interstitial lung disease (ILD) in SSc.
Methods
Clinical data for SSc patients enrolled in the Australian Scleroderma Cohort Study were linked with healthcare databases for the period 2008–2015. ILD was defined by characteristic fibrotic changes on high-resolution CT (HRCT) lung, while severity was defined by the extent lung involvement on HRCT (mild <10%, moderate 10–30%, severe >30%). Determinants of healthcare cost were estimated using logistic regression.
Results
SSc-ILD patients utilized more healthcare resources, including hospitalization, emergency department presentation and ambulatory care services, than those without ILD with a total cost per patient of AUD$48 368 (26 230–93 615) vs AUD$33 657 (15 144–66 905), P<0.001) between 2008–2015. Healthcare utilization was associated with an annual median (25th–75th) excess cost per SSc-ILD patient compared with those without ILD of AUD$1192 (807–1212), P<0.001. Increasing ILD severity was associated with significantly more healthcare utilization and costs with an annual excess cost per patient with severe ILD compared with mild ILD of AUD$2321 (645–1846), P<0.001. ILD severity and the presence of coexistent PAH were the main determinants of overall healthcare cost above median for this SSc-ILD cohort (OR 5.1, P<0.001, and OR 2.6, P=0.01, respectively). Furthermore, SSc-ILD patients reported worse physical HRQoL compared with those without ILD [34.3 (10.5) vs 39.1 (10.8), P<0.001], with a progressive decline with increasing ILD severity (P=0.002).
Conclusion
SSc-ILD places a large burden on the healthcare system and the patient through poor HRQoL in addition to incremental healthcare resource utilization and associated direct cost.
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Affiliation(s)
- Kathleen Morrisroe
- Department of Medicine, The University of Melbourne at St Vincent’s Hospital, Melbourne, Victoria
- Department of Rheumatology, St Vincent’s Hospital, Melbourne, Victoria
| | - Wendy Stevens
- Department of Rheumatology, St Vincent’s Hospital, Melbourne, Victoria
| | - Joanne Sahhar
- Department of Medicine, Monash University, Clayton and Monash Health, Melbourne, Victoria
| | - Gene-Siew Ngian
- Department of Medicine, Monash University, Clayton and Monash Health, Melbourne, Victoria
| | - Nava Ferdowsi
- Department of Rheumatology, St Vincent’s Hospital, Melbourne, Victoria
| | - Dylan Hansen
- Department of Rheumatology, St Vincent’s Hospital, Melbourne, Victoria
| | - Shreeya Patel
- Department of Rheumatology, St Vincent’s Hospital, Melbourne, Victoria
| | - Catherine L Hill
- Rheumatology Unit, Royal Adelaide Hospital, North Terrace, South Australia
- Rheumatology Unit, The Queen Elizabeth Hospital, South Australia
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, Western Australia
| | - Jennifer Walker
- Rheumatology Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, North Terrace, South Australia
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent’s Hospital, Melbourne, Victoria
- Department of Rheumatology, St Vincent’s Hospital, Melbourne, Victoria
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15
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Metwally M, Thabet K, Bayoumi A, Nikpour M, Stevens W, Sahhar J, Zochling J, Roddy J, Tymms K, Strickland G, Lester S, Rischmueller M, Ngian GS, Walker J, Hissaria P, Shaker O, Liddle C, Manolios N, Beretta L, Proudman S, George J, Eslam M. IFNL3 genotype is associated with pulmonary fibrosis in patients with systemic sclerosis. Sci Rep 2019; 9:14834. [PMID: 31619697 PMCID: PMC6795812 DOI: 10.1038/s41598-019-50709-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/18/2019] [Indexed: 12/17/2022] Open
Abstract
Fibrosis across different organs and tissues is likely to share common pathophysiological mechanisms and pathways. Recently, a polymorphism (rs12979860) near the interferon lambda gene (IFNL3) was shown to be associated with fibrosis in liver across multiple disease etiologies. We determined whether this variant is a risk factor for pulmonary fibrosis (PF) and worsening cutaneous fibrosis in systemic sclerosis (SSc). Caucasian patients with SSc (n = 733) were genotyped to test for association with the presence of PF and worsening of skin fibrosis. Serum IFN-λ3 levels from 200 SSc cases were evaluated. An association of the IFNL3 polymorphism with PF was demonstrated (OR: 1.66 (95% CI: 1.142-2.416, p = 0.008). The IFNL3 variant was not a risk factor for worsening of skin fibrosis. Functionally, IFN-λ3 serum levels were higher among subjects with PF compared to those unaffected (P < 0.0001). In conclusion, IFNL3 serum levels and the genetic variant known to be associated with liver fibrosis are similarly linked to PF, but not to worsening of skin fibrosis in SSc. These data highlight both common fibrosis pathways operating between organs, as well as differential effects within the same disease.
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Affiliation(s)
- Mayada Metwally
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia
| | - Khaled Thabet
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia
- Department of Biochemistry, Faculty of Pharmacy, Minia University, Minia, Egypt
| | - Ali Bayoumi
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia
| | - Mandana Nikpour
- Department of Rheumatology St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, 3065, Victoria, Australia
- Department of Medicine, The University of Melbourne at St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, 3065, Victoria, Australia
| | - Wendy Stevens
- Department of Rheumatology St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, 3065, Victoria, Australia
| | - Joanne Sahhar
- Department of Rheumatology, Monash Health, 246 Clayton Road, Clayton, Victoria, 3168, Australia
- Department of Medicine, Monash University (Melbourne), Wellington Rd, Clayton, 3168, Victoria, Australia
| | - Jane Zochling
- Department of Rheumatology, The Menzies Research Institute of Tasmania, Private Bag 23, Tasmania, 7001, Australia
| | - Janet Roddy
- Department of Rheumatology, Fiona Stanley Hospital (Perth), 11 Robin Warren Drive, Murdoch, 6150, Western Australia, Australia
| | | | - Gemma Strickland
- Department of Rheumatology St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, 3065, Victoria, Australia
- Barwon Rheumatology Services, Victoria, Australia
| | - Susan Lester
- Rheumatology Unit, The Queen Elizabeth Hospital (Adelaide), 28 Woodville Rd, Woodville, 5011, SA, Australia
- Discipline of Medicine, University of Adelaide (Adelaide), North Terrace, Adelaide, SA, 5000, Australia
| | - Maureen Rischmueller
- Rheumatology Unit, The Queen Elizabeth Hospital (Adelaide), 28 Woodville Rd, Woodville, 5011, SA, Australia
- Discipline of Medicine, University of Adelaide (Adelaide), North Terrace, Adelaide, SA, 5000, Australia
| | - Gene-Siew Ngian
- Department of Rheumatology, Monash Health, 246 Clayton Road, Clayton, Victoria, 3168, Australia
- Department of Medicine, Monash University (Melbourne), Wellington Rd, Clayton, 3168, Victoria, Australia
| | - Jennifer Walker
- Rheumatology Unit, Flinders Medical Centre (Adelaide), Flinders Drive, Bedford Park, 5042, South Australia, Australia
- Rheumatology Unit, Royal Adelaide Hospital (Adelaide), Port Rd, Adelaide, SA, 5000, Australia
- Immunology, Allergy and Arthritis Department, Flinders University (Adelaide), Sturt Road, Bedford Park, 5042, South Australia, Australia
| | - Pravin Hissaria
- Departments of Clinical Immunology and Immunopathology, Royal Adelaide Hospital, South Australia, Adelaide, Australia
| | - Olfat Shaker
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Christopher Liddle
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia
| | - Nicholas Manolios
- Rheumatology Department, The University of Sydney, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Lorenzo Beretta
- Referral Center for Systemic Autoimmune Diseases, University of Milan and Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, via Pace 9, I-20122, Milan, Italy
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital (Adelaide), Port Rd, Adelaide, SA, 5000, Australia
- Discipline of Medicine, University of Adelaide (Adelaide), North Terrace, Adelaide, SA, 5000, Australia
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia.
| | - Mohammed Eslam
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and University of Sydney, Sydney, NSW, Australia.
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Irwin R, Stanescu S, Buzaianu C, Rademan M, Roddy J, Gormley C, Tan T. Quadratus lumborum block for analgesia after caesarean section: a randomised controlled trial. Anaesthesia 2019; 75:89-95. [DOI: 10.1111/anae.14852] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2019] [Indexed: 12/13/2022]
Affiliation(s)
- R. Irwin
- Department of Anaesthesia and Peri‐operative Medicine Coombe Women and Infants University Hospital Dublin Ireland
| | - S. Stanescu
- Department of Anaesthesia and Peri‐operative Medicine Coombe Women and Infants University Hospital Dublin Ireland
| | - C. Buzaianu
- Department of Anaesthesia and Peri‐operative Medicine Coombe Women and Infants University Hospital Dublin Ireland
| | - M. Rademan
- Department of Anaesthesia and Peri‐operative Medicine Coombe Women and Infants University Hospital Dublin Ireland
| | - J. Roddy
- Department of Anaesthesia and Peri‐operative Medicine Coombe Women and Infants University Hospital Dublin Ireland
| | - C. Gormley
- Department of Anaesthesia and Peri‐operative Medicine Coombe Women and Infants University Hospital Dublin Ireland
| | - T. Tan
- Department of Anaesthesia and Peri‐operative Medicine Coombe Women and Infants University Hospital Dublin Ireland
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17
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Quinlivan A, Proudman S, Sahhar J, Stevens W, Nikpour M, Major G, Ngian G, Nikpour M, Proudman S, Roddy J, Sahhar J, Stevens W, Strickland G, Walker J, Youseff P. Cost savings with a novel algorithm for early detection of systemic sclerosis‐related pulmonary arterial hypertension: alternative scenario analyses. Intern Med J 2019; 49:781-785. [DOI: 10.1111/imj.14316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/20/2018] [Accepted: 12/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Susanna Proudman
- University of Adelaide Adelaide South Australia Australia
- Royal Adelaide Hospital Adelaide South Australia Australia
| | - Joanne Sahhar
- Monash Health Melbourne Victoria Australia
- Monash University Melbourne Victoria Australia
| | - Wendy Stevens
- St Vincent’s Hospital Melbourne Melbourne Victoria Australia
| | - Mandana Nikpour
- St Vincent’s Hospital Melbourne Melbourne Victoria Australia
- The University of Melbourne Melbourne Victoria Australia
| | - Gabor Major
- University of Newcastle and Royal Newcastle Centre, John Hunter Hospital Newcastle New South Wales Australia
| | - Gene‐Siew Ngian
- Monash Health and Monash University Melbourne Victoria Australia
| | - Mandana Nikpour
- The University of Melbourne and St Vincent's Hospital Melbourne Victoria Australia
| | - Susanna Proudman
- University of Adelaide and Royal Adelaide Hospital Adelaide South Australia Australia
| | - Janet Roddy
- Fiona Stanley Hospital Perth Western Australia Australia
| | - Joanne Sahhar
- Monash Health and Monash University Melbourne Victoria Australia
| | | | | | | | - Peter Youseff
- Royal Prince Alfred Hospital Sydney New South Wales Australia
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18
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Moxey J, Huq M, Proudman S, Sahhar J, Ngian GS, Walker J, Strickland G, Wilson M, Ross L, Major G, Roddy J, Stevens W, Nikpour M. Significance of anti-neutrophil cytoplasmic antibodies in systemic sclerosis. Arthritis Res Ther 2019; 21:57. [PMID: 30764870 PMCID: PMC6376778 DOI: 10.1186/s13075-019-1839-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/01/2019] [Indexed: 11/26/2022] Open
Abstract
Background Up to 12% of patients with systemic sclerosis (SSc) have anti-neutrophil cytoplasmic antibodies (ANCA). However, the majority of these patients do not manifest ANCA-associated vasculitis (AAV) and the significance of ANCA in these patients is unclear. The aim of this study is to determine the prevalence of ANCA in a well-characterised SSc cohort and to examine the association between ANCA and SSc clinical characteristics, other autoantibodies, treatments and mortality. Methods Clinical data were obtained from 5 centres in the Australian Scleroderma Cohort Study (ASCS). ANCA positive was defined as the presence of any one or combination of cytoplasmic ANCA (c-ANCA), perinuclear ANCA (p-ANCA), atypical ANCA, anti-myeloperoxidase (anti-MPO) or anti-proteinase-3 (anti-PR3). Associations of demographic and clinical features with ANCA were investigated by logistic or linear regression. Survival analysis was performed using Kaplan-Meyer curves and Cox regression models. Results Of 1303 patients, 116 (8.9%) were ANCA positive. Anti-PR3 was more common than anti-MPO (13.8% and 11.2% of ANCA-positive patients, respectively). Only 3 ANCA-positive patients had AAV. Anti-Scl-70 was more common in ANCA positive vs ANCA negative (25% vs 12.8%, p < 0.001), anti-MPO positive vs anti-MPO negative (38.5% vs 13.6%, p = 0.006) and anti-PR3 positive vs anti-PR3 negative patients (44.4% vs 13.4%, p < 0.001). A higher prevalence of interstitial lung disease (ILD) was found in the ANCA positive (44.8% vs 21.8%, p < 0.001) and the anti-PR3 positive groups (50.0% vs 23.4%, p = 0.009). In multivariable analysis, ANCA-positive status remained associated with ILD after adjusting for anti-Scl-70 antibodies. Pulmonary embolism (PE) was more common in ANCA-positive patients (8.6% vs 3.0%, p = 0.002) and anti-PR3-positive patients (16.7% vs 3.3%, p = 0.022). ANCA-positive status remained associated with PE in a multivariable analysis adjusting for anti-phospholipid antibodies. Kaplan-Meier analysis revealed increased mortality in ANCA-positive patients (p = 0.006). In Cox regression analysis, ANCA was associated with increased mortality, after adjusting for age and sex. Conclusions ANCA is associated with increased prevalence of ILD and PE in SSc. ANCA should be tested in SSc, as it identifies individuals with worse prognosis who require close monitoring for adverse outcomes.
