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Lehmann J, Giaglis S, Kyburz D, Daoudlarian D, Walker UA. Plasma mtDNA as a possible contributor to and biomarker of inflammation in rheumatoid arthritis. Arthritis Res Ther 2024; 26:97. [PMID: 38715082 PMCID: PMC11075188 DOI: 10.1186/s13075-024-03329-2] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES Neutrophil extracellular trap formation and cell-free DNA (cfDNA) contribute to the inflammation in rheumatoid arthritis (RA), but it is unknown if mitochondrial DNA (mtDNA) or nuclear DNA (nDNA) is more abundant in the circulation. It is unclear if DNA concentration measurements may assist in clinical decision-making. METHODS This single-center prospective observational study collected plasma from consecutive RA patients and healthy blood donors. Platelets were removed, and mtDNA and nDNA copy numbers were quantified by polymerase chain reaction (PCR). RESULTS One hundred six RA patients and 85 healthy controls (HC) were recruited. Circulating median mtDNA copy numbers were increased 19.4-fold in the plasma of patients with RA (median 1.1 x108 copies/mL) compared to HC (median 5.4 x106 copies/mL, p<0.0001). Receiver operating characteristics (ROC) curve analysis of mtDNA copy numbers identified RA patients with high sensitivity (92.5%) and specificity (89.4%) with an area under the curve (AUC) of 0.97, p <0.0001 and a positive likelihood ratio of 8.7. Demographic, serological (rheumatoid factor (RF) positivity, anti-citrullinated protein antibodies (ACPA) positivity) and treatment factors were not associated with DNA concentrations. mtDNA plasma concentrations, however, correlated significantly with disease activity score-28- erythrocyte sedimentation rate (DAS28-ESR) and increased numerically with increasing DAS28-ESR and clinical disease activity index (CDAI) activity. MtDNA copy numbers also discriminated RA in remission (DAS28 <2.6) from HC (p<0.0001). Also, a correlation was observed between mtDNA and the ESR (p = 0.006, R= 0.29). Similar analyses showed no significance for nDNA. CONCLUSION In contrast to nDNA, mtDNA is significantly elevated in the plasma of RA patients compared with HC. Regardless of RA activity, the abundance of circulating mtDNA is a sensitive discriminator between RA patients and HC. Further validation of the diagnostic value of mtDNA testing is required.
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Affiliation(s)
- Julia Lehmann
- Laboratory for Experimental Rheumatology, Department of Biomedicine, University of Basel, Basel, Switzerland
- Department of Rheumatology, University Hospital Basel, Petersgraben 4, CH 4037, Basel, Switzerland
| | - Stavros Giaglis
- Laboratory for Experimental Rheumatology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Diego Kyburz
- Laboratory for Experimental Rheumatology, Department of Biomedicine, University of Basel, Basel, Switzerland
- Department of Rheumatology, University Hospital Basel, Petersgraben 4, CH 4037, Basel, Switzerland
| | - Douglas Daoudlarian
- Laboratory for Experimental Rheumatology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Ulrich A Walker
- Laboratory for Experimental Rheumatology, Department of Biomedicine, University of Basel, Basel, Switzerland.
- Department of Rheumatology, University Hospital Basel, Petersgraben 4, CH 4037, Basel, Switzerland.
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Caratsch L, Lechtenboehmer C, Caorsi M, Oung K, Zanchi F, Aleman Y, Walker UA, Omoumi P, Hügle T. Detection and Grading of Radiographic Hand Osteoarthritis Using an Automated Machine Learning Platform. ACR Open Rheumatol 2024. [PMID: 38576187 DOI: 10.1002/acr2.11665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVE Automated machine learning (autoML) platforms allow health care professionals to play an active role in the development of machine learning (ML) algorithms according to scientific or clinical needs. The aim of this study was to develop and evaluate such a model for automated detection and grading of distal hand osteoarthritis (OA). METHODS A total of 13,690 hand radiographs from 2,863 patients within the Swiss Cohort of Quality Management (SCQM) and an external control data set of 346 non-SCQM patients were collected and scored for distal interphalangeal OA (DIP-OA) using the modified Kellgren/Lawrence (K/L) score. Giotto (Learn to Forecast [L2F]) was used as an autoML platform for training two convolutional neural networks for DIP joint extraction and subsequent classification according to the K/L scores. A total of 48,892 DIP joints were extracted and then used to train the classification model. Heatmaps were generated independently of the platform. User experience of a web application as a provisional user interface was investigated by rheumatologists and radiologists. RESULTS The sensitivity and specificity of this model for detecting DIP-OA were 79% and 86%, respectively. The accuracy for grading the correct K/L score was 75%, with a κ score of 0.76. The accuracy per DIP-OA class differed, with 86% for no OA (defined as K/L scores 0 and 1), 71% for a K/L score of 2, 46% for a K/L score of 3, and 67% for a K/L score of 4. Similar values were obtained in an independent external test set. Qualitative and quantitative user experience testing of the web application revealed a moderate to high demand for automated DIP-OA scoring among rheumatologists. Conversely, radiologists expressed a low demand, except for the use of heatmaps. CONCLUSION AutoML platforms are an opportunity to develop clinical end-to-end ML algorithms. Here, automated radiographic DIP-OA detection is both feasible and usable, whereas grading among individual K/L scores (eg, for clinical trials) remains challenging.
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Affiliation(s)
- Leo Caratsch
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- City Hospital Waid, Zurich, Switzerland
- L2F (Learn to Forecast), Lausanne, Switzerland
| | - Christian Lechtenboehmer
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- City Hospital Waid, Zurich, Switzerland
- L2F (Learn to Forecast), Lausanne, Switzerland
- University Hospital of Basel, Basel, Switzerland
| | | | - Karine Oung
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Fabio Zanchi
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Yasser Aleman
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Patrick Omoumi
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thomas Hügle
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Guler S, Sarbu AC, Stalder O, Allanore Y, Bernardino V, Distler J, Gabrielli A, Hoffmann-Vold AM, Matucci-Cerinic M, Müller-Ladner U, Ortiz-Santamaria V, Rednic S, Riccieri V, Smith V, Ullman S, Walker UA, Geiser TK, Distler O, Maurer B, Kollert F. Phenotyping by persistent inflammation in systemic sclerosis associated interstitial lung disease: a EUSTAR database analysis. Thorax 2023; 78:1188-1196. [PMID: 37798114 DOI: 10.1136/thorax-2023-220541] [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: 05/31/2023] [Accepted: 08/31/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Systemic sclerosis (SSc) is a heterogeneous disease with frequently associated interstitial lung disease (SSc-ILD). We aimed to determine the prognostic potential of phenotyping patients with SSc and SSc-ILD by inflammation and to describe disease trajectories stratified by inflammation and immunosuppressive treatment. METHODS Patients from the European Scleroderma Trials and Research (EUSTAR) group cohort were allocated to persistent inflammatory, intermediate and non-inflammatory phenotypes if C-reactive protein (CRP) levels were ≥5 mg/L at ≥80%, at 20-80% and at <20% of visits, respectively. Cox regression models were used to analyse mortality risk and mixed effect models to describe trajectories of FVC and diffusing capacity for carbon monoxide (DLCO) %-predicted stratified by inflammation and immunosuppressive treatment. RESULTS 2971 patients with SSc and 1171 patients with SSc-ILD had at least three CRP measurements available. Patients with SSc-ILD with a persistent inflammatory phenotype had a 6.7 times higher risk of mortality within 5 years compared with those with a persistent non-inflammatory phenotype (95% CI 3 to 15). In the inflammatory phenotype, FVC %-predicted was declining without (-1.11 (95% CI -2.14 to -0.08)/year), but stable with immunosuppressive treatment (-0.00 (95% CI -0.92 to 0.92)/year). In the non-inflammatory phenotype, patients with and without immunosuppressive treatment had a significant decline in FVC %-predicted, which was more pronounced in those with immunosuppressive treatment (-1.26 (95% CI -1.87 to -0.64) and -0.84 (95% CI -1.35 to -0.33)/year, respectively). CONCLUSIONS Phenotyping by persistent inflammation provides valuable prognostic information, independent of demographics, disease duration, cutaneous subtype, treatment and SSc-ILD severity. The findings from this study support early immunosuppressive treatment in patients with SSc-ILD with persistent inflammation.
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Affiliation(s)
- Sabina Guler
- Department of Pulmonary Medicine, Inselspital University Hospital Bern, Bern, Switzerland
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Adela-Cristina Sarbu
- Department of Rheumatology and Immunology, Inselspital University Hospital Bern, Bern, Switzerland
| | | | | | - Vera Bernardino
- Internal Medicine Department 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Joerg Distler
- Department of Rheumatology and Hiller Research Center, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Armando Gabrielli
- Fondazione di Medicina Molecolare e Terapia Cellulare, Università Politecnica delle Marche, Ancona, Italy
| | | | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), San Raffaele Hospital, Milano, Italy
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, University of Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Vera Ortiz-Santamaria
- Unidad de Enfermedades Sistémicas, Reumatología, Hospital General de Granollers, Granollers, Spain
| | - Simona Rednic
- Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Valeria Riccieri
- Clinical Medicine and Therapy, Sapienza University of Rome, Roma, Italy
| | - Vanessa Smith
- Rheumatology, Ghent University Hospital, Gent, Belgium
| | - Susanne Ullman
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg, Denmark
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Thomas K Geiser
- Department of Pulmonary Medicine, Inselspital University Hospital Bern, Bern, Switzerland
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Britta Maurer
- Department of BioMedical Research, University of Bern, Bern, Switzerland
- Department of Rheumatology and Immunology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Florian Kollert
- Department of Rheumatology and Immunology, Inselspital University Hospital Bern, Bern, Switzerland
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Lepri G, Airò P, Distler O, Andréasson K, Braun-Moscovici Y, Hachulla E, Balbir-Gurman A, De Langhe E, Rednic S, Ingegnoli F, Rosato E, Groseanu L, Ionescu R, Bellando-Randone S, Garzanova L, Beretta L, Bellocchi C, Moiseev S, Novikov P, Szabo I, Krasowska D, Codullo V, Walker UA, Manolaraki C, Guiducci S, Truchetet ME, Iannone F, Tofani L, Bruni C, Smith V, Cuomo G, Krusche M, Matucci-Cerinic M, Allanore Y. Systemic sclerosis and primary biliary cholangitis: Longitudinal data to determine the outcomes. J Scleroderma Relat Disord 2023; 8:210-220. [PMID: 37744053 PMCID: PMC10515998 DOI: 10.1177/23971983231155948] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/15/2022] [Indexed: 09/26/2023]
Abstract
Background Several studies described the cross-sectional characteristics of systemic sclerosis patients and coexisting primary biliary cholangitis, but longitudinal prognostic data are lacking. Aims To describe the systemic sclerosis-primary biliary cholangitis phenotype, including baseline characteristics and outcomes. Methods We performed a multicentre the European Scleroderma Trials and Research Group study of systemic sclerosis patients with primary biliary cholangitis or with primary biliary cholangitis-specific antibodies, matched with systemic sclerosis controls free from hepatobiliary involvement matched for disease duration and cutaneous subset. Data were recorded at baseline and at the last available visit. Results A total of 261 patients were enrolled (115 primary biliary cholangitis-systemic sclerosis, 161 systemic sclerosis). At baseline, systemic sclerosis-primary biliary cholangitis patients had a higher prevalence of anti-centromere antibodies (p = 0.0023) and a lower prevalence of complete absence of digital ulcers. The milder vascular involvement was confirmed at follow-up when crucial differences emerged in the percentage of patients experiencing digital ulcers; a significantly higher number of patients who never experienced digital ulcers were observed among primary biliary cholangitis-systemic sclerosis patients (p = 0.0015). Moreover, a greater incidence of pulmonary arterial hypertension (p < 0.001) and of conduction blocks (p = 0.0256) was observed in systemic sclerosis patients without primary biliary cholangitis. Patients with primary biliary cholangitis had higher levels of liver enzymes at baseline than systemic sclerosis patients; a significant decrease in liver enzymes was observed at follow-up. Out of 18 patients with cholangitis, one received a liver transplant at follow-up. Conclusion Our data show that systemic sclerosis-primary biliary cholangitis exhibit a mild systemic sclerosis and primary biliary cholangitis phenotype with outcomes being in general favourable.