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Affiliation(s)
- Jayne Moxey
- The University of Melbourne, 41 Victoria Parade Fitzroy, Melbourne, Victoria, 3065, Australia.,St. Vincent's Hospital Melbourne, 41 Victoria Parade Fitzroy, Melbourne, Victoria, 3065, Australia
| | - Molla Huq
- The University of Melbourne, 41 Victoria Parade Fitzroy, Melbourne, Victoria, 3065, Australia
| | - Susanna Proudman
- University of Adelaide, Adelaide, South Australia, Australia.,Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joanne Sahhar
- Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Gene-Siew Ngian
- Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Jenny Walker
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | | | - Michelle Wilson
- St. Vincent's Hospital Melbourne, 41 Victoria Parade Fitzroy, Melbourne, Victoria, 3065, Australia
| | - Laura Ross
- The University of Melbourne, 41 Victoria Parade Fitzroy, Melbourne, Victoria, 3065, Australia.,St. Vincent's Hospital Melbourne, 41 Victoria Parade Fitzroy, Melbourne, Victoria, 3065, Australia
| | - Gabor Major
- Royal Newcastle Centre John Hunter Hospital, Newcastle, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia
| | - Janet Roddy
- Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Wendy Stevens
- St. Vincent's Hospital Melbourne, 41 Victoria Parade Fitzroy, Melbourne, Victoria, 3065, Australia
| | - Mandana Nikpour
- The University of Melbourne, 41 Victoria Parade Fitzroy, Melbourne, Victoria, 3065, Australia. .,St. Vincent's Hospital Melbourne, 41 Victoria Parade Fitzroy, Melbourne, Victoria, 3065, Australia.
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19
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Nikpour M, Calderone A, Host L, Cannell P, Roddy J. Letter to the Editor Regarding "Autologous Hematopoietic Stem Cell Transplantation for Systemic Sclerosis: A Systematic Review and Meta-Analysis". Biol Blood Marrow Transplant 2019; 25:e112-e113. [PMID: 30615981 DOI: 10.1016/j.bbmt.2018.12.838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Mandana Nikpour
- Department of Medicine, The University of Melbourne at St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Department of Rheumatology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Alicia Calderone
- Department of Rheumatology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Lauren Host
- Department of Rheumatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Paul Cannell
- Department of Haematology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Janet Roddy
- Department of Rheumatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
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20
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Ross L, Stevens W, Rabusa C, Wilson M, Ferdowsi N, Walker J, Sahhar J, Ngian GS, Zochling J, Roddy J, Tymms K, Major G, Strickland G, Proudman SM, Nikpour M. The role of inflammatory markers in assessment of disease activity in systemic sclerosis. Clin Exp Rheumatol 2018; 36 Suppl 113:126-134. [PMID: 30277869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/12/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The role of the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in the assessment of disease activity in systemic sclerosis (SSc) remains controversial. We sought to evaluate the relationship between clinical features of SSc and raised inflammatory markers and to determine if changes in ESR and CRP reflect changes in other disease features over time. METHODS One thousand, five hundred and forty-five patients enrolled in the Australian Scleroderma Cohort Study were observed over a mean 3.52±2.91 years and assessed at 6,119 study visits. Generalised estimating equations were used to determine the relationship between ESR≥20mm/hr and CRP≥5mg/L and features of disease. The associations between change in inflammatory markers and change in skin scores and respiratory function tests were analysed. RESULTS Overall, there was a significant association between raised ESR and forced vital capacity (FVC)<80% predicted, diffusing capacity of the lung (DLCO)<80% predicted, pulmonary arterial hypertension (PAH), body mass index (BMI), proximal muscle strength, anaemia, and hypocomplementaemia (p<0.05). Raised CRP was significantly associated with modified Rodnan Skin Score>20, FVC<80%, DLCO<80%, PAH, digital ulcers, BMI, synovitis, tendon friction rub, anaemia, and hypocomplementaemia (p<0.05). A significant deterioration in respiratory function tests (RFTs) was associated with a 2-fold increase in both ESR and CRP (p<0.05). CONCLUSIONS Raised inflammatory markers are associated with pulmonary, cutaneous and musculoskeletal manifestations of SSc. Rising inflammatory markers are correlated with declining respiratory function tests. This suggests inflammatory markers have a role in the assessment of SSc disease activity.
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Affiliation(s)
- Laura Ross
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, and Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Candice Rabusa
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Michelle Wilson
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Nava Ferdowsi
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, and Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Jennifer Walker
- Rheumatology Unit, Flinders Medical Centre, Adelaide, Australia
| | - Joanne Sahhar
- Department of Rheumatology, Department of Medicine, Monash Health & Monash University, Melbourne, Australia
| | - Gene-Siew Ngian
- Department of Rheumatology, Department of Medicine, Monash Health & Monash University, Melbourne, Australia
| | | | - Janet Roddy
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Australia
| | - Kathleen Tymms
- Department of Rheumatology, Canberra Hospital, Canberra, Australia
| | - Gabor Major
- Department of Rheumatology, John Hunter Hospital, Newcastle, Australia
| | - Gemma Strickland
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
| | - Susanna M Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, and Discipline of Medicine, University of Adelaide, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital, and Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia
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21
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Peytrignet S, Denton CP, Lunt M, Hesselstrand R, Mouthon L, Silman A, Pan X, Brown E, Czirják L, Distler JHW, Distler O, Fligelstone K, Gregory WJ, Ochiel R, Vonk M, Ancuta C, Ong VH, Farge D, Hudson M, Matucci-Cerinic M, Balbir-Gurman A, Midtvedt Ø, Jordan AC, Stevens W, Moinzadeh P, Hall FC, Agard C, Anderson ME, Diot E, Madhok R, Akil M, Buch MH, Chung L, Damjanov N, Gunawardena H, Lanyon P, Ahmad Y, Chakravarty K, Jacobsen S, MacGregor AJ, McHugh N, Müller-Ladner U, Riemekasten G, Becker M, Roddy J, Carreira PE, Fauchais AL, Hachulla E, Hamilton J, Inanç M, McLaren JS, van Laar JM, Pathare S, Proudman S, Rudin A, Sahhar J, Coppere B, Serratrice C, Sheeran T, Veale DJ, Grange C, Trad GS, Herrick AL. Disability, fatigue, pain and their associates in early diffuse cutaneous systemic sclerosis: the European Scleroderma Observational Study. Rheumatology (Oxford) 2018; 57:370-381. [PMID: 29207002 PMCID: PMC5850714 DOI: 10.1093/rheumatology/kex410] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Indexed: 11/21/2022] Open
Abstract
Objectives Our aim was to describe the burden of early dcSSc in terms of disability, fatigue and pain in the European Scleroderma Observational Study cohort, and to explore associated clinical features. Methods Patients completed questionnaires at study entry, 12 and 24 months, including the HAQ disability index (HAQ-DI), the Cochin Hand Function Scale (CHFS), the Functional Assessment of Chronic Illness Therapy-fatigue and the Short Form 36 (SF36). Associates examined included the modified Rodnan skin score (mRSS), current digital ulcers and internal organ involvement. Correlations between 12-month changes were also examined. Results The 326 patients recruited (median disease duration 11.9 months) displayed high levels of disability [mean (s.d.) HAQ-DI 1.1 (0.83)], with ‘grip’ and ‘activity’ being most affected. Of the 18 activities assessed in the CHFS, those involving fine finger movements were most affected. High HAQ-DI and CHFS scores were both associated with high mRSS (ρ = 0.34, P < 0.0001 and ρ = 0.35, P < 0.0001, respectively). HAQ-DI was higher in patients with digital ulcers (P = 0.004), pulmonary fibrosis (P = 0.005), cardiac (P = 0.005) and muscle involvement (P = 0.002). As anticipated, HAQ-DI, CHFS, the Functional Assessment of Chronic Illness Therapy and SF36 scores were all highly correlated, in particular the HAQ-DI with the CHFS (ρ = 0.84, P < 0.0001). Worsening HAQ-DI over 12 months was strongly associated with increasing mRSS (ρ = 0.40, P < 0.0001), decreasing hand function (ρ = 0.57, P < 0.0001) and increasing fatigue (ρ = −0.53, P < 0.0001). Conclusion The European Scleroderma Observational Study highlights the burden of disability in early dcSSc, with high levels of disability and fatigue, associating with the degree of skin thickening (mRSS). Impaired hand function is a major contributor to overall disability.
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Affiliation(s)
- Sébastien Peytrignet
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Christopher P Denton
- Centre for Rheumatology and Connective Tissue Diseases, UCL Division of Medicine, Royal Free Campus, London, UK
| | - Mark Lunt
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Luc Mouthon
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence pour les Vascularités Nécrosantes et la Sclérodermie Systémique, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alan Silman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Xiaoyan Pan
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Edith Brown
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - László Czirják
- Department of Rheumatology and Immunology, Medical Center, University of Pécs, Pécs, Hungary, Erlangen, Germany
| | - Jörg H W Distler
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Oliver Distler
- Department of Rheumatology, University of Zurich, Zurich, Switzerland
| | - Kim Fligelstone
- Centre for Rheumatology and Connective Tissue Diseases, UCL Division of Medicine, Royal Free Campus, London, UK
| | - William J Gregory
- Rehabilitation Services, Salford Royal NHS Foundation Trust, Salford, UK
| | - Rachel Ochiel
- Centre for Rheumatology and Connective Tissue Diseases, UCL Division of Medicine, Royal Free Campus, London, UK
| | - Madelon Vonk
- Department of the Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Codrina Ancuta
- Rheumatology 2 Department, Clinical Rehabilitation Hospital, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi, Romania
| | - Voon H Ong
- Centre for Rheumatology and Connective Tissue Diseases, UCL Division of Medicine, Royal Free Campus, London, UK
| | - Dominique Farge
- Unité Clinique de Médecine Interne, Maladies Auto-immunes et Pathologie Vasculaire, Hôpital Saint-Louis, Paris, France
| | - Marie Hudson
- Lady Davis Institute, Jewish General Hospital, Montreal, Canada.,Department of Medicine, McGill University, Montreal, Canada
| | - Marco Matucci-Cerinic
- Department Experimental and Clinical Medicine, Division Rheumatology AOUC, University of Florence, Florence, Italy
| | - Alexandra Balbir-Gurman
- B. Shine Rheumatology Unit, Rambam Heath Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Øyvind Midtvedt
- Rheumatology Unit, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Alison C Jordan
- Queen Elizabeth Hospital Birmingham, UHB Foundation Trust, Birmingham, UK
| | - Wendy Stevens
- Rheumatology Unit, St Vincent's Hospital, Melbourne, Australia
| | - Pia Moinzadeh
- Department for Dermatology, University of Cologne, Köln, Germany
| | - Frances C Hall
- Department of Clinical Medicine, Cambridge University NHS Hospital Foundation Trust, Cambridge, UK
| | - Christian Agard
- Department of Internal Medicine, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | | | - Elisabeth Diot
- Service de Médecine Interne, Hôpital Bretonneau Tours, Tours, France
| | - Rajan Madhok
- Centre for Rheumatic Diseases, Royal Infirmary, Glasgow, UK
| | - Mohammed Akil
- Department of Rheumatology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Maya H Buch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Stanford University, Stanford, CA, USA
| | - Nemanja Damjanov
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Harsha Gunawardena
- Clinical and Academic Rheumatology, North Bristol NHS Trust, Bristol, UK
| | - Peter Lanyon
- Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Rheumatology, Nottingham NHS Treatment Centre, Nottingham, UK
| | - Yasmeen Ahmad
- Peter Maddison Rheumatology Centre, Llandudno Hospital, Llandudno, UK
| | | | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Alexander J MacGregor
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Neil McHugh
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Klinik, Bad Nauheim, Germany
| | | | - Michael Becker
- Department of Rheumatology and Clinical Immunology, University Hospital Charité Berlin, Berlin, Germany
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, Australia
| | - Patricia E Carreira
- Servicio de Reumatologia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Eric Hachulla
- Centre National de Référence Maladies Systémiques et Auto-immunes Rares, Département de Médecine Interne et Immunologie Clinique, Université de Lille, Lille, France
| | - Jennifer Hamilton
- Department of Rheumatology, Gateshead Hospitals Foundation Trust, Gateshead, UK
| | - Murat Inanç
- Department of Internal Medicine, Division of Rheumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - John S McLaren
- Fife Rheumatic Diseases Unit, Whyteman's Brae Hospital, Kirkcaldy, Scotland, UK
| | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, the Netherlands
| | - Sanjay Pathare
- Rheumatology, James Cook University Hospital, Middlesbrough, UK
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital.,Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Anna Rudin
- Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Joanne Sahhar
- Monash Centre for Inflammatory Diseases, Monash University, Melbourne, Australia
| | - Brigitte Coppere
- Department of Internal Medicine, Hôpital Edouard Herriot, Lyon, France
| | - Christine Serratrice
- Department of Internal Medicine, Foundation Hospital Saint Joseph, Marseille, France
| | - Tom Sheeran
- Department of Rheumatology, Cannock Chase Hospital, Cannock, UK
| | - Douglas J Veale
- Rheumatology, St Vincent's University Hospital, Dublin, Ireland
| | - Claire Grange
- Department of Internal Medicine 69310, Centre Hospitalier Lyon Sud, Pierre-Bénite, Lyon, France
| | - Georges-Selim Trad
- Internal Medecine, Ambroise Paré Hospital, Boulogne, Billancourt, France
| | - Ariane L Herrick
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Thakkar V, Patterson KA, Stevens W, Wilson M, Roddy J, Sahhar J, Proudman S, Hissaria P, Nikpour M. Increased serum levels of adhesion molecules ICAM-1 and VCAM-1 in systemic sclerosis are not specific for pulmonary manifestations. Clin Rheumatol 2018; 37:1563-1571. [PMID: 29687288 DOI: 10.1007/s10067-018-4081-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/15/2018] [Accepted: 03/23/2018] [Indexed: 01/15/2023]
Abstract
Studies suggest elevated serum intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) levels may be markers of pulmonary arterial hypertension in systemic sclerosis (SSc-PAH). We sought to evaluate whether ICAM-1 and VCAM-1 levels are useful screening biomarkers for incident SSc-PAH. In this cross-sectional study, four groups were selected from the Australian Scleroderma Cohort Study: group 1 (n = 15) had definite PAH; group 2 (n = 19) had interstitial lung disease (ILD); group 3 (n = 30) were SSc-controls; and group 4 (n = 34) were healthy controls. Serum ICAM-1 and VCAM-1 levels were measured using the Millipore Milliplex MAP Human 2-Plex Panel. There were no differences in ICAM-1 levels in the PAH versus ILD group (263.0 ± 85.4 vs 380.4 ± 168.3 ng/mL, p = 0.136), SSc-controls (263.0 ± 85.4 vs 253.1 ± 98.0 ng/mL, p = 1.00), or healthy controls (263.0 ± 85.4 vs 201.8 ± 57.2 ng/mL, p = 0.093). Similarly, there were no differences in VCAM-1 level in PAH versus ILD groups (1476.2 ± 434.9 vs 1424.8 ± 527.6 ng/mL, p = 1.00) and SSc-controls (1476.2 ± 434.9 vs 1409.5 ± 341.1 ng/mL, p = 1.00). SSc subjects had significantly higher levels of ICAM-1 (297.4 ± 134.0 vs 201.8 ± 57.2 ng/mL, p < 0.0001) and VCAM-1 compared to healthy controls (1432.7 ± 427.4 vs 1125.6 ± 273.4 ng/mL, p < 0.0001). Neither ICAM-1 nor VCAM-1 is a specific screening biomarker of SSc-PAH. Instead, increased levels of these adhesion molecules in SSc, irrespective of pulmonary complications, suggest that they may play a role in SSc pathogenesis.
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Affiliation(s)
- Vivek Thakkar
- Department of Rheumatology, Liverpool Hospital, Liverpool BC, NSW, 2170, Australia.,School of Medicine, Western Sydney University, Campbelltown, NSW, Australia.,South Western Clinical School, University of New South Wales, Liverpool, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Parade, Fitzroy, VIC, 3065, Australia.,Department of Medicine, The University of Melbourne at St Vincent's Hospital, 41 Parade, Fitzroy, VIC, 3065, Australia
| | - Karen A Patterson
- Flinders University, Bedford Park, South Australia, Australia.,Commonwealth Scientific and Industrial Research Organisation CSIRO, Adelaide, South Australia, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Parade, Fitzroy, VIC, 3065, Australia
| | - Michelle Wilson
- Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Parade, Fitzroy, VIC, 3065, Australia
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, GPO Box X2213, Perth, WA, 6001, Australia
| | - Joanne Sahhar
- Department of Rheumatology, Monash Health & Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia.,Department of Medicine, Monash Health & Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Pravin Hissaria
- Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia.,Department of Clinical Immunology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia
| | - Mandana Nikpour
- Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Parade, Fitzroy, VIC, 3065, Australia. .,Department of Medicine, The University of Melbourne at St Vincent's Hospital, 41 Parade, Fitzroy, VIC, 3065, Australia.
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23
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Herrick AL, Peytrignet S, Lunt M, Pan X, Hesselstrand R, Mouthon L, Silman AJ, Dinsdale G, Brown E, Czirják L, Distler JHW, Distler O, Fligelstone K, Gregory WJ, Ochiel R, Vonk MC, Ancuţa C, Ong VH, Farge D, Hudson M, Matucci-Cerinic M, Balbir-Gurman A, Midtvedt Ø, Jobanputra P, Jordan AC, Stevens W, Moinzadeh P, Hall FC, Agard C, Anderson ME, Diot E, Madhok R, Akil M, Buch MH, Chung L, Damjanov NS, Gunawardena H, Lanyon P, Ahmad Y, Chakravarty K, Jacobsen S, MacGregor AJ, McHugh N, Müller-Ladner U, Riemekasten G, Becker M, Roddy J, Carreira PE, Fauchais AL, Hachulla E, Hamilton J, İnanç M, McLaren JS, van Laar JM, Pathare S, Proudman SM, Rudin A, Sahhar J, Coppere B, Serratrice C, Sheeran T, Veale DJ, Grange C, Trad GS, Denton CP. Patterns and predictors of skin score change in early diffuse systemic sclerosis from the European Scleroderma Observational Study. Ann Rheum Dis 2018; 77:563-570. [PMID: 29306872 PMCID: PMC5890636 DOI: 10.1136/annrheumdis-2017-211912] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 11/13/2017] [Accepted: 11/19/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Our aim was to use the opportunity provided by the European Scleroderma Observational Study to (1) identify and describe those patients with early diffuse cutaneous systemic sclerosis (dcSSc) with progressive skin thickness, and (2) derive prediction models for progression over 12 months, to inform future randomised controlled trials (RCTs). METHODS The modified Rodnan skin score (mRSS) was recorded every 3 months in 326 patients. 'Progressors' were defined as those experiencing a 5-unit and 25% increase in mRSS score over 12 months (±3 months). Logistic models were fitted to predict progression and, using receiver operating characteristic (ROC) curves, were compared on the basis of the area under curve (AUC), accuracy and positive predictive value (PPV). RESULTS 66 patients (22.5%) progressed, 227 (77.5%) did not (33 could not have their status assessed due to insufficient data). Progressors had shorter disease duration (median 8.1 vs 12.6 months, P=0.001) and lower mRSS (median 19 vs 21 units, P=0.030) than non-progressors. Skin score was highest, and peaked earliest, in the anti-RNA polymerase III (Pol3+) subgroup (n=50). A first predictive model (including mRSS, duration of skin thickening and their interaction) had an accuracy of 60.9%, AUC of 0.666 and PPV of 33.8%. By adding a variable for Pol3 positivity, the model reached an accuracy of 71%, AUC of 0.711 and PPV of 41%. CONCLUSIONS Two prediction models for progressive skin thickening were derived, for use both in clinical practice and for cohort enrichment in RCTs. These models will inform recruitment into the many clinical trials of dcSSc projected for the coming years. TRIAL REGISTRATION NUMBER NCT02339441.