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Affiliation(s)
- Gemma Lepri
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Paolo Airò
- Rheumatology and Clinical Immunology, Spedali Civili of Brescia, Brescia, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Kristofer Andréasson
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Yolanda Braun-Moscovici
- Rheumatology Department, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Eric Hachulla
- Department of Internal Medicine, Hôpital Claude Huriez, Lille, France
| | - Alexandra Balbir-Gurman
- Rheumatology Department, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ellen De Langhe
- ERN ReCONNET, Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Simona Rednic
- Department of Rheumatology, Emergency County Teaching Hospital, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Francesca Ingegnoli
- Clinical Rheumatology Unit, ASST Pini-CTO, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Laura Groseanu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ruxandra Ionescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Silvia Bellando-Randone
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Liudmila Garzanova
- Laboratory of Microcirculation and Inflammation, VA Nasonova Institute of Rheumatology, Moscow, Russian Federation
| | - Lorenzo Beretta
- Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Chiara Bellocchi
- Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Sergey Moiseev
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Pavel Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Iulia Szabo
- Department of Rheumatology, Emergency County Teaching Hospital, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Dorota Krasowska
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, Lublin, Poland
| | | | - Ulrich A. Walker
- Department of Rheumatology, Universitätsspital Basel, Basel, Switzerland
| | | | - Serena Guiducci
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Florenzo Iannone
- Rheumatology Unit – DETO, School of Medicine, University of Bari, Bari, Italy
| | - Lorenzo Tofani
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Cosimo Bruni
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital and Department of Internal Medicine, Ghent University, Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Giovanna Cuomo
- Department of Precision of Medicine, University of Campania – L. Vanvitelli, Naples, Italy
| | - Martin Krusche
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Yannick Allanore
- Rheumatology, Cochin Hospital, APHP, Paris Cité University, Paris, France
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Giaglis S, Daoudlarian D, Thiel J, Rizzi M, Kyburz D, Venhoff N, Walker UA. Mitochondrial DNA: a novel indicator of active inflammation in ANCA-associated vasculitides. Rheumatology (Oxford) 2023:6988030. [PMID: 36645235 PMCID: PMC10393440 DOI: 10.1093/rheumatology/kead015] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/10/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) includes granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). ANCA triggers neutrophil extracellular trap formation, which releases either mitochondrial (mt) DNA or nuclear DNA (n) DNA, contributing to inflammation. Our aim was to prospectively examine the extent and nature of circulating DNA in AAV and the clinical utility of DNA quantification. METHODS DNA was isolated from platelet-free plasma of consecutive GPA and MPA patients and healthy controls (HC). mtDNA and nDNA copy numbers were quantified by PCR. Clinical data including the Birmingham Vasculitis Activity Score (BVAS), were collected. RESULTS Ninety-two HC (median age 51 years, 58.7% female) and 101 AAV patients (80 GPA, 21 MPA, median age 64 years, 50.5% female, BVAS range: 0-30) were included. Median mtDNA copies were 13-fold higher in AAV than HC; nDNA concentrations did not differ. Patients with active AAV (BVAS > 0) had 4-fold higher median mtDNA copies than patients in remission (P= 0.03). mtDNA, unlike nDNA, correlated with BVAS (r = 0.30, P= 0.002) and was associated with AAV activity at multivariable analysis. Receiver operating characteristic curve analysis indicates that mtDNA quantification differentiates active AAV (BVAS >0) from HC with 96.1% sensitivity and 98.9% specificity (AUC 0.99). In 27 AAV patients with follow-up, mtDNA changes but not CRP or ANCA-titers correlated with BVAS changes (r = 0.56, P= 0.002). CONCLUSIONS mtDNA, unlike nDNA, is elevated in the plasma of AAV patients and may contribute to systemic inflammation. mtDNA could be superior to established biomarkers in the laboratory monitoring of AAV activity.
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Affiliation(s)
- Stavros Giaglis
- Laboratory for Experimental Rheumatology, Department of Biomedicine, University of Basel, Basel, Switzerland.,Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Douglas Daoudlarian
- Laboratory for Experimental Rheumatology, Department of Biomedicine, University of Basel, Basel, Switzerland.,Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Jens Thiel
- Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany
| | - Marta Rizzi
- Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany
| | - Diego Kyburz
- Laboratory for Experimental Rheumatology, Department of Biomedicine, University of Basel, Basel, Switzerland.,Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany
| | - Ulrich A Walker
- Laboratory for Experimental Rheumatology, Department of Biomedicine, University of Basel, Basel, Switzerland.,Department of Rheumatology, University Hospital Basel, Basel, Switzerland
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Kocher A, Simon M, Dwyer AA, Blatter C, Bogdanovic J, Künzler-Heule P, Villiger PM, Dan D, Distler O, Walker UA, Nicca D. Patient Assessment Chronic Illness Care (PACIC) and its associations with quality of life among Swiss patients with systemic sclerosis: a mixed methods study. Orphanet J Rare Dis 2023; 18:7. [PMID: 36624535 PMCID: PMC9828378 DOI: 10.1186/s13023-022-02604-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The Chronic Care Model (CCM) is a longstanding and widely adopted model guiding chronic illness management. Little is known about how CCM elements are implemented in rare disease care or how patients' care experiences relate to health-related quality of life (HRQoL). We engaged patients living with systemic sclerosis (SSc) to assess current care according to the CCM from the patient perspective and their HRQoL. METHODS We employed an explanatory sequential mixed methods design. First, we conducted a cross-sectional quantitative survey (n = 101) using the Patient Assessment of Chronic Illness Care (PACIC) and Systemic Sclerosis Quality of Life (SScQoL) questionnaires. Next, we used data from individual patient interviews (n = 4) and one patient focus group (n = 4) to further explore care experiences of people living with SSc with a focus on the PACIC dimensions. RESULTS The mean overall PACIC score was 3.0/5.0 (95% CI 2.8-3.2, n = 100), indicating care was 'never' to 'generally not' aligned with the CCM. Lowest PACIC subscale scores related to 'goal setting/tailoring' (mean = 2.5, 95% CI 2.2-2.7) and 'problem solving/contextual counselling' (mean = 2.9, 95% CI 2.7-3.2). No significant correlations were identified between the mean PACIC and SScQoL scores. Interviews revealed patients frequently encounter major shortcomings in care including 'experiencing organized care with limited participation', 'not knowing which strategies are effective or harmful' and 'feeling left alone with disease and psychosocial consequences'. Patients often responded to challenges by 'dealing with the illness in tailored measure', 'taking over complex coordination of care' and 'relying on an accessible and trustworthy team'. CONCLUSIONS The low PACIC mean overall score is comparable to findings in patients with common chronic diseases. Key elements of the CCM have yet to be systematically implemented in Swiss SSc management. Identified gaps in care related to lack of shared decision-making, goal-setting and individual counselling-aspects that are essential for supporting patient self-management skills. Furthermore, there appears to be a lack of complex care coordination tailored to individual patient needs.
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Affiliation(s)
- Agnes Kocher
- Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland. .,Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Michael Simon
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,grid.5734.50000 0001 0726 5157Department of Nursing, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew A. Dwyer
- grid.208226.c0000 0004 0444 7053Boston College, Connell School of Nursing, Chestnut Hill, MA USA ,grid.32224.350000 0004 0386 9924Center for Nursing Research, Massachusetts General Hospital Munn, Boston, MA USA
| | - Catherine Blatter
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Jasmina Bogdanovic
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Patrizia Künzler-Heule
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,grid.413349.80000 0001 2294 4705Department of Gastroenterology/Hepatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland ,grid.413349.80000 0001 2294 4705Department of Nursing, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | - Diana Dan
- grid.9851.50000 0001 2165 4204Service of Rheumatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Oliver Distler
- grid.7400.30000 0004 1937 0650Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich A. Walker
- grid.410567.1Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Dunja Nicca
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,grid.7400.30000 0004 1937 0650Department of Global and Public Health, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
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Roessinger O, Hügle T, Walker UA, Geurts J. Polg mtDNA mutator mice reveal limited involvement of vertebral bone loss in premature aging-related thoracolumbar hyperkyphosis. Bone Rep 2022; 17:101618. [PMID: 36120646 PMCID: PMC9479024 DOI: 10.1016/j.bonr.2022.101618] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background Age-related hyperkyphosis is multifactorial and involves alterations of vertebral bone, intervertebral discs (IVD) and paraspinal muscles. The relative contribution of these tissues remains unclear. Here, we compared differences in vertebral bone microarchitecture and IVD thickness between prematurely aging mice with spinal hyperkyphosis and wild type littermates. Methods Thoracolumbar vertebral columns were dissected from homozygous Polg D257A and age-matched wild type littermates. Micro-computed tomography was performed to quantify cortical and trabecular bone parameters at anterior and posterior portions of T8-L4 vertebrae. In addition, vertebral shape, transaxial facet joint orientation and IVD thickness were quantified. Differences in anterior/posterior ratios between genotypes were compared by Student's t-test and association between vertebral bone and IVD parameters was investigated using Pearson correlation analysis. Results Hyperkyphotic homozygous mice displayed generalized osteopenia that was more pronounced at the posterior compared with anterior portion of thoracolumbar vertebrae. An increase in the anterior/posterior ratio of trabecular bone parameters was revealed at the thoracolumbar junction (T13-L1). Polg D257A displayed diffuse loss of cortical bone thickness, yet anterior/posterior ratios were unchanged. Despite generalized and regional bone loss, vertebral shape was unaffected. PolG D257A mice showed a 10-20 % reduction of IVD thickness at both thoracic and lumbar levels, with only minimal histopathological changes. IVD thickness was negatively correlated with anterior/posterior ratios of trabecular bone parameters, as well as with more coronally oriented facet joints, but negatively correlated with the anterior/posterior ratio of cortical bone thickness. Conclusions Aging-induced regional changes of vertebral trabecular and cortical bone did not lead to altered vertebral shape in Polg D257A mice but may indirectly cause hyperkyphosis through reduction of IVD thickness. These findings suggest a limited role for aging-induced bone loss in spinal hyperkyphosis and warrants further research on the involvement of paraspinal muscle degeneration.