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Affiliation(s)
- Ariane L Herrick
- Centre for Musculoskeletal Research, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Sebastien Peytrignet
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Mark Lunt
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Xiaoyan Pan
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Luc Mouthon
- Service de Medicine Interne, Hôpital Cochin, Centre de Référence pour les Vascularites Nécrosantes et la Sclérodermie Systémique, Université Paris Descartes, Paris, France
| | - Alan J Silman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Graham Dinsdale
- Centre for Musculoskeletal Research, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Edith Brown
- University of Manchester, Manchester, Greater Manchester, UK
| | - László Czirják
- Department of Rheumatology and Immunology, Medical Center, University of Pecs, Pecs, Hungary
| | - Jörg H W Distler
- Department of Internal Medicine III, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Oliver Distler
- Department of Rheumatology, University of Zurich, Zurich, Switzerland
| | | | - William J Gregory
- Rehabilitation Services, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Madelon C Vonk
- Department of the Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Codrina Ancuţa
- Rheumatology 2 Department, 'Grigore T. Popa' University of Medicine and Pharmacy, Clinical Rehabilitation Hospital, Iasi, Romania
| | - Voon H Ong
- UCL Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, London, UK
| | - Dominique Farge
- Unite Clinique de Medicine Interne, Maladies Auto-immunes et Pathologie Vasculaire, UF 04, Hôpital Saint-Louis, AP-HP Assistance Publique des Hôpitaux de Paris, INSERM UMRS 1160, Paris Denis Diderot University, Paris, France
| | - Marie Hudson
- Jewish General Hospital, Lady Davis Institute and McGill University, Montreal, Canada
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Alexandra Balbir-Gurman
- Shine Rheumatology Unit, Rambam Health Care Campus, Rappaport Faculty of Medicine, Haifa, Israel
| | - Øyvind Midtvedt
- Rheumatology Unit, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Paresh Jobanputra
- Queen Elizabeth Hospital Birmingham, UHB Foundation Trust, Birmingham, UK
| | - Alison C Jordan
- Queen Elizabeth Hospital Birmingham, UHB Foundation Trust, Birmingham, UK
| | - Wendy Stevens
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Pia Moinzadeh
- Department for Dermatology, University of Cologne Kerpener Str, Cologne, Germany
| | - Frances C Hall
- Cambridge University NHS Hospital Foundation Trust, Cambridge, UK
| | - Christian Agard
- Department of Internal Medicine, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | | | - Elisabeth Diot
- Service de Médecine Interne, Hôpital Bretonneau Tours, Tours, France
| | - Rajan Madhok
- Centre for Rheumatic Diseases, Royal Infirmary, Glasgow, UK
| | | | - Maya H Buch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Nemanja S Damjanov
- University of Belgrade School of Medicine, Institute of Rheumatology, Belgrade, Serbia
| | - Harsha Gunawardena
- Clinical and Academic Rheumatology, North Bristol NHS Trust, Bristol, UK
| | - Peter Lanyon
- Nottingham University Hospitals NHS Trust and Nottingham NHS Treatment Centre, Nottingham, UK
| | | | | | - Søren Jacobsen
- University of Copenhagen, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | - Neil McHugh
- Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Bad Nauheim, Germany
| | | | - Michael Becker
- Department of Rheumatology and Clinical Immunology, University Hospital Charité Berlin, Berlin, Germany
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, Australia
| | - Patricia E Carreira
- Servicio de Reumatologia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Eric Hachulla
- Centre National de Référence Maladies Systémiques et Auto-immunes Rares, Département de Médecine Interne et Immunologie Clinique, Université de Lille, Lille, France
| | | | - Murat İnanç
- Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - John S McLaren
- Fife Rheumatic Diseases Unit, Whyteman's Brae Hospital, Kirkcaldy, UK
| | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Susanna M Proudman
- Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, University of Adelaide, Adelaide, Victoria, Australia
| | - Anna Rudin
- Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Joanne Sahhar
- Monash Health and Department Medicine, Monash Centre for Inflammatory Diseases, Monash University, Melbourne, Victoria, Australia
| | - Brigitte Coppere
- Department of Internal Medicine, Hôpital Edouard Herriot, Lyon, France
| | - Christine Serratrice
- Department of Internal Medicine, Foundation Hospital Saint Joseph, Marseille, France
| | | | | | - Claire Grange
- Department of Internal Medicine, Centre Hospitalier Lyon Sud, Lyon, France
| | | | - Christopher P Denton
- UCL Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, London, UK
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24
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Morrisroe K, Sudararajan V, Stevens W, Sahhar J, Zochling J, Roddy J, Proudman S, Nikpour M. Work productivity in systemic sclerosis, its economic burden and association with health-related quality of life. Rheumatology (Oxford) 2017; 57:73-83. [PMID: 29155994 DOI: 10.1093/rheumatology/kex362] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate work productivity and its economic burden in SSc patients. Methods Consecutive SSc patients enrolled in the Australian Scleroderma Cohort Study were mailed questionnaires assessing employment (Workers' Productivity and Activity Impairment Questionnaire and a custom-made questionnaire) and health-related quality of life (HRQoL) (36-item Short Form Health Survey and Patient-Reported Outcomes Measurement Information System 29). Linear regression methods were used to determine factors associated with work productivity. Results Among 476 patients submitting responses, 55.2% <65 years of age were employed. Unemployed patients were older at the time of survey completion (57.1 vs 53.7 years; P < 0.001) and had longer disease duration from first SSc clinical manifestation (16.2 vs 14.9 years; P = 0.01) than employed patients. The mean age at unemployment onset was 13.2 years below the average Australian retirement age. Of those working in the week prior to completing the survey, 16.0% reported missing work (absenteeism) due to their SSc, accounting for 32.9% of their working week. Reduced productivity while at work (presenteeism) accounted for 22% of their working week. Annual costs per patient as a consequence of unemployment and reduced productivity equated to a total of AUD$67 595.40. Factors independently associated with reduced work productivity were presence of synovitis and sicca symptoms, while tertiary education protected against work impairment. Patients with low HRQoL scores also had low work productivity. Conclusion SSc is associated with considerable unemployment and reduced productivity, which in turn is associated with a substantial economic burden and poor HRQoL. Raising awareness and identifying modifiable factors are possible ways of reducing this burden.
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Affiliation(s)
- Kathleen Morrisroe
- Department of Medicine, University of Melbourne at St Vincent's Hospital Melbourne.,Department of Rheumatology St Vincent's Hospital Melbourne, Melbourne
| | - Vijaya Sudararajan
- Department of Medicine, University of Melbourne at St Vincent's Hospital Melbourne
| | - Wendy Stevens
- Department of Rheumatology St Vincent's Hospital Melbourne, Melbourne
| | - Joanne Sahhar
- Department of Rheumatology, Monash Health, Monash University, Clayton, VIC
| | - Jane Zochling
- Department of Rheumatology, Menzies Institute for Medical Research, Hobart, Tasmania
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, WA
| | - Susanna Proudman
- Royal Adelaide Hospital, Rheumatology Unit.,Department of Rheumatology, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Mandana Nikpour
- Department of Medicine, University of Melbourne at St Vincent's Hospital Melbourne.,Department of Rheumatology St Vincent's Hospital Melbourne, Melbourne
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25
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Host L, Nikpour M, Calderone A, Cannell P, Roddy J. Autologous stem cell transplantation in systemic sclerosis: a systematic review. Clin Exp Rheumatol 2017; 35 Suppl 106:198-207. [PMID: 28869416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 05/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Haematopoetic autologous stem cell transplantation (ASCT) has emerged as a treatment option for patients with refractory, severe autoimmune disease. This is a systematic review of the current literature on ASCT in adult patients with systemic sclerosis (SSc). METHODS Original articles published between 2005 and 2016 that evaluated the use of ASCT in patients with SSc were reviewed with respect to the primary outcomes of overall and transplant related mortality (TRM) rates, and secondary outcomes of changes in modified Rodnan Skin Score (mRSS), forced vital capacity (FVC), progression/event free survival (P/EFS) and quality of life measures. We also focussed on patient characteristics, the ASCT conditioning and mobilisation regimens used, and their relationship to patient outcome in each study. RESULTS Of the 155 articles found, only 9 articles were suitable for review. There were 2 placebo-controlled trials (RCTs), ASTIS and ASSIST, and 7 observational and cohort studies. In general, patients undergoing ASCT had diffuse SSc with mRSS >14, and interstitial lung disease. The 2 RCTs showed a benefit in P/EFS (80-81%), FVC and quality of life measures in ASCT compared to monthly cyclophosphamide. All the studies showed an improvement in mRSS. TRM rates varied among studies, from 0 to 23%, with a trend to higher mortality rates in studies using higher doses of cyclophosphamide or myeloablative conditioning regimens. CONCLUSIONS We conclude that ASCT is beneficial in some patients with SSc and that patient selection and conditioning regimens are critical determinants of prognosis and mortality post-ASCT.
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Affiliation(s)
- Lauren Host
- The Department of Rheumatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Mandana Nikpour
- The Departments of Medicine and Rheumatology, The University of Melbourne at St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Alicia Calderone
- The Department of Rheumatology, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Paul Cannell
- The Department of Haematology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Janet Roddy
- The Department of Rheumatology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
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26
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Morrisroe K, Stevens W, Huq M, Sahhar J, Ngian GS, Zochling J, Roddy J, Proudman SM, Nikpour M. Validity of the Workers Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI:SHP) in patients with systemic sclerosis. Clin Exp Rheumatol 2017; 35 Suppl 106:130-137. [PMID: 28516877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate the construct validity of the Workers Productivity and Impairment Activity Index: Specific Health Problem (WPAI:SHP) in Australian systemic sclerosis (SSc) patients. METHODS SSc patients, identified through the Australian Scleroderma Cohort Study database, completed the WPAI:SHP and a quality of life instrument (PROMIS-29) cross-sectionally. The construct validity of the WPAI:SHP was assessed by the correlations between the WPAI:SHP and a range of SSc health states. Non-parametric correlation, including Spearman's correlation (ρ), was used to test the validity of WPAI:SHP and ability to distinguish between different health states. RESULTS A total of 476 completed questionnaires was returned, equating to a response rate of 63.7%. Among those under 65 years of age, 155 patients (55.2%) were in paid employment. Employed patients had a mean (± SD) age of 56.5 (9.8) years and were predominantly female (87.3%) with limited disease subtype (75.6%). The WPAI:SHP showed construct validity based on moderate to strong correlations with health status as assessed by a range of health outcome measures including disease activity (ρ=0.34-0.39, p=0.001), physical function (ρ=0.55-0.62, p=0.001), disease severity(ρ=0.55-0.62, p=0.001), fatigue (ρ= 0.62-0.63, p=0.001), pain (ρ=0.68-0.71, p=0.001), and breathlessness (ρ=0.39-0.46, p=0.001). Furthermore, according to the effect size, the WPAI:SHP scores have a large discriminative ability (d=1.26-1.47) for distinguishing SSc patients with different health outcomes. CONCLUSIONS The WPAI is a valid questionnaire for assessing impairments in paid employment and social activities in SSc patients, and for measuring the relative differences between SSc patients with varying health states.
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Affiliation(s)
- Kathleen Morrisroe
- Department of Medicine, The University of Melbourne at St. Vincent's Hospital; and Department of Rheumatology, St. Vincent's Hospital, Melbourne, Australia
| | - Wendy Stevens
- Department of Rheumatology, St. Vincent's Hospital, Melbourne, Australia
| | - Molla Huq
- Department of Medicine, The University of Melbourne at St. Vincent's Hospital, Melbourne, Australia
| | - Joanne Sahhar
- Monash University and Monash Health, Clayton, Australia
| | | | - Jane Zochling
- Department of Rheumatology, Menzies Institute for Medical Research, Hobart, Australia
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, Australia
| | - Susanna M Proudman
- Rheumatology Unit, Royal Adelaide Hospital, North Terrace; and Discipline of Medicine, University of Adelaide, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St. Vincent's Hospital; and Department of Rheumatology, St. Vincent's Hospital, Melbourne, Australia.
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27
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Boulos D, Ngian GS, Rajadurai A, Elford K, Stevens W, Proudman S, Owen C, Roddy J, Nikpour M, Youssef P, Hill C, Sahhar J. Long-term efficacy and tolerability of mycophenolate mofetil therapy in diffuse scleroderma skin disease. Int J Rheum Dis 2017; 20:481-488. [DOI: 10.1111/1756-185x.13035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Daniel Boulos
- Department of Rheumatology; Monash Health; Melbourne Victoria Australia
| | - Gene-Siew Ngian
- Department of Rheumatology; Monash Health; Melbourne Victoria Australia
| | - Anton Rajadurai
- Department of Rheumatology; Monash Health; Melbourne Victoria Australia
| | - Kathleen Elford
- Department of Rheumatology; Monash Health; Melbourne Victoria Australia
| | - Wendy Stevens
- Department of Rheumatology; St Vincent's Health; Melbourne Victoria Australia
| | - Susanna Proudman
- Department of Rheumatology; Royal Adelaide Hospital; Adelaide South Australia Australia
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Claire Owen
- Department of Rheumatology; Austin Health; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
| | - Janet Roddy
- Department of Rheumatology; Royal Perth Hospital; Perth Western Australia Australia
| | - Mandana Nikpour
- Department of Rheumatology; St Vincent's Health; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
| | - Peter Youssef
- Department of Rheumatology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Catherine Hill
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
- Department of Rheumatology; Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - Joanne Sahhar
- Department of Rheumatology; Monash Health; Melbourne Victoria Australia
- Department of Medicine; Monash University; Melbourne Victoria Australia
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28
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Herrick AL, Pan X, Peytrignet S, Lunt M, Hesselstrand R, Mouthon L, Silman A, Brown E, Czirják L, Distler JHW, Distler O, Fligelstone K, Gregory WJ, Ochiel R, Vonk M, Ancuţa C, Ong VH, Farge D, Hudson M, Matucci-Cerinic M, Balbir-Gurman A, Midtvedt Ø, Jordan AC, Jobanputra P, Stevens W, Moinzadeh P, Hall FC, Agard C, Anderson ME, Diot E, Madhok R, Akil M, Buch MH, Chung L, Damjanov N, Gunawardena H, Lanyon P, Ahmad Y, Chakravarty K, Jacobsen S, MacGregor AJ, McHugh N, Müller-Ladner U, Riemekasten G, Becker M, Roddy J, Carreira PE, Fauchais AL, Hachulla E, Hamilton J, İnanç M, McLaren JS, van Laar JM, Pathare S, Proudman S, Rudin A, Sahhar J, Coppere B, Serratrice C, Sheeran T, Veale DJ, Grange C, Trad GS, Denton CP. Treatment outcome in early diffuse cutaneous systemic sclerosis: the European Scleroderma Observational Study (ESOS). Ann Rheum Dis 2017; 76:1207-1218. [PMID: 28188239 PMCID: PMC5530354 DOI: 10.1136/annrheumdis-2016-210503] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/24/2016] [Accepted: 11/25/2016] [Indexed: 12/30/2022]
Abstract
Objectives The rarity of early diffuse cutaneous systemic sclerosis (dcSSc) makes randomised controlled trials very difficult. We aimed to use an observational approach to compare effectiveness of currently used treatment approaches. Methods This was a prospective, observational cohort study of early dcSSc (within three years of onset of skin thickening). Clinicians selected one of four protocols for each patient: methotrexate, mycophenolate mofetil (MMF), cyclophosphamide or ‘no immunosuppressant’. Patients were assessed three-monthly for up to 24 months. The primary outcome was the change in modified Rodnan skin score (mRSS). Confounding by indication at baseline was accounted for using inverse probability of treatment (IPT) weights. As a secondary outcome, an IPT-weighted Cox model was used to test for differences in survival. Results Of 326 patients recruited from 50 centres, 65 were prescribed methotrexate, 118 MMF, 87 cyclophosphamide and 56 no immunosuppressant. 276 (84.7%) patients completed 12 and 234 (71.7%) 24 months follow-up (or reached last visit date). There were statistically significant reductions in mRSS at 12 months in all groups: −4.0 (−5.2 to −2.7) units for methotrexate, −4.1 (−5.3 to −2.9) for MMF, −3.3 (−4.9 to −1.7) for cyclophosphamide and −2.2 (−4.0 to −0.3) for no immunosuppressant (p value for between-group differences=0.346). There were no statistically significant differences in survival between protocols before (p=0.389) or after weighting (p=0.440), but survival was poorest in the no immunosuppressant group (84.0%) at 24 months. Conclusions These findings may support using immunosuppressants for early dcSSc but suggest that overall benefit is modest over 12 months and that better treatments are needed. Trial registration number NCT02339441.