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Affiliation(s)
- Olivier Roessinger
- Department of Rheumatology, Lausanne University Hospital, Avenue Pierre Decker 4, 1005 Lausanne, Switzerland
| | - Thomas Hügle
- Department of Rheumatology, Lausanne University Hospital, Avenue Pierre Decker 4, 1005 Lausanne, Switzerland
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Jeroen Geurts
- Department of Rheumatology, Lausanne University Hospital, Avenue Pierre Decker 4, 1005 Lausanne, Switzerland
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8
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Mischlinger J, Jaeger VK, Ciurea A, Gabay C, Hasler P, Mueller RB, Siegrist CA, Villiger P, Walker UA, Hatz C, Bühler S. Long-term persistence of antibodies after diphtheria/tetanus vaccination in immunosuppressed patients with inflammatory rheumatic diseases and healthy controls. Vaccine 2022; 40:4897-4904. [PMID: 35810064 DOI: 10.1016/j.vaccine.2022.06.013] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/16/2022] [Accepted: 06/02/2022] [Indexed: 10/17/2022]
Abstract
Many vaccines demonstrate high effectiveness for years. This prospective multicentre study was conducted in Switzerland to assess the long-term persistence of antibodies to the diphtheria/tetanus (dT)-vaccine in adult patients with rheumatic diseases (PRDs). 163 PRDs and 169 controls were included in the study. The median age of all participants was 50 years (range: 18-83 years) and 56% were female. After a median time interval of 16 years after vaccination, the median anti-vaccine antibody concentrations were lower in PRDs than in controls for tetanus (1.68 vs 2.01; p = 0.049) and diphtheria (0.05 vs 0.22; p = 0.002). Based on the currently accepted seroprotection threshold (antibody concentration ≥ 0.1 IU/ml), PRDs had lower proportions of short-term tetanus and diphtheria protection as demonstrated by crude odds ratios (OR) of 0.30 (p = 0.017) and OR: 0.52 (p = 0.004), respectively. After adjusting for 'age' and 'time since last dT vaccination', the strength of associations became weaker; for tetanus, borderline evidence remained for a true difference between PRDs and controls (OR: 0.36 [p = 0.098]), however, not for diphtheria (OR: 0.86 [p = 0.58]). We hypothesize that in the presence of rheumatic diseases and its immunosuppressive treatment, vaccine-specific long-lived plasma cells (LLPCs) may be diminished or competitively displaced by rheumatism-specific LLPCs, a process which may decrease the persistence of vaccine-specific antibodies. Novel studies should be designed by incorporating methodologies allowing to determine the attributable fraction of immunosuppressive/immunomodulatory medications and rheumatic disease itself on long-lasting vaccine-specific antibody persistence, as well as, further study the role of LLPCs.
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Affiliation(s)
- Johannes Mischlinger
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Veronika K Jaeger
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland; Institute of Epidemiology and Social Medicine, University of Münster, Germany
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Cem Gabay
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | - Paul Hasler
- Division of Rheumatology, University Department of Medicine, University of Basel Medical Faculty, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Ruediger B Mueller
- Division of Rheumatology, University Department of Medicine, University of Basel Medical Faculty, Cantonal Hospital Aarau, Aarau, Switzerland; Division of Rheumatology, Department of Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Division of Rheumatology and Clinical Immunology, Department of Internal Medicine Ludwig-Maximilians-University Munich, Germany
| | - Claire Ann Siegrist
- Center for Vaccinology, University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Peter Villiger
- Department of Rheumatology and Clinical Immunology/Allergology, University Hospital of Bern, Bern, Switzerland
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Christoph Hatz
- Department of Public Health / Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Department of Medicine and Diagnostics, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Switzerland; Division of Infectious Diseases & Hospital Epidemiology, Kantonsspital St. Gallen, Switzerland
| | - Silja Bühler
- Department of Public Health / Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Division of Hygiene and Infectious Diseases, Institute for Hygiene and Environment, Hamburg, Germany.
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9
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Bruni C, Heidenreich S, Duenas A, Hoffmann-Vold AM, Gabrielli A, Allanore Y, Chatelus E, Distler JHW, Hachulla E, Hsu VM, Hunzelmann N, Khanna D, Truchetet ME, Walker UA, Alves M, Schoof N, Saketkoo LA, Distler O. Patient preferences for the treatment of systemic sclerosis-associated interstitial lung disease: a discrete choice experiment. Rheumatology (Oxford) 2022; 61:4035-4046. [PMID: 35238334 PMCID: PMC9536797 DOI: 10.1093/rheumatology/keac126] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/17/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives Treatments for SSc-associated interstitial lung disease (SSc-ILD) differ in attributes, i.e. mode of administration, adverse events (AEs) and efficacy. As physicians and patients may perceive treatments differently, shared decision-making can be essential for optimal treatment provision. We therefore aimed to quantify patient preferences for different treatment attributes. Methods Seven SSc-ILD attributes were identified from mixed-methods research and clinician input: mode of administration, shortness of breath, skin tightness, cough, tiredness, risk of gastrointestinal AEs (GI-AEs) and risk of serious and non-serious infections. Patients with SSc-ILD completed an online discrete choice experiment (DCE) in which they were asked to repeatedly choose between two alternatives characterized by varying severity levels of the included attributes. The data were analysed using a multinomial logit model; relative attribute importance and maximum acceptable risk measures were calculated. Results Overall, 231 patients with SSc-ILD completed the DCE. Patients preferred twice-daily oral treatments and 6–12 monthly infusions. Patients’ choices were mostly influenced by the risk of GI-AEs or infections. Improvement was more important in respiratory symptoms than in skin tightness. Concerning trade-offs, patients accepted different levels of increase in GI-AE risk: +21% if it reduced the infusions’ frequency; +15% if changing to an oral treatment; up to +37% if it improved breathlessness; and up to +36% if it reduced the risk of infections. Conclusions This is the first study to quantitatively elicit patients’ preferences for treatment attributes in SSc-ILD. Patients showed willingness to make trade-offs, providing a firm basis for shared decision-making in clinical practice.
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Affiliation(s)
- Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | | | | | | | - Armando Gabrielli
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Yannick Allanore
- Department of Rheumatology A, Cochin Hospital, Paris Descartes University, Paris, France
| | - Emmanuel Chatelus
- Department of Rheumatology, University Hospital of Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | - Jörg H W Distler
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO), CHU Lille, Univ. Lille, Inserm, U1286 - INFINITE-Institute for Translational Research in Inflammation, Lille, F-59000, France
| | - Vivien M Hsu
- Department of Medicine, Division of Rheumatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Dinesh Khanna
- Scleroderma Program, University of Michigan, Ann Arbor, MI, USA.,Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Margarida Alves
- TA Inflammation, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Nils Schoof
- TA Inflammation, Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, USA.,Departments of Internal Medicine, Louisiana State University, and Tulane University Schools of Medicine, New Orleans, LA, USA
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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10
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Ritter F, Franzeck F, Geisshardt J, Walker UA, Osthoff M. Gout Arthritis During Admission for Decompensated Heart Failure—A Descriptive Analysis of Risk Factors, Treatment and Prognosis. Front Med (Lausanne) 2022; 9:789414. [PMID: 35237621 PMCID: PMC8882955 DOI: 10.3389/fmed.2022.789414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/04/2021] [Accepted: 01/17/2022] [Indexed: 12/16/2022] Open
Abstract
BackgroundChronic heart failure and hospital admissions are well-known risk factors for acute gouty arthritis. However, in-depth analyses of patients admitted for decompensated heart failure (DHF) who subsequently developed a gout attack are sparse. This study aims to characterize DHF patients who developed a gout attack during their inpatient treatment and describe potential risk factors, its consequences, and its management in the setting of heart failure exacerbation.MethodsRetrospective chart review of 50 patients with an admission diagnosis of DHF who subsequently experienced a gout attack during admission at a Swiss tertiary care hospital between 2018 and 2020. Patients with a refusal of the general research consent were excluded (n = 10).ResultsA gout attack developed in 66/1,832 (3.6%) DHF admissions of whom 50 individual patients were analyzed. Patients were predominately male (76%), of advanced age (median 80.5 years), with several comorbidities including chronic kidney disease (74%), comorbid gout (70%, only 43% on urate lowering therapy) and hyperuricemia (median 547 μmol/l, IQR 434–667 μmol/l). Diuretics were intensified in all patients. Acute gout presented as polyarticular arthritis (62%) and was often accompanied by fever (30%). Joint aspiration was performed in 32%, and intra-articular steroid injections administered in 20% of patients. Median length of stay and 6-month mortality were 16 days (IQR 12–25) and 32%, respectively, compared to 9 days (IQR 6–14) and 16% for DHF patients without a gout attack.ConclusionOur study highlights features of gout attacks in the context of DHF including the absence of comorbid gout in a significant proportion of patients, the presence of polyarticular disease during the flare, and a poor prognosis. The present study identifies the necessity to better address gout as a comorbidity in DHF patients and may assist clinicians in identifying DHF patients at risk for a gout attack.
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Affiliation(s)
- Fabian Ritter
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Fabian Franzeck
- Department of Research and Analytical Services, University Hospital Basel, Basel, Switzerland
| | - Julian Geisshardt
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Ulrich A. Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Michael Osthoff
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- *Correspondence: Michael Osthoff
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11
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Giaglis S, Sur Chowdhury C, van Breda SV, Stoikou M, Tiaden AN, Daoudlarian D, Schaefer G, Buser A, Walker UA, Lapaire O, Hoesli I, Hasler P, Hahn S. Circulatory Neutrophils Exhibit Enhanced Neutrophil Extracellular Trap Formation in Early Puerperium: NETs at the Nexus of Thrombosis and Immunity. Int J Mol Sci 2021; 22:ijms222413646. [PMID: 34948443 PMCID: PMC8704360 DOI: 10.3390/ijms222413646] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/17/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022] Open
Abstract
Pregnancy is associated with elevated maternal levels of cell-free DNA of neutrophil extracellular trap (NET) origin, as circulatory neutrophils exhibit increased spontaneous NET formation, mainly driven by G-CSF and finely modulated by sex hormones. The postpartum period, on the other hand, involves physiological alterations consistent with the need for protection against infections and fatal haemorrhage. Our findings indicate that all relevant serum markers of neutrophil degranulation and NET release are substantially augmented postpartum. Neutrophil pro-NETotic activity in vitro is also upregulated particularly in post-delivery neutrophils. Moreover, maternal puerperal neutrophils exhibit a strong pro-NETotic phenotype, associated with increased levels of all key players in the generation of NETs, namely citH3, MPO, NE, and ROS, compared to non-pregnant and pregnant controls. Intriguingly, post-delivery NET formation is independent of G-CSF in contrast to late gestation and complemented by the presence of TF on the NETs, alterations in the platelet activity status, and activation of the coagulation cascade, triggered by circulating microparticles. Taken together, our results reveal the highly pro-NETotic and potentially procoagulant nature of postpartum neutrophils, bridging an overt immune activation with possible harmful thrombotic incidence.
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Affiliation(s)
- Stavros Giaglis
- Laboratory for Prenatal Medicine, Department of Biomedicine, University of Basel, 4001 Basel, Switzerland; (C.S.C.); (S.V.v.B.); (M.S.); (G.S.); (O.L.); (I.H.); (S.H.)
- University Women’s Hospital, University Hospital Basel, 4056 Basel, Switzerland
- Division of Rheumatology, Department of Internal Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland;
- Laboratory for Experimental Rheumatology, Department of Biomedicine, University of Basel, 4001 Basel, Switzerland; (A.N.T.); (D.D.); (U.A.W.)
- Department of Rheumatology, University Hospital Basel, 4031 Basel, Switzerland
- Correspondence:
| | - Chanchal Sur Chowdhury
- Laboratory for Prenatal Medicine, Department of Biomedicine, University of Basel, 4001 Basel, Switzerland; (C.S.C.); (S.V.v.B.); (M.S.); (G.S.); (O.L.); (I.H.); (S.H.)
- University Women’s Hospital, University Hospital Basel, 4056 Basel, Switzerland
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Shane Vontelin van Breda
- Laboratory for Prenatal Medicine, Department of Biomedicine, University of Basel, 4001 Basel, Switzerland; (C.S.C.); (S.V.v.B.); (M.S.); (G.S.); (O.L.); (I.H.); (S.H.)
- University Women’s Hospital, University Hospital Basel, 4056 Basel, Switzerland
- Division of Rheumatology, Department of Internal Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland;
| | - Maria Stoikou
- Laboratory for Prenatal Medicine, Department of Biomedicine, University of Basel, 4001 Basel, Switzerland; (C.S.C.); (S.V.v.B.); (M.S.); (G.S.); (O.L.); (I.H.); (S.H.)
- University Women’s Hospital, University Hospital Basel, 4056 Basel, Switzerland
| | - André N. Tiaden
- Laboratory for Experimental Rheumatology, Department of Biomedicine, University of Basel, 4001 Basel, Switzerland; (A.N.T.); (D.D.); (U.A.W.)
- Department of Rheumatology, University Hospital Basel, 4031 Basel, Switzerland
| | - Douglas Daoudlarian
- Laboratory for Experimental Rheumatology, Department of Biomedicine, University of Basel, 4001 Basel, Switzerland; (A.N.T.); (D.D.); (U.A.W.)
- Department of Rheumatology, University Hospital Basel, 4031 Basel, Switzerland
| | - Guenther Schaefer
- Laboratory for Prenatal Medicine, Department of Biomedicine, University of Basel, 4001 Basel, Switzerland; (C.S.C.); (S.V.v.B.); (M.S.); (G.S.); (O.L.); (I.H.); (S.H.)
- University Women’s Hospital, University Hospital Basel, 4056 Basel, Switzerland
| | - Andreas Buser
- Swiss Red Cross, Blood Transfusion Center, Department of Internal Medicine, Division of Hematology, University Hospital Basel, 4031 Basel, Switzerland;
| | - Ulrich A. Walker
- Laboratory for Experimental Rheumatology, Department of Biomedicine, University of Basel, 4001 Basel, Switzerland; (A.N.T.); (D.D.); (U.A.W.)
- Department of Rheumatology, University Hospital Basel, 4031 Basel, Switzerland
| | - Olav Lapaire
- Laboratory for Prenatal Medicine, Department of Biomedicine, University of Basel, 4001 Basel, Switzerland; (C.S.C.); (S.V.v.B.); (M.S.); (G.S.); (O.L.); (I.H.); (S.H.)
- University Women’s Hospital, University Hospital Basel, 4056 Basel, Switzerland
| | - Irene Hoesli
- Laboratory for Prenatal Medicine, Department of Biomedicine, University of Basel, 4001 Basel, Switzerland; (C.S.C.); (S.V.v.B.); (M.S.); (G.S.); (O.L.); (I.H.); (S.H.)
- University Women’s Hospital, University Hospital Basel, 4056 Basel, Switzerland
| | - Paul Hasler
- Division of Rheumatology, Department of Internal Medicine, Kantonsspital Aarau, 5001 Aarau, Switzerland;
| | - Sinuhe Hahn
- Laboratory for Prenatal Medicine, Department of Biomedicine, University of Basel, 4001 Basel, Switzerland; (C.S.C.); (S.V.v.B.); (M.S.); (G.S.); (O.L.); (I.H.); (S.H.)
- University Women’s Hospital, University Hospital Basel, 4056 Basel, Switzerland
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12
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Giaglis S, Daoudlarian D, Voll RE, Kyburz D, Venhoff N, Walker UA. Circulating mitochondrial DNA copy numbers represent a sensitive marker for diagnosis and monitoring of disease activity in systemic lupus erythematosus. RMD Open 2021; 7:rmdopen-2021-002010. [PMID: 34916301 PMCID: PMC8679121 DOI: 10.1136/rmdopen-2021-002010] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/28/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Cell-free DNA is involved in the pathogenesis of systemic lupus erythematosus (SLE) but the clinical value of cell-free DNA measurements in SLE is unknown. Our aim was therefore to examine the utility of mitochondrial (mt) DNA and nuclear (n) DNA quantification in SLE. METHODS EDTA plasma was drawn from 103 consecutive patients with SLE and from 56 healthy blood donors. mtDNA and nDNA copy numbers were quantified by PCR from cell-free plasma. Clinical parameters were recorded prospectively. RESULTS Circulating mtDNA copy numbers were increased 8.8-fold in the plasma of patients with SLE (median 6.6×107 /mL) compared with controls (median 7.6×106 /mL, p<0.0001). Among all 159 individuals, a cut-off set at 1.8×107 mtDNA copies in a receiver operated curve identified patients with SLE with 87.4% sensitivity and 94.6% specificity; the area under the curve was 0.95 (p<0.0001). mtDNA levels were independent of age or gender, but correlated with Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) on multivariable analysis (p=0.004). Conversely, SLEDAI was associated with prednisone dose (p<0.001), anti-double stranded DNA-titres (p=0.003) and mtDNA levels (p=0.005), but not nDNA copy numbers. In 33 patients with SLE with available follow-up, the changes of mtDNA, but not those of nDNA concentrations, robustly correlated with the evolution of the SLEDAI (r=0.55, p=0.001). CONCLUSIONS Circulating mtDNA unlike nDNA molecules are markedly increased in SLE plasma. Regardless of disease activity, circulating mtDNA levels distinguish patients with SLE from healthy controls with high sensitivity and represent an independent marker of SLE activity.
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Affiliation(s)
- Stavros Giaglis
- Laboratory for Experimental Rheumatology, Department of Biomedicine, University of Basel, Basel, Basel-Stadt, Switzerland.,Department of Rheumatology, University Hospital Basel, Basel, Basel-Stadt, Switzerland
| | - Douglas Daoudlarian
- Laboratory for Experimental Rheumatology, Department of Biomedicine, University of Basel, Basel, Basel-Stadt, Switzerland.,Department of Rheumatology, University Hospital Basel, Basel, Basel-Stadt, Switzerland
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, Medical Center - Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Baden-Württemberg, Germany
| | - Diego Kyburz
- Laboratory for Experimental Rheumatology, Department of Biomedicine, University of Basel, Basel, Basel-Stadt, Switzerland.,Department of Rheumatology, University Hospital Basel, Basel, Basel-Stadt, Switzerland
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Center - Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Baden-Württemberg, Germany
| | - Ulrich A Walker
- Laboratory for Experimental Rheumatology, Department of Biomedicine, University of Basel, Basel, Basel-Stadt, Switzerland .,Department of Rheumatology, University Hospital Basel, Basel, Basel-Stadt, Switzerland
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13
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Kocher A, Simon M, Dwyer AA, Blatter C, Bogdanovic J, Künzler-Heule P, Villiger PM, Dan D, Distler O, Walker UA, Nicca D. Patient and healthcare professional eHealth literacy and needs for systemic sclerosis support: a mixed methods study. RMD Open 2021; 7:rmdopen-2021-001783. [PMID: 34475248 PMCID: PMC8413951 DOI: 10.1136/rmdopen-2021-001783] [Citation(s) in RCA: 3] [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: 06/18/2021] [Accepted: 07/28/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES We engaged patients with systemic sclerosis (SSc) and healthcare professionals to assess electronic health (eHealth) literacy and needs relating to web-based support using internet-based information and communication technologies (ICT). METHODS We employed an explanatory sequential mixed methods design. First, we conducted a cross-sectional survey in patients (n=101) and professionals (n=47). Next, we conducted three focus groups with patients, family members and professionals (n=17). RESULTS Of patients, 89.1% used ICT at least weekly for private communication. Patients reported relatively high comprehension of eHealth information ([Formula: see text] =6.7, 95% CI: 6.2 to 7.3, range 1-10), yet were less confident evaluating information reliability ([Formula: see text] =5.8, 95% CI: 5.1 to 6.4) and finding eHealth apps ([Formula: see text] =4.8, 95% CI: 4.2 to 5.4). Patients and professionals reported little experience with web-based self-management support. Focus groups revealed 'considering non-ICT-accessible groups' and 'fitting patients' and professionals' technology' as crucial for acceptability. In relation to understanding/appraising eHealth, participants highlighted that general SSc information is not tailored to individual's disease course. Recommendations included 'providing timely, understandable and safe information' and 'empowering end-users in ICT and health decision-making skills'. Professionals expressed concerns about lacking resources. Patients were concerned about data security and person-centredness. Key eHealth drivers included 'addressing end-user perceptions' and 'putting people at the centre of technology'. CONCLUSIONS Patients and professionals need education/training to support uptake of eHealth resources. Key elements include guiding patients to timely/reliable information and using eHealth to optimise patient-provider communication. Design that is responsive to end-users' needs and considers individuals with limited eHealth literacy and/or ICT access appears to be critical for acceptability.