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Affiliation(s)
- Ariane L Herrick
- Centre for Musculoskeletal Research, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Xiaoyan Pan
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Sébastien Peytrignet
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Mark Lunt
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Luc Mouthon
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence pour les Vascularites Nécrosantes et la Sclérodermie Systémique, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alan Silman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences,University of Oxford, Oxford, UK
| | - Edith Brown
- Member of Steering Committee, contact via Professor Herrick, The University of Manchester, Manchester, UK
| | - László Czirják
- Department of Rheumatology and Immunology, Medical Center, University of Pécs, Pecs, Hungary
| | - Jörg H W Distler
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Oliver Distler
- Department of Rheumatology, University of Zurich, Zurich, Switzerland
| | | | - William J Gregory
- Rehabilitation Services, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Madelon Vonk
- Department of the Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Codrina Ancuţa
- Rheumatology 2 Department, "Grigore T. Popa" University of Medicine and Pharmacy, Clinical Rehabilitation Hospital, Iași, Romania
| | - Voon H Ong
- UCL Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, London, UK
| | - Dominique Farge
- Unité Clinique de Médecine Interne, Maladies Auto-immunes et Pathologie Vasculaire, UF 04, Hôpital Saint-Louis, AP-HP Assistance Publique des Hôpitaux de Paris, INSERM UMRS 1160, Paris Denis Diderot University, France
| | - Marie Hudson
- Jewish General Hospital, Lady Davis Institute and McGill University, Montreal, Canada
| | - Marco Matucci-Cerinic
- Department Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Alexandra Balbir-Gurman
- Shine Rheumatology Unit, Rambam Heath Care Campus; Rappaport Faculty of Medicine, Haifa, Israel
| | - Øyvind Midtvedt
- Rheumatology Unit, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Alison C Jordan
- Queen Elizabeth Hospital Birmingham, UHB Foundation Trust, Birmingham, UK
| | - Paresh Jobanputra
- Queen Elizabeth Hospital Birmingham, UHB Foundation Trust, Birmingham, UK
| | | | - Pia Moinzadeh
- Department for Dermatology, University of Cologne Kerpenerstr. 62, Köln, Germany
| | - Frances C Hall
- Cambridge University NHS Hospital Foundation Trust, Cambridge, UK
| | - Christian Agard
- Department of Internal Medicine, Hôtel-Dieu Hospital, University of Nantes, Nantes, France
| | | | - Elisabeth Diot
- Service de Médecine Interne, Hôpital Bretonneau Tours Cedex, France
| | - Rajan Madhok
- Centre for Rheumatic Diseases, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Maya H Buch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, UK
| | | | - Nemanja Damjanov
- University of Belgrade School of Medicine, Institute of Rheumatology, Belgrade, Serbia
| | - Harsha Gunawardena
- Clinical and Academic Rheumatology, North Bristol NHS Trust, Bristol, UK
| | - Peter Lanyon
- Nottingham University Hospitals NHS Trust, and Nottingham NHS Treatment Centre, Nottingham, UK
| | | | | | - Søren Jacobsen
- University of Copenhagen, Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | - Neil McHugh
- Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Bad Nauheim, Germany
| | | | - Michael Becker
- Department of Rheumatology and Clinical Immunology, University Hospital Charité Berlin, Berlin, Germany
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, Australia
| | - Patricia E Carreira
- Servicio de Reumatologia. Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre National de Référence Maladies Systémiques etAuto-immunes Rares, Université de Lille, Inserm, U995, FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies, Lille, France
| | | | - Murat İnanç
- Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul, Turkey
| | - John S McLaren
- Fife Rheumatic Diseases Unit, Whyteman's Brae Hospital, Kirkcaldy, UK
| | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Susannah Proudman
- Rheumatology Unit, Royal Adelaide Hospital, and Discipline of Medicine, University of Adelaide, Adelaide, South Australia
| | - Anna Rudin
- Department of Rheumatology and Inflammation Research, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Joanne Sahhar
- Monash Centre for Inflammatory Diseases, Monash University, Clayton, Melbourne, Australia
| | - Brigitte Coppere
- Department of Internal Medicine, Hôpital Edouard Herriot, Lyon, France
| | - Christine Serratrice
- Department of Internal Medicine, Foundation Hospital Saint Joseph, Marseille, France
| | | | | | - Claire Grange
- Department of Internal Medicine, Centre Hospitalier Lyon Sud, Pierre Benite, France
| | | | - Christopher P Denton
- UCL Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, London, UK
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Esposito J, Brown Z, Stevens W, Sahhar J, Rabusa C, Zochling J, Roddy J, Walker J, Proudman SM, Nikpour M. The association of low complement with disease activity in systemic sclerosis: a prospective cohort study. Arthritis Res Ther 2016; 18:246. [PMID: 27770830 PMCID: PMC5075219 DOI: 10.1186/s13075-016-1147-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 10/05/2016] [Indexed: 01/27/2023] Open
Abstract
Background In some rheumatic diseases such as systemic lupus erythematosus (SLE), low serum complement (‘hypocomplementaemia’) is a feature of active disease. However, the role of hypocomplementaemia in systemic sclerosis (SSc) is unknown. We sought to determine the frequency, clinical associations and relationship to disease activity of hypocomplementaemia in SSc. Methods The study included 1140 patients fulfilling the 2013 American College of Rheumatology criteria for SSc. Demographic, serological and clinical data, obtained prospectively through annual review, were analysed using univariable methods. Linear and logistic regression, together with generalised estimating equations, were used to determine the independent correlates of hypocomplementaemia ever, and at each visit, respectively. Results At least one episode of hypocomplementaemia (low C3 and/or low C4) occurred in 24.1 % of patients over 1893 visits; these patients were more likely to be seropositive for anti-ribonucleoprotein (OR = 3.8, p = 0.002), anti-Ro (OR = 2.2, p = 0.002), anti-Smith (OR = 6.3, p = 0.035) and anti-phospholipid antibodies (OR = 1.4, p = 0.021) and were more likely to display features of overlap connective tissue disease, in particular polymyositis (OR = 16.0, p = 0.012). However, no association was found between hypocomplementaemia and either the European Scleroderma Study Group disease activity score or any of its component variables (including erythrocyte sedimentation rate) in univariate analysis. Among patients with SSc overlap disease features, those who were hypocomplementaemic were more likely to have digital ulcers (OR = 1.6, p = 0.034), tendon friction rubs (OR = 2.4, p = 0.037), forced vital capacity <80 % predicted (OR = 2.9, p = 0.008) and lower body mass index (BMI) (OR for BMI = 0.9, p < 0.0005) at that visit, all of which are features associated with SSc disease activity and/or severity. Conclusions While hypocomplementaemia is not associated with disease activity in patients with non-overlap SSc, it is associated with some features of increased SSc disease activity in patients with overlap disease features.
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Affiliation(s)
- James Esposito
- Department of Medicine, The University of Melbourne at St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.,Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Zoe Brown
- Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Joanne Sahhar
- Department of Rheumatology, Monash Health and Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia.,Department of Medicine, Monash Health and Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Candice Rabusa
- Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Jane Zochling
- Department of Rheumatology, Menzies Institute for Medical Research, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, 197 Wellington Street, GPO Box X2213, Perth, WA, 6001, Australia
| | - Jennifer Walker
- Department of Rheumatology, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia
| | - Susanna M Proudman
- Rheumatology Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA, 5000, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Mandana Nikpour
- Department of Medicine, The University of Melbourne at St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, VIC, 3065, Australia. .,Department of Rheumatology, St Vincent's Hospital (Melbourne), 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
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30
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Quinlivan A, Thakkar V, Stevens W, Morrisroe K, Prior D, Rabusa C, Youssef P, Gabbay E, Roddy J, Walker JG, Zochling J, Sahhar J, Nash P, Lester S, Rischmueller M, Proudman SM, Nikpour M. Cost savings with a new screening algorithm for pulmonary arterial hypertension in systemic sclerosis. Intern Med J 2016; 45:1134-40. [PMID: 26337683 DOI: 10.1111/imj.12890] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 08/20/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Screening for pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) is now standard care in this disease. The existing Australian Scleroderma Interest Group algorithm (ASIGSTANDARD ) is based on transthoracic echocardiography (TTE) and pulmonary function tests (PFT). Recently, ASIG has derived and validated a new screening algorithm (ASIGPROPOSED ) that incorporates N-terminal pro-B-type natriuretic peptide level together with PFT in order to decrease reliance on TTE, which has some limitations. Right heart catheterisation (RHC) remains the gold standard for the diagnosis of PAH in patients who screen 'positive'. AIM To compare the cost of PAH screening in SSc with ASIGSTANDARD and ASIGPROPOSED algorithms. METHODS We applied both ASIGSTANDARD and ASIGPROPOSED algorithms to 643 screen-naïve SSc patients from the Australian Scleroderma Cohort Study (ASCS), assuming a PAH prevalence of 10%. We compared the costs of screening, the number of TTE required and both the total number of RHC required and the number of RHC needed to diagnose one case of PAH, and costs, according to each algorithm. We then extrapolated the costs to the estimated total Australian SSc population. RESULTS In screen-naïve patients from the ASCS, ASIGPROPOSED resulted in 64% fewer TTE and 10% fewer RHC compared with ASIGSTANDARD , with $1936 (15%) saved for each case of PAH diagnosed. When the costs were extrapolated to the entire Australian SSc population, there was an estimated screening cost saving of $946 000 per annum with ASIGPROPOSED , with a cost saving of $851 400 in each subsequent year of screening. CONCLUSIONS ASIGPROPOSED substantially reduces the number of TTE and RHC required and results in substantial cost savings in SSc-PAH screening compared with ASIGSTANDARD .
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Affiliation(s)
- A Quinlivan
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine at St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - V Thakkar
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Rheumatology, Liverpool Hospital, Sydney, New South Wales, Australia.,School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
| | - W Stevens
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - K Morrisroe
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - D Prior
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine at St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
| | - C Rabusa
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - P Youssef
- Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - E Gabbay
- The University of Notre Dame, Fremantle, Australia
| | - J Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - J G Walker
- Department of Rheumatology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - J Zochling
- Menzies Institute for Medical Research, Hobart, Tasmania, Australia
| | - J Sahhar
- Department of Rheumatology, Monash University, Monash Health, Melbourne, Victoria, Australia
| | - P Nash
- Rheumatology Research Unit, Department of Medicine, University of Queensland, Sunshine Coast, Queensland, Australia
| | - S Lester
- Rheumatology Department, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - M Rischmueller
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Rheumatology Department, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - S M Proudman
- Department of Rheumatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - M Nikpour
- Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine at St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia
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31
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Owen C, Ngian GS, Elford K, Moore O, Stevens W, Nikpour M, Rabusa C, Proudman S, Roddy J, Zochling J, Hill C, Sturgess A, Tymms K, Youssef P, Sahhar J. Mycophenolate mofetil is an effective and safe option for the management of systemic sclerosis-associated interstitial lung disease: results from the Australian Scleroderma Cohort Study. Clin Exp Rheumatol 2016; 34 Suppl 100:170-176. [PMID: 27049330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 12/21/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To report the efficacy and tolerability of mycophenolate mofetil (MMF) and azathioprine (AZA) in the management of systemic sclerosis-associated interstitial lung disease (SSc-ILD). METHODS Patients in the Australian Scleroderma Cohort Study treated with at least 3 months of MMF or AZA for SSc-ILD confirmed on high resolution computed tomography (HRCT) chest were identified and their pulmonary function tests (PFTs) retrieved. Individuals with available results for T-1 (12 months prior to treatment commencement), T0 (date of treatment commencement) and at least one subsequent time point were included in the drug efficacy analysis. The Wilcoxon signed-rank test was used to compare absolute FVC at T1, T0, 12 months (T1), 24 months (T2) and 36 months (T3). Analysis of drug tolerability included all identified patients treated with MMF or AZA. RESULTS 18/22 patients treated with MMF and 29/49 treated with AZA had adequate PFTs for inclusion in the drug efficacy analysis. Median absolute FVC at T1 for MMF treatment was 2.50L, declining to 2.12L at T0 (p=0.02). Following MMF therapy, FVC results were stable at T1 (2.13L, p=0.86), T2 (2.17L, p=0.65) and T3 (2.25L, p=0.78). In the AZA group, a statistically significant decline did not occur prior to treatment, however FVC results remained stable at T1, T2 and T3.Adverse events leading to early discontinuation (<12 months treatment) were less common in the MMF group (4/22 vs. 13/49). Gastrointestinal complications were the main cause of discontinuation in both groups. CONCLUSIONS In patients with SSc-ILD with declining pulmonary function, MMF therapy was associated with stability for up to 36 months. Early adverse events leading to discontinuation occurred less frequently in patients treated with MMF than in AZA treated patients.
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MESH Headings
- Adult
- Aged
- Australia
- Azathioprine/therapeutic use
- Databases, Factual
- Drug Therapy, Combination
- Female
- Humans
- Immunosuppressive Agents/adverse effects
- Immunosuppressive Agents/therapeutic use
- Longitudinal Studies
- Lung/drug effects
- Lung/physiopathology
- Lung Diseases, Interstitial/diagnosis
- Lung Diseases, Interstitial/drug therapy
- Lung Diseases, Interstitial/etiology
- Lung Diseases, Interstitial/physiopathology
- Male
- Middle Aged
- Mycophenolic Acid/adverse effects
- Mycophenolic Acid/therapeutic use
- Respiratory Function Tests
- Retrospective Studies
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/diagnosis
- Scleroderma, Systemic/drug therapy
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Claire Owen
- Department of Rheumatology, Monash Health, Clayton VIC, Australia
| | - Gene-Siew Ngian
- Department of Rheumatology, Monash Health, Clayton VIC, Australia
| | - Kathleen Elford
- Department of Rheumatology, Monash Health, Clayton VIC, Australia
| | | | | | - Mandana Nikpour
- St. Vincent's Hospital, Melbourne VIC, Australia; and University of Melbourne, Parkville VIC, Australia
| | | | - Susanna Proudman
- Royal Adelaide Hospital, North Terrace SA, Australia; and Discipline of Medicine, University of Adelaide, SA, Australia
| | | | - Jane Zochling
- Menzies Institute for Medical Research, Hobart TAS, Australia
| | - Catherine Hill
- The Queen Elizabeth Hospital, Woodville South SA, Australia; and Discipline of Medicine, University of Adelaide, SA, Australia
| | | | | | - Peter Youssef
- Royal Prince Alfred Hospital, Camperdown NSW, Australia
| | - Joanne Sahhar
- Department of Rheumatology, Monash Health, Clayton VIC, Australia; and Department of Medicine, Monash University, Clayton, VIC, Australia.
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Thakkar V, Stevens W, Prior D, Rabusa C, Sahhar J, Walker JG, Roddy J, Lester S, Rischmueller M, Zochling J, Nash P, Gabbay E, Youssef P, Proudman SM, Nikpour M. The role of asymmetric dimethylarginine alone and in combination with N-terminal pro-B-type natriuretic peptide as a screening biomarker for systemic sclerosis-related pulmonary arterial hypertension: a case control study. Clin Exp Rheumatol 2016; 34 Suppl 100:129-136. [PMID: 27214686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 01/08/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Asymmetric dimethylarginine (ADMA) is a novel biomarker of endothelial cell dysfunction. In this proof of concept study, we sought to evaluate the role of ADMA as a screening biomarker for incident systemic sclerosis-related pulmonary arterial hypertension (SSc-PAH). METHODS ADMA levels were measured using high performance liquid chromatography in 15 consecutive treatment-naive patients with newly-diagnosed SSc-PAH and compared with 30 SSc-controls without PAH. Logistic regression models were used to evaluate the independent association of ADMA with PAH. The optimal cut-point of ADMA for SSc-PAH screening was determined. NT-proBNP levels were previously measured in the same patients and the optimal cut-point of NT-proBNP of ≥210ng/mL was coupled with the optimal cut-point of ADMA to create a screening model that combined the two biomarkers. RESULTS The PAH group had significantly higher mean ADMA levels than the control group (0.76±0.14 μM versus 0.59±0.07 μM; p<0.0001). ADMA levels remained significantly associated with PAH after the adjustment for specific disease characteristics, cardiovascular risk factors and other SSc-related vascular complications (all p<0.01). An ADMA level ≥0.7 μM had a sensitivity of 86.7%, specificity of 90.0% and AUC of 0.86 for diagnosing PAH. A screening model that combined an NT-proBNP ≥210ng/mL and/ or ADMA ≥0.7 ng/mL resulted in a sensitivity of 100% and specificity of 90% for the detection of SSc-PAH. CONCLUSIONS In this small study, use of ADMA in combination with NT-proBNP produced excellent sensitivity and specificity for the non-invasive identification of SSc-PAH. The role of ADMA as a screening biomarker for SSc-PAH merits further evaluation.
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Affiliation(s)
- Vivek Thakkar
- Department of Medicine; Department of Rheumatology, St. Vincent's Hospital Melbourne, Fitzroy; Department of Rheumatology, Liverpool Hospital, Liverpool; and School of Medicine, University of Western Sydney, Penrith, Australia
| | - Wendy Stevens
- Department of Medicine, St. Vincent's Hospital Melbourne, Fitzroy, Australia
| | - David Prior
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Candice Rabusa
- Department of Rheumatology, St. Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Joanne Sahhar
- Department of Rheumatology, Monash Medical Centre, Clayton, Australia
| | - Jennifer G Walker
- Department of Rheumatology, Flinders Medical Centre, Bedford Park, Australia
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Perth, Australia
| | - Susan Lester
- Rheumatology Department, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Maureen Rischmueller
- Rheumatology Department, The Queen Elizabeth Hospital, Woodville South, Australia
| | - Jane Zochling
- Department of Rheumatology, The Menzies Institute, Hobart, Australia
| | - Peter Nash
- Rheumatology Research Unit, Department of Medicine, University of Queensland, Maroochydore, Australia
| | - Eli Gabbay
- The University of Notre Dame, Fremantle, Australia
| | - Peter Youssef
- Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Susanna M Proudman
- Royal Adelaide Hospital, North Terrace; and Discipline of Medicine, University of Adelaide, Australia
| | - Mandana Nikpour
- Department of Medicine; and Department of Rheumatology, St. Vincent's Hospital Melbourne, Fitzroy, Australia.
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33
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Boulos D, Rajadurai A, Ngian G, Elford K, Stevens W, Proudman S, Roddy J, Nikpour M, Youssef P, Hill C, Sahhar J. FRI0266 Long-Term Efficacy and Tolerability of Mycophenolate Mofetil Therapy in Diffuse Scleroderma Skin Disease. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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34
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Patterson KA, Roberts-Thomson PJ, Lester S, Tan JA, Hakendorf P, Rischmueller M, Zochling J, Sahhar J, Nash P, Roddy J, Hill C, Nikpour M, Stevens W, Proudman SM, Walker JG. Interpretation of an Extended Autoantibody Profile in a Well-Characterized Australian Systemic Sclerosis (Scleroderma) Cohort Using Principal Components Analysis. Arthritis Rheumatol 2016; 67:3234-44. [PMID: 26246178 DOI: 10.1002/art.39316] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/30/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To determine the relationships between systemic sclerosis (SSc)-related autoantibodies, as well as their clinical associations, in a well-characterized Australian patient cohort. METHODS Serum from 505 Australian SSc patients were analyzed with a commercial line immunoassay (EuroLine; Euroimmun) for autoantibodies to centromere proteins CENP-A and CENP-B, RNA polymerase III (RNAP III; epitopes 11 and 155), the 90-kd nucleolar protein NOR-90, fibrillarin, Th/To, PM/Scl-75, PM/Scl-100, Ku, topoisomerase I (topo I), tripartite motif-containing protein 21/Ro 52, and platelet-derived growth factor receptor. Patient subgroups were identified by hierarchical clustering of the first 2 dimensions of a principal components analysis of quantitative autoantibody scores. Results were compared with detailed clinical data. RESULTS A total of 449 of the 505 patients were positive for at least 1 autoantibody by immunoblotting. Heatmap visualization of autoantibody scores, along with principal components analysis clustering, demonstrated strong, mutually exclusive relationships between CENP, RNAP III, and topo I. Five patient clusters were identified: CENP, RNAP III strong, RNAP III weak, topo I, and other. Clinical features associated with CENP, RNAP III, and topo I were consistent with previously published reports concerning limited cutaneous and diffuse cutaneous SSc. A novel finding was the statistical separation of RNAP III into 2 clusters. Patients in the RNAP III strong cluster had an increased risk of gastric antral vascular ectasia, but a lower risk of esophageal dysmotility. Patients in the other cluster were more likely to be male and to have a history of smoking and a history of malignancy, but were less likely to have telangiectasia, Raynaud's phenomenon, and joint contractures. CONCLUSION Five major autoantibody clusters with specific clinical and serologic associations were identified in Australian SSc patients. Subclassification and disease stratification using autoantibodies may have clinical utility, particularly in early disease.
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Affiliation(s)
- K A Patterson
- Flinders University, Bedford Park, South Australia, and Commonwealth Scientific and Industrial Research Organization (CSIRO), Adelaide, South Australia, Australia
| | - P J Roberts-Thomson
- Flinders University and Flinders Medical Centre, Bedford Park, South Australia, and SA Pathology, Adelaide, South Australia, Australia
| | - S Lester
- Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - J A Tan
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - P Hakendorf
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - M Rischmueller
- University of Adelaide, Adelaide, South Australia, and Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - J Zochling
- Menzies Institute for Medical Research, Hobart, Tasmania, Australia
| | - J Sahhar
- Monash Health and Monash University, Melbourne, Victoria, Australia
| | - P Nash
- University of Queensland, Brisbane, Queensland, Australia
| | - J Roddy
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - C Hill
- University of Adelaide, Adelaide, South Australia, and Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - M Nikpour
- University of Melbourne and St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - W Stevens
- St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - S M Proudman
- University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - J G Walker
- Flinders University and Flinders Medical Centre, Bedford Park, South Australia, and Repatriation General Hospital, Daw Park, South Australia, Australia
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35
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Moore OA, Proudman SM, Goh N, Corte TJ, Rouse H, Hennessy O, Morrisroe K, Thakkar V, Sahhar J, Roddy J, Youssef P, Gabbay E, Nash P, Zochling J, Stevens W, Nikpour M. Quantifying change in pulmonary function as a prognostic marker in systemic sclerosis-related interstitial lung disease. Clin Exp Rheumatol 2015; 33:S111-S116. [PMID: 26243401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 04/23/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Clinically meaningful change in systemic sclerosis (SSc) related interstitial lung (SSc-ILD) disease is unknown. The aim of this study was to quantify change in pulmonary function as a predictor of outcome in SSc-ILD. METHODS All patients had SSc-ILD defined by HRCT chest. All PFTs during follow-up, including FVC (L), DLCO (ml/min/mmHg) and KCO (DLCO/alveolar volume ratio; DLCO/VA) (ml/min/mmHg/L) were retrieved. The rate of change over the first four years, and percentage change in the first year of follow-up were used in ROC curve analysis to determine the best cut-off points to predict adverse outcome (home oxygen, lung transplantation, or death). RESULTS Among 264 patients, there were 49 events (38 deaths, 10 supplemental oxygen, one lung transplant) over a mean (±SD) follow-up of 3.0 (±1.7) years. The rates of decline over time and percentage change over one year in each of FVC, DLCO and KCO were predictive of adverse outcome. Stable PFTs over four years gave the optimal negative predictive values (NPVs) of 88-96%. The best sensitivity-specificity trade-off was a decline in FVC of 10% and in DLCO and KCO of 15% with NPVs of 92-93%. CONCLUSIONS The course that SSc-ILD takes is evident within the first 1-4 years of follow up. Patients who have no decline in PFTs over 4 years have better outcomes. A decline within one year in DLCO or KCO of 15% or more is a poor prognostic factor, and identifies patients who should be monitored more closely and considered for therapy.