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Affiliation(s)
- Agnes Kocher
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Head Office of Nursing, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Simon
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Nursing & Midwifery Research Unit, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew A Dwyer
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA.,Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Catherine Blatter
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jasmina Bogdanovic
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Patrizia Künzler-Heule
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Gastroenterology/Hepatology and Department of Nursing, Cantonal Hospital St. Gallen, St Gallen, Switzerland
| | | | - Diana Dan
- Service of Rheumatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Dunja Nicca
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland .,Department of Global and Public Health, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
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Walker UA, Tilson HH, Hawkins PN, Poll TVD, Noviello S, Levy J, Vritzali E, Hoffman HM, Kuemmerle-Deschner JB. Long-term safety and effectiveness of canakinumab therapy in patients with cryopyrin-associated periodic syndrome: results from the β-Confident Registry. RMD Open 2021; 7:rmdopen-2021-001663. [PMID: 34001647 PMCID: PMC8130749 DOI: 10.1136/rmdopen-2021-001663] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/24/2021] [Accepted: 05/04/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To report the long-term safety and effectiveness of canakinumab, a fully human anti-interleukin 1β monoclonal antibody, in patients with cryopyrin-associated periodic syndromes (CAPS), including familial cold autoinflammatory syndrome (FCAS), Muckle-Wells syndrome (MWS) and neonatal-onset multisystem inflammatory disease (NOMID), in a real-world setting. METHODS From December 2009 to December 2015, the β-Confident Registry prospectively enrolled patients with CAPS and non-CAPS conditions who received canakinumab per routine care and were prospectively followed for up to 6 years. The registry protocol did not mandate specific visits or procedures; however, all observed adverse events (AEs) and serious adverse events (SAEs) had to be recorded. Canakinumab effectiveness was evaluated by Physician's Global Assessment (PGA). RESULTS Of 288 patients enrolled, 3 were excluded due to missing informed consent. Among the remaining 285 patients, 243 (85.3%) were patients with CAPS and 42 (14.7%) had atypical CAPS (6.3%) or other conditions (8.4%). The median age was 26.6 years. Based on PGA, 58 of 123 (47.2%) patients with CAPS had no disease activity at 48 months, and 65 of 123 (52.8%) experienced mild/moderate disease activity at 48 months. Among CAPS phenotypes, AE incidence rates per 100 patient-years were lowest for FCAS (73.1; 95% CI 60.3 to 87.8) compared with those with MWS (105.0; 95% CI 97.2 to 113.2) or NOMID (104.6; 95% CI 86.6 to 125.2). One hundred twenty-eight SAEs were reported in 68 patients with CAPS (incidence rate/100 patient-years, 14.0; 95% CI 11.6 to 16.6). One death (metastatic rectal adenocarcinoma in a patient with MWS) was reported. CONCLUSIONS The response to canakinumab was sustained for up to 6 years. Canakinumab demonstrated a favourable safety profile over long-term treatment in patients with CAPS. TRIAL REGISTRATION NUMBER NCT01213641.
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Affiliation(s)
- Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Hugh H Tilson
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Tom van der Poll
- Amsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | - Hal M Hoffman
- University of California San Diego, San Diego, California, USA.,Rady Children's Hospital San Diego, San Diego, California, USA
| | - Jasmin B Kuemmerle-Deschner
- Division of Pediatric Rheumatology, Department of Paediatrics and Autoinflammation Reference Center Tuebingen, University Hospital Tuebingen, Tübingen, Germany
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15
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Shaw Y, Courvoisier DS, Scherer A, Ciurea A, Lehmann T, Jaeger VK, Walker UA, Finckh A. Impact of assessing patient-reported outcomes with mobile apps on patient-provider interaction. RMD Open 2021; 7:rmdopen-2021-001566. [PMID: 33811177 PMCID: PMC8023945 DOI: 10.1136/rmdopen-2021-001566] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 01/01/2021] [Revised: 03/03/2021] [Accepted: 03/18/2021] [Indexed: 01/09/2023] Open
Abstract
Objective To explore the effect of apps measuring patient-reported outcomes (PROs) on patient–provider interaction in the rheumatic diseases in an observational setting. Methods Patients in the Swiss Clinical Quality Management in Rheumatic Diseases Registry were offered mobile apps (iDialog and COmPASS) to track disease status between rheumatology visits using validated PROs (Rheumatoid Arthritis Disease Activity Index-5 score, Bath Ankylosing Spondylitis Disease Activity Index score, Routine Assessment of Patient Index Data-3 score and Visual Analogue Scale score for pain, disease activity and skin symptoms). We assessed two aspects of patient–provider interaction: shared decision making (SDM) and physician awareness of disease fluctuations. We used logistic regressions to compare outcomes among patients who (1) used an app and discussed app data with their physician (app+discussion group), (2) used an app without discussing the data (app-only group) or (3) did not use any app (non-app users). Results 2111 patients were analysed, including 1799 non-app users, 150 app-only users and 162 app+discussion users (43% male; with 902 patients with rheumatoid arthritis, 766 patients with axial spondyloarthritis and 443 patients with psoriatic arthritis). App users were younger than non-app users (mean age of 47 vs 51 years, p<0.001). Compared with non-app users, the app+discussion group rated their rheumatologist more highly in SDM (OR 1.7, 95% CI 1.1 to 2.4) and physician awareness of disease fluctuations (OR 2.0, 95% CI 1.3 to 3.1). This improvement was absent in the app-only group. Conclusion App users who discussed app data with their rheumatologist reported more favourably on patient–provider interactions than app users who did not and non-app users. Apps measuring PROs may contribute little to patient–provider interactions without integration of app data into care processes.
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Affiliation(s)
- Yomei Shaw
- Department of Rheumatology, Geneva University Hospitals, Geneva, Switzerland .,Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Almut Scherer
- Swiss Clinical Quality Management Foundation, Zurich, Switzerland
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Veronika K Jaeger
- Institute of Epidemiology and Social Medicine, University of Munster, Munster, Nordrhein-Westfalen, Germany
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Axel Finckh
- Department of Rheumatology, Geneva University Hospitals, Geneva, Switzerland
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16
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Kocher A, Ndosi M, Denhaerynck K, Simon M, Dwyer AA, Distler O, Hoeper K, Künzler-Heule P, Redmond AC, Villiger PM, Walker UA, Nicca D. A rare disease patient-reported outcome measure: revision and validation of the German version of the Systemic Sclerosis Quality of Life Questionnaire (SScQoL) using the Rasch model. Orphanet J Rare Dis 2021; 16:356. [PMID: 34372892 PMCID: PMC8351336 DOI: 10.1186/s13023-021-01944-9] [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: 03/12/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Rare disease patient-reported outcome measures (PROMs) require linguistic adaptation to overcome the challenge of geographically dispersed patient populations. Importantly, PROMs such as health-related quality of life (HRQoL) should accurately capture responses to patient-identified concerns. The Systemic Sclerosis Quality of Life Questionnaire (SScQoL) is a 29-item tool validated in six languages. Previous evaluation of the German version revealed problems with dichotomous responses. This study aimed to revise the German SScQoL, extend the response structure, and evaluate content and construct validity, reliability and unidimensionality. Methods The instrument validation study involved revising the German SScQoL response structure, cognitive debriefing with patients and validation using Rasch analysis. The revised SScQoL was completed by Swiss-German-speaking patients with SSc within the Swiss MANagement Of Systemic Sclerosis (MANOSS) study. Rasch analysis was employed to test the validity, reliability and unidimensionality of the revised instrument. Results Based on cognitive debriefing with patients (n = 6) dichotomous items were extended to a polytomous 4-point response structure. A total of 78 patients completed the revised SScQoL. Initial analysis of the 29 items suggested the scale lacked fit to the model (χ2 = 51.224, df = 29, p = 0.007). Grouping items into five domains resulted in an adequate fit to the Rasch model (χ2 = 5.343, df = 5, p = 0.376) and unidimensionality (proportion of significant independent t tests: 0.045, 95% CI 0.016–0.114). Overall, the scale was well targeted, had high internal consistency (Person Separation Index, PSI = 0.931) and worked consistently in patients with different demographic and clinical characteristics. Conclusions The revised German SScQoL has a 4-point response structure and is a valid, reliable measure. Rasch analysis is useful for validating continuous response structure of quality of life measures. Further evaluation of measurement equivalence with other German-speaking cultures is required for multinational comparisons and data pooling. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01944-9.
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Affiliation(s)
- Agnes Kocher
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Kris Denhaerynck
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Michael Simon
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.,Nursing Research Unit, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew A Dwyer
- Boston College, Connell School of Nursing, Chestnut Hill, MA, USA
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kirsten Hoeper
- Hannover Medical School, Department, Rheumatology and Immunology, Hannover, Germany
| | - Patrizia Künzler-Heule
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Gastroenterology/Hepatology and Department of Nursing, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Peter M Villiger
- Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Dunja Nicca
- Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland. .,Department of Global and Public Health, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland.
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17
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Iudici M, Jarlborg M, Lauper K, Müller-Ladner U, Smith V, Allanore Y, Balbir-Gurman A, Doria A, Airò P, Walker UA, Riccieri V, Vonk MC, Gabrielli A, Hoffmann-Vold AM, Szücs G, Martin T, Distler O, Courvoisier DS. Representativeness of Systemic Sclerosis Patients in Interventional Randomized Trials: an analysis of the EUSTAR database. Rheumatology (Oxford) 2021; 61:743-755. [PMID: 33989387 DOI: 10.1093/rheumatology/keab437] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/10/2021] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To estimate the extent of and the reasons for ineligibility in randomized controlled trials (RCTs) of systemic sclerosis (SSc) patients included in the EUSTAR database, and to determine the association between patient's features and generalizability of study results. METHODS We searched Clinicaltrials.gov for all records on interventional SSc-RCTs registered from January 2013 to January 2018. Two reviewers selected studies, and information on the main trial features were retrieved. Data from 8046 patients having a visit in the EUSTAR database since 2013 were used to check patient's eligibility. The proportion of potentially eligible patients per trial, and the risk factors for ineligibility were analyzed. Complete-, worst- and best-case analyses were performed. RESULTS Of the 37 RCTs included, 43% were conducted in Europe, 35% were industry-funded, and 87% investigated pharmacological treatments. Ninety-one percent of 8046 patients included could have participated in at least one RCT. In complete-case analysis, the median [range] proportion of eligible patients having the main organ complication targeted by each study was 60% [10-100] in the overall sample of trials, ranging from 50% [32-79] for trials on skin fibrosis to 90% [34-77] for those targeting Raynaud's phenomenon. Among the criteria checked, treatment- and safety-related but not demographic were the main barriers to patient's recruitment. Older age, absence of Raynaud's phenomenon, and lower mRSS were independently associated with the failure to fulfill criteria for any of the included studies. CONCLUSIONS Patient's representativeness in SSc-RCTs is highly variable and is driven more by treatment- and safety-related rather than demographic criteria.
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Affiliation(s)
- Michele Iudici
- Rheumatology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Matthias Jarlborg
- Rheumatology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Kim Lauper
- Rheumatology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Ulf Müller-Ladner
- Justus-Liebig-University of Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Yannick Allanore
- Service de Rhumatologie, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | | | - Andrea Doria
- Department of Rheumatology, University of Padova, Padova, Italy
| | - Paolo Airò
- Rheumatology and Clinical Immunology, Spedali Civili, Brescia, Italy
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Valeria Riccieri
- Dipartimento di Scienze Cliniche Internistiche Anestesiologiche e Cardiovascolari, Sapienza University of Rome, Rome, Italy
| | - Madelon C Vonk
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Gabriella Szücs
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Thierry Martin
- Clinical immunology department, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Grand-Est Sud-Ouest (RESO), Strasbourg, France
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Delphine S Courvoisier
- Rheumatology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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18
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Arnold S, Jaeger VK, Scherer A, Ciurea A, Walker UA, Kyburz D. Discontinuation of biologic DMARDs in a real-world population of patients with rheumatoid arthritis in remission: outcome and risk factors. Rheumatology (Oxford) 2021; 61:131-138. [PMID: 33848332 DOI: 10.1093/rheumatology/keab343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Data from randomized controlled trials have shown the feasibility of discontinuation of bDMARD therapy in patients with RA that have reached remission. Criteria for selecting patients that are likely to remain in remission are still incompletely defined.We aimed to identify predictors of successful discontinuation of bDMARD therapy in the Swiss Clinical Quality Management (SCQM) registry, a real-world cohort of RA patients. METHODS RA patients in DAS28-ESR remission who stopped bDMARD/tsDMARD treatment were included. Loss of remission was defined as a DAS28-ESR > 2.6 or restart of a bDMARD/tsDMARD. Time to loss of remission was the main outcome. Kaplan-Meier methods were applied and cox regression was used for multivariable analyses adjusting for confounding factors. Missing data were imputed using multiple imputation. RESULTS 318 patients in a bDMARD/tsDMARD-free remission were followed between 1997 and 2017. 241 patients (76%) lost remission after a median time of 0.9 years (95%CI 0.7-1.0). The time to loss of remission was shorter in women, in patients with a longer disease duration >4yrs and in patients who did not meet CDAI remission criteria at baseline. Remission was longer in patients with csDMARD therapy during b/tsDMARD free remission (HR 0.8, p= 0.05, 95%CI 0.6-1.0). CONCLUSION In a real-world patient population the majority of patients who discontinued b/tsDMARD treatment lost remission within <1 year. Our study confirms that fulfilment of more rigorous remission criteria and csDMARD treatment increases the chance of maintaining b/tsDMARD free remission.
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Affiliation(s)
- Simone Arnold
- Department of Rheumatology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Veronika K Jaeger
- Department of Rheumatology, University Hospital Basel and University of Basel, Basel, Switzerland.,Institute for Epidemiology and Social Medicine, University of Münster, Germany
| | - Almut Scherer
- Swiss Clinical Quality Management Foundation, Zurich, Switzerland
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Diego Kyburz
- Department of Rheumatology, University Hospital Basel and University of Basel, Basel, Switzerland
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19
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Vonk MC, Walker UA, Volkmann ER, Kreuter M, Johnson SR, Allanore Y. Natural variability in the disease course of SSc-ILD: implications for treatment. Eur Respir Rev 2021; 30:30/159/200340. [PMID: 33762426 DOI: 10.1183/16000617.0340-2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/04/2021] [Indexed: 11/05/2022] Open
Abstract
Interstitial lung disease (ILD) affects approximately 50% of patients with systemic sclerosis (SSc) and is the leading cause of death in SSc. Our objective was to gain insight into the progression of SSc-associated ILD (SSc-ILD). Using data from longitudinal clinical trials and observational studies, we assessed definitions and patterns of progression, risk factors for progression, and implications for treatment. SSc-ILD progression was commonly defined as exceeding specific thresholds of lung function worsening and/or increasing radiographic involvement. One definition used in several studies is decline in forced vital capacity (FVC) of ≥10%, or ≥5-10% plus a decline in diffusing capacity of the lung for carbon monoxide ≥15%. Based on these criteria, 20-30% of patients in observational cohorts develop progressive ILD, starting early in the disease course and progressing at a highly variable rate.Risk factors such as age, FVC, extent of fibrosis and presence of anti-topoisomerase I antibodies can help predict progression of SSc-ILD, though composite risk scores may offer greater predictive power. Whilst the variability of the disease course in SSc-ILD makes risk stratification of patients challenging, the decision to initiate, change or stop treatment should be based on a combination of the current disease state and the speed of progression.
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Affiliation(s)
- Madelon C Vonk
- Dept of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ulrich A Walker
- Dept of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Elizabeth R Volkmann
- Dept of Medicine, Division of Rheumatology, University of California, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Care Medicine, Thoraxklinik, University of Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Sindhu R Johnson
- University Health Network, Mount Sinai Hospital, Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Yannick Allanore
- Dept of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
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20
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Spierings J, van Rhenen A, Welsing PM, Marijnissen AC, De Langhe E, Del Papa N, Dierickx D, Gheorghe KR, Henes J, Hesselstrand R, Kerre T, Ljungman P, van de Loosdrecht AA, Marijt EW, Mayer M, Schmalzing M, Schroers R, Smith V, Voll RE, Vonk MC, Voskuyl AE, de Vries-Bouwstra JK, Walker UA, Wuttge DM, van Laar JM. A randomised, open-label trial to assess the optimal treatment strategy in early diffuse cutaneous systemic sclerosis: the UPSIDE study protocol. BMJ Open 2021; 11:e044483. [PMID: 33737437 PMCID: PMC7978271 DOI: 10.1136/bmjopen-2020-044483] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Systemic sclerosis (SSc) is a chronic, autoimmune connective tissue disease associated with high morbidity and mortality, especially in diffuse cutaneous SSc (dcSSc). Currently, there are several treatments available in early dcSSc that aim to change the disease course, including immunosuppressive agents and autologous haematopoietic stem cell transplantation (HSCT). HSCT has been adopted in international guidelines and is offered in current clinical care. However, optimal timing and patient selection for HSCT are still unclear. In particular, it is unclear whether HSCT should be positioned as upfront therapy or rescue treatment for patients refractory to immunosuppressive therapy. We hypothesise that upfront HSCT is superior and results in lower toxicity and lower long-term medical costs. Therefore, we propose this randomised trial aiming to determine the optimal treatment strategy for early dcSSc by comparing two strategies used in standard care: (1) upfront autologous HSCT versus (2) immunosuppressive therapy (intravenous cyclophosphamide pulse therapy followed by mycophenolate mofetil) with rescue HSCT in case of treatment failure. METHODS AND ANALYSIS The UPSIDE (UPfront autologous hematopoietic Stem cell transplantation vs Immunosuppressive medication in early DiffusE cutaneous systemic sclerosis) study is a multicentre, randomised, open-label, controlled trial. In total, 120 patients with early dcSSc will be randomised. The primary outcome is event-free survival at 2 years after randomisation. Secondary outcomes include serious adverse events, functional status and health-related quality of life. We will also evaluate changes in nailfold capillaroscopy pattern, pulmonary function, cardiac MR and high-resolution CT of the chest. Follow-up visits will be scheduled 3-monthly for 2 years and annually in the following 3 years. ETHICS AND DISSEMINATION The study was approved by the Dutch Central Committee on Research Concerning Human Subjects (NL72607.041.20). The results will be disseminated through patient associations and conventional scientific channels. TRIAL REGISTRATION NUMBERS NCT04464434; NL 8720.
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Affiliation(s)
- Julia Spierings
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Anna van Rhenen
- Department of Haematology, UMC Utrecht, Utrecht, the Netherlands
| | - Paco Mw Welsing
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Anne Ca Marijnissen
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
| | - Ellen De Langhe
- Department of Rheumatology, KU Leuven Hospital, Leuven, Flanders, Belgium
| | | | - Daan Dierickx
- Department of Haematology, KU Leuven Hospital, Leuven, Flanders, Belgium
| | - Karina R Gheorghe
- Department of Rheumatology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Joerg Henes
- Department for Internal Medicine (Oncology, Haematology, Rheumatology and Immunology), University Hospital Tubingen, Tubingen, Baden-Württemberg, Germany
| | - Roger Hesselstrand
- Department of Clinical Sciences, Lund, Section for Rheumatology, Lund University and Skåne University Hospital, Lund, Skåne, Sweden
| | - Tessa Kerre
- Department of Haematology, University Hospital Ghent, Gent, Oost-Vlaanderen, Belgium
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | | | - Erik Waf Marijt
- Department of Haematology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Miro Mayer
- Department of Clinical Immunology and Rheumatology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marc Schmalzing
- Department of Internal Medicine, Rheumatology and Clinical Immunology, University Hospital Wurzburg, Wurzburg, Bayern, Germany
| | - Roland Schroers
- Department of Medicine, Haematology and Oncology, Ruhr University of Bochum, Faculty of Medicine, Bochum, Nordrhein-Westfalen, Germany
| | - Vanessa Smith
- Department of Rheumatology, University Hospital Ghent, Gent, Oost-Vlaanderen, Belgium
- Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Gent, Oost-Vlaanderen, Belgium
| | - Reinhard E Voll
- Department of Rheumatology, Medical Center-University of Freiburg, Freiburg, Baden-Württemberg, Germany
| | - Madelon C Vonk
- Rheumatology, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Alexandre E Voskuyl
- Department of Rheumatology, Amsterdam UMC Locatie VUmc, Amsterdam, Noord-Holland, The Netherlands
| | | | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Dirk M Wuttge
- Department of Clinical Sciences, Lund, Section for Rheumatology, Lund University and Skåne University Hospital, Lund, Skåne, Sweden
| | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, The Netherlands
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21
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Manoil D, Courvoisier DS, Gilbert B, Möller B, Walker UA, Muehlenen IV, Rubbert-Roth A, Finckh A, Bostanci N. Associations between serum antibodies to periodontal pathogens and preclinical phases of rheumatoid arthritis. Rheumatology (Oxford) 2021; 60:4755-4764. [PMID: 33512428 DOI: 10.1093/rheumatology/keab097] [Citation(s) in RCA: 7] [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: 10/14/2020] [Accepted: 01/17/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To examine whether serum antibodies against selected periodontal pathogens are associated with early symptoms of RA development in healthy individuals at risk of developing the disease. METHODS Within an ongoing study cohort of first-degree relatives of patients with RA (RA-FDRs), we selected four groups corresponding to specific preclinical phases of RA development (n = 201). (i) RA-FDR controls without signs and symptoms of arthritis nor RA-related autoimmunity (n = 51); (ii) RA-FDRs with RA-related autoimmunity (n = 51); (iii) RA-FDRs with inflammatory arthralgias without clinical arthritis (n = 51); and (iv) RA-FDRs who have presented at least one swollen joint ('unclassified arthritis') (n = 48). Groups were matched for smoking, age, sex and shared epitope status. The primary outcome was IgG serum levels against five selected periodontal pathogens and one commensal oral species assessed using validated-in-house ELISA assays. Associations between IgG measurements and preclinical phases of RA development were examined using Kruskal-Wallis or Mann-Whitney tests (α = 0.05). RESULTS None of the IgGs directed against individual periodontal pathogens significantly differed between the four groups of RA-FDRs. Further analyses of cumulated IgG levels into bacterial clusters representative of periodontal infections revealed significantly higher IgG titres against periodontopathogens in anti-citrullinated protein antibodies (ACPA)-positive RA-FDRs (P = 0.015). Current smoking displayed a marked trend towards reduced IgG titres against periodontopathogens. CONCLUSION Our results do not suggest an association between serum IgG titres against individual periodontal pathogens and specific preclinical phases of RA development. However, associations between cumulative IgG titres against periodontopathogens and the presence of ACPAs suggest a synergistic contribution of periodontopathogens to ACPA development.