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MESH Headings
- Aged
- Area Under Curve
- Australia
- Disease Progression
- Female
- Humans
- Lung/physiopathology
- Lung Diseases, Interstitial/diagnosis
- Lung Diseases, Interstitial/etiology
- Lung Diseases, Interstitial/mortality
- Lung Diseases, Interstitial/physiopathology
- Lung Diseases, Interstitial/therapy
- Male
- Middle Aged
- Predictive Value of Tests
- Prognosis
- Prospective Studies
- Pulmonary Diffusing Capacity
- ROC Curve
- Respiratory Function Tests
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/diagnosis
- Scleroderma, Systemic/mortality
- Scleroderma, Systemic/therapy
- Time Factors
- Tomography, X-Ray Computed
- Vital Capacity
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Affiliation(s)
- Owen A Moore
- Department of Rheumatology, St. Vincent's Hospital Melbourne, Victoria, Australia, and Department of Rheumatology, Derriford Hospital, Plymouth, Devon, UK
| | - Susanna M Proudman
- Rheumatology Unit, Royal Adelaide Hospital; and Discipline of Medicine, University of Adelaide, South Australia
| | - Nicole Goh
- Department of Respiratory Medicine, Austin Hospital Melbourne, Victoria; and Department of Respiratory Medicine, Alfred Hospital Melbourne, Victoria, Australia
| | - Tamera J Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital Sydney, New South Wales, Australia
| | - Hannah Rouse
- Department of Radiology, St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Oliver Hennessy
- Department of Radiology, St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Kathleen Morrisroe
- Department of Rheumatology, St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Vivek Thakkar
- Department of Rheumatology, St. Vincent's Hospital Melbourne, Victoria; and Department of Rheumatology, Liverpool Hospital Sydney; and School of Medicine, University of Western Sydney, New South Wales, Australia
| | - Joanne Sahhar
- Department of Rheumatology, Monash Medical Centre Melbourne, Victoria, Australia
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Western Australia
| | - Peter Youssef
- Department of Rheumatology, Royal Prince Alfred Hospital and Sydney University, New South Wales, Australia
| | - Eli Gabbay
- Advanced Lung Disease Unit, Royal Perth Hospital; and The University of Notre Dame, Fremantle, Western Australia
| | - Peter Nash
- Rheumatology Research Unit, Department of Medicine, University of Queensland, QLD, Australia
| | | | - Wendy Stevens
- Department of Rheumatology, St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Mandana Nikpour
- Department of Rheumatology, St. Vincent's Hospital Melbourne, Victoria; and The University of Melbourne Department of Medicine, St. Vincent's Hospital Melbourne, Victoria, Australia.
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Hao Y, Thakkar V, Stevens W, Morrisroe K, Prior D, Rabusa C, Youssef P, Gabbay E, Roddy J, Walker J, Zochling J, Sahhar J, Nash P, Lester S, Rischmueller M, Proudman SM, Nikpour M. A comparison of the predictive accuracy of three screening models for pulmonary arterial hypertension in systemic sclerosis. Arthritis Res Ther 2015; 17:7. [PMID: 25596924 PMCID: PMC4332896 DOI: 10.1186/s13075-015-0517-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 01/05/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION There is evidence that early screening for pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) improves outcomes. We compared the predictive accuracy of two recently published screening algorithms (DETECT 2013 and Australian Scleroderma Interest Group (ASIG) 2012) for SSc-associated PAH (SSc-PAH) with the commonly used European Society of Cardiology/European Respiratory Society (ESC/ERS 2009) guidelines. METHODS We included 73 consecutive SSc patients with suspected PAH undergoing right heart catheterization (RHC). The three screening models were applied to each patient. For each model, contingency table analysis was used to determine sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values for PAH. These properties were also evaluated in an 'alternate scenario analysis' in which the prevalence of PAH was set at 10%. RESULTS RHC revealed PAH in 27 (36.9%) patients. DETECT and ASIG algorithms performed equally in predicting PAH with sensitivity and NPV of 100%. The ESC/ERS guidelines had sensitivity of 96.3% and NPV of only 91%, missing one case of PAH; these guidelines could not be applied to three patients who had absent tricuspid regurgitant (TR) jet. The ASIG algorithm had the highest specificity (54.5%). With PAH prevalence set at 10%, the NPV of the models was unchanged, but the PPV dropped to less than 20%. CONCLUSIONS In this cohort, the DETECT and ASIG algorithms out-perform the ESC/ERS guidelines, detecting all patients with PAH. The ESC/ERS guidelines have limitations in the absence of a TR jet. Ultimately, the choice of SSc-PAH screening algorithm will also depend on cost and ease of application.
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Affiliation(s)
- Yanjie Hao
- Department of Rheumatology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia. .,Department of Rheumatology and Clinical Immunology, Peking University First Hospital, 8 Xishiku Street, Beijing, China.
| | - Vivek Thakkar
- Department of Rheumatology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia. .,Department of Rheumatology, Liverpool Hospital, Elizabeth Street, Liverpool, NSW 2170, Australia. .,School of Medicine, University of Western Sydney, Locked bag 1797, Penrith, NSW 2751, Australia.
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
| | - Kathleen Morrisroe
- Department of Rheumatology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
| | - David Prior
- Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
| | - Candice Rabusa
- Department of Rheumatology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
| | - Peter Youssef
- Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Queen Elizabeth II building, Missendon Road, Camperdown, NSW 2050, Australia.
| | - Eli Gabbay
- The University of Notre Dame, 19 Mouat Street, Fremantle, WA, 6959, Australia.
| | - Janet Roddy
- Department of Rheumatology, Royal Perth Hospital, Wellington Street, GPO Box X2213, Perth, WA, 6001, Australia.
| | - Jennifer Walker
- Department of Rheumatology, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.
| | - Jane Zochling
- Department of Rheumatology, The Menzies Institute Tasmania, Private Bag 23, Hobart, TAS 7001, Australia.
| | - Joanne Sahhar
- Department of Rheumatology, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Australia.
| | - Peter Nash
- Rheumatology Research Unit, Department of Medicine, University of Queensland, PO Box 368, Maroochydore, QLD 4558, Australia.
| | - Susan Lester
- Rheumatology Department, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, 5011, Australia.
| | - Maureen Rischmueller
- Rheumatology Department, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA, 5011, Australia. .,Discipline of Medicine, University of Adelaide, North Terrace, SA, 5000, Australia.
| | - Susanna M Proudman
- Department of Rheumatology, Royal Adelaide Hospital, North Terrace, SA, 5000, Australia. .,Discipline of Medicine, University of Adelaide, North Terrace, SA, 5000, Australia.
| | - Mandana Nikpour
- Department of Rheumatology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia. .,Department of Medicine at St Vincent's Hospital Melbourne, The University of Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
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Thakkar V, Stevens W, Prior D, Youssef P, Liew D, Gabbay E, Roddy J, Walker JG, Zochling J, Sahhar J, Nash P, Lester S, Rischmueller M, Proudman SM, Nikpour M. The inclusion of N-terminal pro-brain natriuretic peptide in a sensitive screening strategy for systemic sclerosis-related pulmonary arterial hypertension: a cohort study. Arthritis Res Ther 2014; 15:R193. [PMID: 24246100 PMCID: PMC3978999 DOI: 10.1186/ar4383] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 11/07/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) is a major cause of mortality in systemic sclerosis (SSc). Screening guidelines for PAH recommend multiple investigations, including annual echocardiography, which together have low specificity and may not be cost-effective. We sought to evaluate the predictive accuracy of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) in combination with pulmonary function tests (PFT) (‘proposed’ algorithm) in a screening algorithm for SSc-PAH. METHODS We evaluated our proposed algorithm (PFT with NT-proBNP) on 49 consecutive SSc patients with suspected pulmonary hypertension undergoing right heart catherisation (RHC). The predictive accuracy of the proposed algorithm was compared with existing screening recommendations, and is presented as sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS Overall, 27 patients were found to have pulmonary hypertension (PH) at RHC, while 22 had no PH. The sensitivity, specificity, PPV and NPV of the proposed algorithm for PAH was 94.1%, 54.5%, 61.5% and 92.3%, respectively; current European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines achieved a sensitivity, specificity, PPV and NPV of 94.1%, 31.8%, 51.6% and 87.5%, respectively. In an alternate case scenario analysis, estimating a PAH prevalence of 10%, the proposed algorithm achieved a sensitivity, specificity, PPV and NPV for PAH of 94.1%, 54.5%, 18.7% and 98.8%, respectively. CONCLUSIONS The combination of NT-proBNP with PFT is a sensitive, yet simple and non-invasive, screening strategy for SSc-PAH. Patients with a positive screening result can be referred for echocardiography, and further confirmatory testing for PAH. In this way, it may be possible to shift the burden of routine screening away from echocardiography. The findings of this study should be confirmed in larger studies.
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Morrisroe KB, Stevens W, Nandurkar H, Prior D, Thakkar V, Roddy J, Zochling J, Sahhar J, Tymms K, Sturgess A, Major G, Kermeen F, Hill C, Walker J, Nash P, Gabbay E, Youssef P, Proudman SM, Nikpour M. The association of antiphospholipid antibodies with cardiopulmonary manifestations of systemic sclerosis. Clin Exp Rheumatol 2014; 32:S-133-7. [PMID: 24564981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 11/15/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To determine the prevalence and correlates of antiphospholipid antibodies (APLA) in systemic sclerosis (SSc). METHODS Nine hundred and forty SSc patients were tested for APLA using an ELISA assay at recruitment. Clinical manifestations were defined as present, if ever present from SSc diagnosis. Logistic regression analysis was used to determine the associations of APLA. RESULTS One or more types of APLA were present in 226 (24.0%) patients. Anticardiolipin (ACA) IgG (ACA-IgG) antibodies were associated with right heart catheter-diagnosed pulmonary arterial hypertension (PAH), with higher titres corresponding with a higher likelihood of PAH (moderate titre (20-39 U/ml) ACA-IgG odds ratio [OR] 1.70, 95% CI: 1.01-2.93, p=0.047; high titre (>40 U/ml) ACA-IgG OR 4.60, 95% CI:1.02-20.8, p=0.047). Both ACA-IgM (OR 2.04, 95% CI: 1.4-3.0, p<0.0001) and ACA-IgG (OR 1.84, 95% CI: 1.2-2.8, p=0.005) were associated with interstitial lung disease (ILD). Increasing ACA-IgM and IgG titres were associated with increased likelihood of ILD. ACA-IgG was a marker of coexistent pulmonary hypertension and ILD (ILD-PH) (OR 2.10, 95% CI: 1.1-4.2, p=0.036). We also found an association between ACA-IgG and digital ulcers (OR 1.76, 95% CI: 1.16-2.67, p=0.008) and ACA-IgM and Raynaud's phenomenon (OR 2.39, 95% CI: 1.08-5.27, p=0.031). There was no association between APLA and SSc disease subtype, peak skin score, presence of other autoantibodies, mortality or other disease manifestations. CONCLUSIONS The association of APLA with PAH, ILD, ILD-PH, Raynaud's phenomenon and digital ulcers suggests that endothelial abnormalities and small vessel thrombosis may be important in the pathogenesis of these disease features.
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Affiliation(s)
- K B Morrisroe
- Department of Rheumatology, St. Vincent's Hospital, Melbourne, Australia.