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Affiliation(s)
- Daniel Manoil
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Delphine S Courvoisier
- Division of Rheumatology, Department of Internal Medicine Specialties, University Hospitals of Geneva, Geneva
| | - Benoit Gilbert
- Division of Rheumatology, Department of Internal Medicine Specialties, University Hospitals of Geneva, Geneva
| | - Burkhard Möller
- Department of Rheumatology, Immunology and Allergology, University Hospital Inselspital Bern, Bern
| | | | | | - Andrea Rubbert-Roth
- Division of Rheumatology and Immunology, Kantonsspital St. Gallen, St Gallen
| | - Axel Finckh
- Division of Rheumatology, Department of Internal Medicine Specialties, University Hospitals of Geneva, Geneva
| | - Nagihan Bostanci
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.,Center of Dental Medicine, University of Zürich, Zürich, Switzerland
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22
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Fallet B, Walker UA. Current immunosuppressive and antifibrotic therapies of systemic sclerosis and emerging therapeutic strategies. Expert Rev Clin Pharmacol 2020; 13:1203-1218. [PMID: 33008265 DOI: 10.1080/17512433.2020.1832466] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Systemic sclerosis (SSc) is a rare, difficult to treat disease with profound effects on quality of life and high mortality. Complex and incompletely understood pathophysiologic processes and greatly heterogeneous clinical presentations and outcomes have hampered drug development. AREAS COVERED This review summarizes the currently available immunosuppressive and antifibrotic therapies and discusses novel approaches for the treatment of SSc. We reviewed the literature using the MEDLINE and ClinicalTrial.gov databases between May and September 2020. EXPERT OPINION Available immunosuppressive and antifibrotic drugs only modestly impact the course of the disease. Most drugs are currently only investigated in the subset of patients with early diffuse cutaneous SSc. In this patient population, hematopoietic stem-cell transplantation is currently the only treatment that has demonstrated reversal of lung involvement, enhanced quality of life and reduced long-term mortality, but carries the risk of short-term treatment-related mortality. A great need to provide better therapeutic options to patients exists also for those patients who have limited cutaneous skin involvement. A better understanding of SSc pathophysiology has enabled the identification of numerous new therapeutic targets. The progress made in the design of clinical trials and outcome parameters will likely result in the improvement of effective management options.
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Affiliation(s)
- Bénédict Fallet
- Department of Rheumatology, University Hospital Basel , Basel, Switzerland
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel , Basel, Switzerland
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23
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Jaeger VK, Tikly M, Xu D, Siegert E, Hachulla E, Airò P, Valentini G, Matucci Cerinic M, Distler O, Cozzi F, Carreira P, Allanore Y, Müller-Ladner U, Ananieva LP, Balbir-Gurman A, Distler JHW, Czirják L, Li M, Henes J, Jimenez SA, Smith V, Damjanov N, Denton CP, DelGaldo F, Saketkoo LA, Walker UA. Racial differences in systemic sclerosis disease presentation: a European Scleroderma Trials and Research group study. Rheumatology (Oxford) 2020; 59:1684-1694. [PMID: 31680161 DOI: 10.1093/rheumatology/kez486] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 09/19/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Racial factors play a significant role in SSc. We evaluated differences in SSc presentations between white patients (WP), Asian patients (AP) and black patients (BP) and analysed the effects of geographical locations. METHODS SSc characteristics of patients from the EUSTAR cohort were cross-sectionally compared across racial groups using survival and multiple logistic regression analyses. RESULTS The study included 9162 WP, 341 AP and 181 BP. AP developed the first non-RP feature faster than WP but slower than BP. AP were less frequently anti-centromere (ACA; odds ratio (OR) = 0.4, P < 0.001) and more frequently anti-topoisomerase-I autoantibodies (ATA) positive (OR = 1.2, P = 0.068), while BP were less likely to be ACA and ATA positive than were WP [OR(ACA) = 0.3, P < 0.001; OR(ATA) = 0.5, P = 0.020]. AP had less often (OR = 0.7, P = 0.06) and BP more often (OR = 2.7, P < 0.001) diffuse skin involvement than had WP. AP and BP were more likely to have pulmonary hypertension [OR(AP) = 2.6, P < 0.001; OR(BP) = 2.7, P = 0.03 vs WP] and a reduced forced vital capacity [OR(AP) = 2.5, P < 0.001; OR(BP) = 2.4, P < 0.004] than were WP. AP more often had an impaired diffusing capacity of the lung than had BP and WP [OR(AP vs BP) = 1.9, P = 0.038; OR(AP vs WP) = 2.4, P < 0.001]. After RP onset, AP and BP had a higher hazard to die than had WP [hazard ratio (HR) (AP) = 1.6, P = 0.011; HR(BP) = 2.1, P < 0.001]. CONCLUSION Compared with WP, and mostly independent of geographical location, AP have a faster and earlier disease onset with high prevalences of ATA, pulmonary hypertension and forced vital capacity impairment and higher mortality. BP had the fastest disease onset, a high prevalence of diffuse skin involvement and nominally the highest mortality.
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Affiliation(s)
- Veronika K Jaeger
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Mohammed Tikly
- Division of Rheumatology, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Dong Xu
- Department of Rheumatology, Peking Union Medical College Hospital, Beijing, China
| | - Elise Siegert
- Department of Rheumatology and Immunology, University Hospital Charité, Berlin, Germany
| | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord et Nord-Ouest (CERAINO), LIRIC, INSERM, Univ. Lille, CHU Lille, Lille, France
| | - Paolo Airò
- UO Reumatologia ed Immunologia Clinica, Spedali Civili, Brescia, Italy
| | | | - Marco Matucci Cerinic
- Department of Experimental and Clinical Rheumatology, Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Franco Cozzi
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Patricia Carreira
- Servicio de Reumatologia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Yannick Allanore
- Department of Rheumatology A, Paris Descartes University, Cochin Hospital, Paris, France
| | - Ulf Müller-Ladner
- Justus-Liebig-University of Giessen, Kerckhoff-Klinik, Germany, Bad Nauheim
| | - Lidia P Ananieva
- VA Nasonova Institute of Rheumatology, Moscow, Russian Federation
| | - Alexandra Balbir-Gurman
- B. Shine Rheumatology Institute, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion - Institute of Technology, Haifa, Israel
| | - Jörg H W Distler
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Laszlo Czirják
- Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Beijing, China
| | - Jörg Henes
- Department of Internal Medicine II, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Sergio A Jimenez
- Scleroderma Centre, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vanessa Smith
- Faculty of Internal Medicine, Ghent University, Ghent, Belgium
| | - Nemanja Damjanov
- Institute of Rheumatology, University of Belgrade Medical School, Belgrade, Serbia
| | - Christopher P Denton
- Department of Rheumatology, University College London, Royal Free Hospital, London, UK
| | - Francesco DelGaldo
- Leeds Musculoskeletal Biomedical Research Unit (LMBRU), University of Leeds, Leeds, UK
| | - Lesley Ann Saketkoo
- Tulane University Lung Centre, University Medical Centre Scleroderma and Sarcoidosis Patient Care and Research Centre, New Orleans, LA, USA
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
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Fallet B, Kyburz D, Walker UA. Mild Course of COVID-19 and Spontaneous Virus Clearance in a Patient With Depleted Peripheral Blood B Cells Due to Rituximab Treatment. Arthritis Rheumatol 2020; 72:1581-1582. [PMID: 32458534 PMCID: PMC7283641 DOI: 10.1002/art.41380] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bühler S, Jaeger VK, Adler S, Bannert B, Brümmerhoff C, Ciurea A, Distler O, Franz J, Gabay C, Hagenbuch N, Herzog C, Hasler P, Kling K, Kyburz D, Müller R, Nissen MJ, Siegrist CA, Villiger PM, Walker UA, Hatz C. Safety and immunogenicity of tetanus/diphtheria vaccination in patients with rheumatic diseases-a prospective multi-centre cohort study. Rheumatology (Oxford) 2020; 58:1585-1596. [PMID: 30877773 DOI: 10.1093/rheumatology/kez045] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 10/31/2018] [Revised: 01/23/2019] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES We aimed to assess the safety and immunogenicity of a diphtheria/tetanus vaccine booster dose in three different patient groups with rheumatic diseases on a variety of immunosuppressive/immunomodulatory medications compared with healthy controls (HCs). METHODS We conducted a multi-centre prospective cohort study in Switzerland. We enrolled patients with RA, axial SpA/PsA, vasculitis (Behçet's disease, ANCA-associated vasculitis) and HCs. Diphtheria/tetanus vaccination was administered according to the Swiss vaccination recommendations. Blood samples were drawn before vaccination, and 1 month and 3 months afterwards. Antibody concentrations against vaccine antigens were measured by ELISA. Immunogenicity was compared between patient and medication groups. A mixed model was applied for multivariate analysis. Missing data were dealt with using multiple imputation. RESULTS Between January 2014 and December 2015, we enrolled 284 patients with rheumatic diseases (131 RA, 114 SpA/PsA, 39 vasculitis) and 253 HCs. Of the patients, 89% were on immunosuppressive/immunomodulatory medication. Three months post-vaccination 100% of HCs vs 98% of patients were protected against tetanus and 84% vs 73% against diphtheria. HCs and SpA/PsA patients had significantly higher responses than RA and vasculitis patients. Assessing underlying diseases and medications in a multivariate model, rituximab was the only factor negatively influencing tetanus immunogenicity, whereas only MTX treatment had a negative influence on diphtheria antibody responses. No vaccine-related serious adverse events were recorded. CONCLUSION Diphtheria/tetanus booster vaccination was safe. Tetanus vaccination was immunogenic; the diphtheria component was less immunogenic. Vaccine responses were blunted by rituximab and MTX. TRIAL REGISTRATION ClinicalTrials.gov, http://clinicaltrials.gov, Identifier: NCT01947465.