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Zochling J, Newell F, Charlesworth JC, Leo P, Stankovich J, Cortes A, Zhou Y, Stevens W, Sahhar J, Roddy J, Nash P, Tymms K, Rischmueller M, Lester S, Proudman S, Brown MA. An Immunochip-based interrogation of scleroderma susceptibility variants identifies a novel association at DNASE1L3. Arthritis Res Ther 2014; 16:438. [PMID: 25332064 PMCID: PMC4230517 DOI: 10.1186/s13075-014-0438-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 08/26/2014] [Indexed: 02/07/2023] Open
Abstract
Introduction The aim of the study was to interrogate the genetic architecture and autoimmune pleiotropy of scleroderma susceptibility in the Australian population. Methods We genotyped individuals from a well-characterized cohort of Australian scleroderma patients with the Immunochip, a custom array enriched for single nucleotide polymorphisms (SNPs) at immune loci. Controls were taken from the 1958 British Birth Cohort. After data cleaning and adjusting for population stratification the final dataset consisted of 486 cases, 4,458 controls and 146,525 SNPs. Association analyses were conducted using logistic regression in PLINK. A replication study was performed using 833 cases and 1,938 controls. Results A total of eight loci with suggestive association (P <10-4.5) were identified, of which five showed significant association in the replication cohort (HLA-DRB1, DNASE1L3, STAT4, TNP03-IRF5 and VCAM1). The most notable findings were at the DNASE1L3 locus, previously associated with systemic lupus erythematosus, and VCAM1, a locus not previously associated with human disease. This study identified a likely functional variant influencing scleroderma susceptibility at the DNASE1L3 locus; a missense polymorphism rs35677470 in DNASE1L3, with an odds ratio of 2.35 (P = 2.3 × 10−10) in anti-centromere antibody (ACA) positive cases. Conclusions This pilot study has confirmed previously reported scleroderma associations, revealed further genetic overlap between scleroderma and systemic lupus erythematosus, and identified a putative novel scleroderma susceptibility locus. Electronic supplementary material The online version of this article (doi:10.1186/s13075-014-0438-8) contains supplementary material, which is available to authorized users.
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Ch'ng SS, Roddy J, Keen HI. A systematic review of ultrasonography as an outcome measure of skin involvement in systemic sclerosis. Int J Rheum Dis 2013; 16:264-72. [DOI: 10.1111/1756-185x.12106] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Shereen S. Ch'ng
- Rheumatology Unit; Department of Medicine; Selayang Hospital; Selangor Malaysia
| | - Janet Roddy
- Department of Rheumatology; Royal Perth Hospital; University of Western Australia; Perth Australia
| | - Helen I. Keen
- School of Medicine and Pharmacology; University of Western Australia; Perth Australia
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Moore O, Goh N, Corte T, Rouse H, Hennessy O, Thakkar V, Byron J, Sahhar J, Roddy J, Youssef P, Nash P, Zochling J, Proudman S, Stevens W, Nikpour M. THU0235 Identifying and quantifying prognostic factors in systemic sclerosis-related interstitial lung disease using a time-varying covariate survival model. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Charlesworth J, Stankovich J, Lewis P, Byron J, Stevens W, Sahhar J, Proudman S, Roddy J, Nash P, Tymms K, Brown M, Zochling J. THU0005 An immunochip based interrogation of scleroderma susceptibility variants. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Nikpour M, Baron M, Hudson M, Carreira P, Hunzelmann N, Frech T, Sahhar J, Nash P, Roddy J, Schrieber L, Stevens W, Proudman S. SAT0202 Early Accrual of Organ Damage in Systemic Sclerosis: Rationale for Forming a Multinational Inception Cohort of Patients with Scleroderma (The Insync Study). Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Moore O, Goh N, Corte T, Rouse H, Hennessy O, Thakkar V, Byron J, Sahhar J, Roddy J, Youssef P, Nash P, Zochling J, Proudman S, Stevens W, Nikpour M. FRI0243 Extent of disease on high-resolution CT lung is a predictor of decline and mortality in systemic sclerosis-related interstitial lung disease. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Thakkar V, Stevens W, Prior D, Moore O, Byron J, Patterson K, Hissaria P, Roddy J, Zochling J, Sahhar J, Nash P, Tymms K, Celermajer D, Gabbay E, Youssef P, Proudman S, Nikpour M. THU0258 N-terminal pro-brain natriuretic peptide in a novel screening algorithm for pulmonary arterial hypertension in systemic sclerosis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Nikpour M, Baron M, Hudson M, Carreira P, Hunzelmann N, Frech T, Sahhar J, Nash P, Major G, Youssef P, Roddy J, Zochling J, Proudman S, Stevens W. FRI0372 Early mortality in systemic sclerosis: rationale for forming a multinational inception cohort of patients with scleroderma (the insync study). Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Moore OA, Goh N, Corte T, Rouse H, Hennessy O, Thakkar V, Byron J, Sahhar J, Roddy J, Gabbay E, Youssef P, Nash P, Zochling J, Proudman SM, Stevens W, Nikpour M. Extent of disease on high-resolution computed tomography lung is a predictor of decline and mortality in systemic sclerosis-related interstitial lung disease. Rheumatology (Oxford) 2012; 52:155-60. [PMID: 23065360 DOI: 10.1093/rheumatology/kes289] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES In a multi-centre study, we sought to determine whether extent of disease on high-resolution CT (HRCT) lung, reported using a simple grading system, is predictive of decline and mortality in SSc-related interstitial lung disease (SSc-ILD), independently of pulmonary function tests (PFTs) and other prognostic variables. METHODS SSc patients with a baseline HRCT performed at the time of ILD diagnosis were identified. All HRCTs and PFTs performed during follow-up were retrieved. Demographic and disease-related data were prospectively collected. HRCTs were graded according to the percentage of lung disease: >20%: extensive; <20%: limited; unclear: indeterminate. Indeterminate HRCTs were converted to limited or extensive using a forced vital capacity threshold of 70%. The composite outcome variable was deterioration (need for home oxygen or lung transplantation), or death. RESULTS Among 172 patients followed for mean (s.d.) of 3.5 (2.9) years, there were 30 outcome events. In Weibull multivariable hazards regression modelling, baseline HRCT grade was independently predictive of outcome, with an adjusted hazard ratio (aHR) = 3.0, 95% CI 1.2, 7.5 and P = 0.02. In time-varying covariate models (based on 1309 serial PFTs and 353 serial HRCTs in 172 patients), serial diffusing capacity of the lung for carbon monoxide by alveolar volume ratio (ml/min/mmHg/l) (aHR = 0.4; 95% CI 0.3, 0.7; P = 0.001) and forced vital capacity (dl) (aHR = 0.9; 95% CI 0.8, 0.97; P = 0.008), were also strongly predictive of outcome. CONCLUSION Extensive disease (>20%) on HRCT at baseline, reported using a semi-quantitative grading system, is associated with a three-fold increased risk of deterioration or death in SSc-ILD, compared with limited disease. Serial PFTs are informative in follow-up of patients.
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Affiliation(s)
- Owen A Moore
- St Vincent's Hospital Melbourne, 41 Victoria Parade Fitzroy, Victoria 3065, Australia
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Ngian GS, Stevens W, Prior D, Gabbay E, Roddy J, Tran A, Minson R, Hill C, Chow K, Sahhar J, Proudman S, Nikpour M. Predictors of mortality in connective tissue disease-associated pulmonary arterial hypertension: a cohort study. Arthritis Res Ther 2012; 14:R213. [PMID: 23039366 PMCID: PMC3580525 DOI: 10.1186/ar4051] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 10/05/2012] [Indexed: 01/14/2023] Open
Abstract
Introduction Pulmonary arterial hypertension (PAH) is a major cause of mortality in connective tissue disease (CTD). We sought to quantify survival and determine factors predictive of mortality in a cohort of patients with CTD-associated PAH (CTD-PAH) in the current era of advanced PAH therapy. Methods Patients with right heart catheter proven CTD-PAH were recruited from six specialised PAH treatment centres across Australia and followed prospectively. Using survival methods including Cox proportional hazards regression, we modelled for all-cause mortality. Independent variables included demographic, clinical and hemodynamic data. Results Among 117 patients (104 (94.9%) with systemic sclerosis), during 2.6 ± 1.8 (mean ± SD) years of follow-up from PAH diagnosis, there were 32 (27.4%) deaths. One-, two- and three-year survivals were 94%, 89% and 73%, respectively. In multiple regression analysis, higher mean right atrial pressure (mRAP) at diagnosis (hazard ratio (HR) = 1.13, 95% CI: 1.04 to 1.24, P = 0.007), lower baseline six-minute walk distance (HR = 0.64, 95% CI: 0.43 to 0.97, P = 0.04), higher baseline World Health Organization functional class (HR = 3.42, 95% CI: 1.25 to 9.36, P = 0.04) and presence of a pericardial effusion (HR = 3.39, 95% CI: 1.07 to 10.68, P = 0.04) were predictive of mortality. Warfarin (HR = 0.20, 95% CI: 0.05 to 0.78, P = 0.02) and combination PAH therapy (HR = 0.20, 95% CI: 0.05 to 0.83, P = 0.03) were protective. Conclusions In this cohort of CTD-PAH patients, three-year survival was 73%. Independent therapeutic predictors of survival included warfarin and combination PAH therapy. Our findings suggest that anticoagulation and combination PAH therapy may improve survival in CTD-PAH. This observation merits further evaluation in randomised controlled trials.
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Thakkar V, Stevens WM, Prior D, Moore OA, Byron J, Liew D, Patterson K, Hissaria P, Roddy J, Zochling J, Sahhar J, Nash P, Tymms K, Celermajer D, Gabbay E, Youssef P, Proudman SM, Nikpour M. N-terminal pro-brain natriuretic peptide in a novel screening algorithm for pulmonary arterial hypertension in systemic sclerosis: a case-control study. Arthritis Res Ther 2012; 14:R143. [PMID: 22691291 PMCID: PMC3446526 DOI: 10.1186/ar3876] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 06/12/2012] [Indexed: 11/19/2022] Open
Abstract
Introduction Pulmonary arterial hypertension is a major cause of mortality in systemic sclerosis. N-terminal pro-brain natriuretic peptide (NT-proBNP) has emerged as a candidate biomarker that may enable the early detection of systemic sclerosis-related pulmonary arterial hypertension (SSc-PAH). The objective of our study was to incorporate NT-proBNP into a screening algorithm for SSc-PAH that could potentially replace transthoracic echocardiography (TTE) as a more convenient and less costly "first tier" test. Methods NT-proBNP levels were measured in patients from four clinical groups: a group with right heart catheter (RHC)-diagnosed SSc-PAH before commencement of therapy for PAH; a group at high risk of SSc-PAH based on TTE; a group with interstitial lung disease; and systemic sclerosis (SSc) controls with no cardiopulmonary complications. NT-proBNP levels were compared by using ANOVA and correlated with other clinical variables by using simple and multiple linear regression. ROC curve analyses were performed to determine the optimal cut point for NT-proBNP and other clinical variables in prediction of PAH. Results NT-proBNP was highest in the PAH group compared with other groups (P < 0.0001), and higher in the risk group compared with controls (P < 0.0001). NT-proBNP was positively correlated with systolic pulmonary artery pressure (PAP) on TTE (P < 0.0001), and mean PAP (P = 0.013), pulmonary vascular resistance (P = 0.005), and mean right atrial pressure (P = 0.006) on RHC. A composite model wherein patients screened positive if NT-proBNP was ≥ 209.8 pg/ml, and/or DLCOcorr was < 70.3% with FVC/DLCOcorr ≥ 1.82, had a sensitivity of 100% and specificity of 77.8% for SSc-PAH. Conclusion We have proposed a screening algorithm for SSc-PAH, incorporating NT-proBNP level and PFTs. This model has high sensitivity and specificity for SSc-PAH and, if positive, should lead to TTE and confirmatory testing for PAH. This screening algorithm must be validated prospectively.
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Affiliation(s)
- Vivek Thakkar
- Department of Rheumatology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia
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Thakkar V, Stevens W, Prior D, Byron J, Patterson K, Hissaria P, Moore O, Roddy J, Zochling J, Sahhar J, Nash P, Tymms K, Youssef P, Proudman S, Nikpour M, Launay D, Sitbon O, Cordier JF, Hachulla E, Mouthon L, Gressin V, Rottat L, Clerson P, Simonneau G, Humbert M, Carreira P, Carmona L, Joven BE, Denton CP, Allanore Y, Walker UA, Matucci-Cerinic M, Muller-Ladner U, Hsu V, Cheng Q, Steen V. S.4.1 N-terminal pro-brain natriuretic peptide levels predict incident pulmonary arterial hypertension in SSc. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/ker459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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