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Affiliation(s)
- Silja Bühler
- Department of Public Health/Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Sabine Adler
- Department of Rheumatology, Immunology and Allergology, University Hospital of Bern, Bern
| | - Bettina Bannert
- Department of Rheumatology, University Hospital Basel, Basel
| | - Carolin Brümmerhoff
- Division of Rheumatology, Department of Internal Medicine, Cantonal Hospital St Gallen, St Gallen
| | - Adrian Ciurea
- Department of Rheumatology, University Hospital of Zurich, Zurich
| | - Oliver Distler
- Department of Rheumatology, University Hospital of Zurich, Zurich
| | - Juliane Franz
- Division of Rheumatology, University Medical Department, Cantonal Hospital Aarau, Aarau
| | - Cem Gabay
- Department of Medicine, Division of Rheumatology, University Hospitals of Geneva, Geneva
| | - Niels Hagenbuch
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich
| | - Christian Herzog
- Department of Medicine and Diagnostics, Swiss Tropical and Public Health Institute.,University of Basel, Basel, Switzerland
| | - Paul Hasler
- Division of Rheumatology, University Medical Department, Cantonal Hospital Aarau, Aarau
| | - Kerstin Kling
- Department of Medicine and Diagnostics, Swiss Tropical and Public Health Institute.,University of Basel, Basel, Switzerland
| | - Diego Kyburz
- Department of Rheumatology, University Hospital Basel, Basel
| | - Rüdiger Müller
- Division of Rheumatology, Department of Internal Medicine, Cantonal Hospital St Gallen, St Gallen.,Division of Rheumatology, University Medical Department, Cantonal Hospital Aarau, Aarau.,Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael John Nissen
- Department of Medicine, Division of Rheumatology, University Hospitals of Geneva, Geneva
| | - Claire-Anne Siegrist
- Center for Vaccinology, University Hospital and Faculty of Medicine, Geneva, Switzerland
| | | | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel
| | - Christoph Hatz
- Department of Public Health/Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.,Department of Medicine and Diagnostics, Swiss Tropical and Public Health Institute.,University of Basel, Basel, Switzerland
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26
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Hoffmann-Vold AM, Maher TM, Philpot EE, Ashrafzadeh A, Barake R, Barsotti S, Bruni C, Carducci P, Carreira PE, Castellví I, Del Galdo F, Distler JHW, Foeldvari I, Fraticelli P, George PM, Griffiths B, Guillén-Del-Castillo A, Hamid AM, Horváth R, Hughes M, Kreuter M, Moazedi-Fuerst F, Olas J, Paul S, Rotondo C, Rubio-Rivas M, Seferian A, Tomčík M, Uzunhan Y, Walker UA, Więsik-Szewczyk E, Distler O. The identification and management of interstitial lung disease in systemic sclerosis: evidence-based European consensus statements. Lancet Rheumatol 2020; 2:e71-e83. [PMID: 38263663 DOI: 10.1016/s2665-9913(19)30144-4] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Systemic sclerosis-associated interstitial lung disease (ILD) carries a high mortality risk; expert guidance is required to aid early recognition and treatment. We aimed to develop the first expert consensus and define an algorithm for the identification and management of the condition through application of well established methods. METHODS Evidence-based consensus statements for systemic sclerosis-associated ILD management were established for six domains (ie, risk factors, screening, diagnosis and severity assessment, treatment initiation and options, disease progression, and treatment escalation) using a modified Delphi process based on a systematic literature analysis. A panel of 27 Europe-based pulmonologists, rheumatologists, and internists with expertise in systemic sclerosis-associated ILD participated in three rounds of online surveys, a face-to-face discussion, and a WebEx meeting, followed by two supplemental Delphi rounds, to establish consensus and define a management algorithm. Consensus was considered achieved if at least 80% of panellists indicated agreement or disagreement. FINDINGS Between July 1, 2018, and Aug 27, 2019, consensus agreement was reached for 52 primary statements and six supplemental statements across six domains of management, and an algorithm was defined for clinical practice use. The agreed statements most important for clinical use included: all patients with systemic sclerosis should be screened for systemic sclerosis-associated ILD using high-resolution CT; high-resolution CT is the primary tool for diagnosing ILD in systemic sclerosis; pulmonary function tests support screening and diagnosis; systemic sclerosis-associated ILD severity should be measured with more than one indicator; it is appropriate to treat all severe cases; no pharmacological treatment is an option for some patients; follow-up assessments enable identification of disease progression; progression pace, alongside disease severity, drives decisions to escalate treatment. INTERPRETATION Through a robust modified Delphi process developed by a diverse panel of experts, the first evidence-based consensus statements were established on guidance for the identification and medical management of systemic sclerosis-associated ILD. FUNDING An unrestricted grant from Boehringer Ingelheim International.
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Affiliation(s)
| | - Toby M Maher
- National Heart and Lung Institute, Imperial College London, London, UK; Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | | | - Ali Ashrafzadeh
- Rheumatology Center of Excellence, IQVIA, San Diego, CA, USA
| | - Rafic Barake
- Department of Pulmonary Diseases, Centre Hospitalier de Rambouillet, Rambouillet, France
| | | | - Cosimo Bruni
- Department of Rheumatology/Scleroderma Unit, University of Florence, Florence, Italy
| | - Paolo Carducci
- Pulmonology Unit, San Salvatore Hospital, L'Aquila, Italy
| | | | - Ivan Castellví
- Department of Rheumatology, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Francesco Del Galdo
- NIHR Biomedical Research Centre and Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Jörg H W Distler
- Department of Internal Medicine 3 and Institute for Clinical Immunology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Hamburg, Germany
| | - Paolo Fraticelli
- Department of Internal Medicine, Ospedali Riuniti-Università Politecnica delle Marche, Ancona, Italy
| | - Peter M George
- National Heart and Lung Institute, Imperial College London, London, UK; Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Bridget Griffiths
- Department of Rheumatology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | | | - Abdul Monem Hamid
- Department of Pneumology and Lung Transplantation, Foch Hospital, Paris, France; Collège de Médecine des Hôpitaux de Paris, Paris, France
| | - Rudolf Horváth
- Department of Paediatric and Adult Rheumatology, Faculty Hospital Motol, Prague, Czech Republic
| | - Michael Hughes
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield, UK
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology Thoraxklinik Heidelberg University Hospital, Heidelberg and German Center for Lung Research, Germany
| | - Florentine Moazedi-Fuerst
- Department of Internal Medicine, Division of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Jacek Olas
- Scleroderma Outpatient Clinic, Małopolska Center of Rheumatology, Immunology and Rehabilitation, Krakow, Poland
| | - Suman Paul
- Respiratory Medicine Department, Royal Preston Hospital, Preston, UK
| | - Cinzia Rotondo
- Scleroderma Outpatient Clinic, Rheumatology Unit, University Hospital Ospedali Riuniti di Foggia, Foggia, Italy
| | - Manuel Rubio-Rivas
- Department of Internal Medicine, Bellvitge University Hospital, Barcelona, Spain
| | - Andrei Seferian
- University Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, France; INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis-Robinson, France; Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Yurdagül Uzunhan
- Assistance Publique-Hôpitaux de Paris, Avicenne Hospital, Pneumology Department, INSERM UMR 1272, Paris 13 University, Bobigny, France
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Ewa Więsik-Szewczyk
- Department of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine, Warsaw, Poland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
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Geurts J, Nasi S, Distel P, Müller-Gerbl M, Prolla TA, Kujoth GC, Walker UA, Hügle T. Prematurely aging mitochondrial DNA mutator mice display subchondral osteopenia and chondrocyte hypertrophy without further osteoarthritis features. Sci Rep 2020; 10:1296. [PMID: 31992827 PMCID: PMC6987232 DOI: 10.1038/s41598-020-58385-w] [Citation(s) in RCA: 14] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/15/2020] [Indexed: 11/23/2022] Open
Abstract
Mitochondrial mutations and dysfunction have been demonstrated in several age-related disorders including osteoarthritis, yet its relative contribution to pathogenesis remains unknown. Here we evaluated whether premature aging caused by accumulation of mitochondrial DNA mutations in PolgD275A mice predisposes to the development of knee osteoarthritis. Compared with wild type animals, homozygous PolgD275A mice displayed a specific bone phenotype characterized by osteopenia of epiphyseal trabecular bone and subchondral cortical plate. Trabecular thickness was significantly associated with osteocyte apoptosis rates and osteoclasts numbers were increased in subchondral bone tissues. While chondrocyte apoptosis rates in articular and growth plate cartilage were similar between groups, homozygous mitochondrial DNA mutator mice displayed elevated numbers of hypertrophic chondrocytes in articular calcified cartilage. Low grade cartilage degeneration, predominantly loss of proteoglycans, was present in all genotypes and the development of osteoarthritis features was not found accelerated in premature aging. Somatically acquired mitochondrial DNA mutations predispose to elevated subchondral bone turnover and hypertrophy in calcified cartilage, yet additional mechanical or metabolic stimuli would seem required for induction and accelerated progression of aging-associated osteoarthritis.
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Affiliation(s)
- Jeroen Geurts
- Department of Rheumatology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Sonia Nasi
- Department of Rheumatology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Pascal Distel
- Department of Biomedical Engineering, University Hospital of Basel, Basel, Switzerland
| | | | - Tomas A Prolla
- Departments of Genetics and Medical Genetics, University of Wisconsin, Madison, USA
| | - Gregory C Kujoth
- Departments of Genetics and Medical Genetics, University of Wisconsin, Madison, USA
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital of Basel, Basel, Switzerland
| | - Thomas Hügle
- Department of Rheumatology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
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28
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Burkhard J, Ciurea A, Gabay C, Hasler P, Müller R, Niedrig M, Fehr J, Villiger P, Visser LG, de Visser AW, Walker UA, Hatz C, Bühler S. Long-term immunogenicity after yellow fever vaccination in immunosuppressed and healthy individuals. Vaccine 2020; 38:3610-3617. [PMID: 31911033 DOI: 10.1016/j.vaccine.2019.12.042] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/11/2019] [Accepted: 12/19/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND The live-attenuated yellow fever vaccine (YFV) is generally contraindicated in immunosuppressed patients. Our aim was to investigate if immunosuppressive therapy impairs the long-term protection against yellow fever virus in patients who had received YFV prior to the start of their immunosuppressive therapy. METHODS Our study examined 35 healthy individuals and 40 immunosuppressed patients with autoimmune diseases or organ transplants. All individuals had received YFV prior to the onset of their immunosuppression. We analysed the long-term influence of the immunosuppressive therapy on the YFV protective immunity by measuring neutralising antibodies (NA) with the Plaque Reduction Neutralisation Test (PRNT). We assessed risk factors for a negative PRNT result (titre below 1: 10) and their influence on the magnitude of the NA. RESULTS A median time interval of 21.1 years (interquartile range 14.4-31.3 years) after the YFV in all patients, a total of 35 immunosuppressed patients (88%) were seropositive (PRNT ≥ 1:10) compared to 31 patients (89%) in the control group. The geometric mean titres of NA did not differ between the groups. The duration of an underlying rheumatic disease was the only risk factor found for a lower magnitude of NA. An insufficient level of NA was found in nine subjects (12%) who had received a single dose of YFV (in one subject, the number of YFV doses was unknown). CONCLUSION The use of an immunosuppressive drug started after the administration of the YFV did not affect long-term persistence of NA. A second dose of YFV may be necessary to secure long-term immunity.
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Affiliation(s)
- J Burkhard
- Department of Public Health / Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - A Ciurea
- Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | - C Gabay
- Division of Rheumatology, University Hospital of Geneva, Geneva, Switzerland
| | - P Hasler
- Department of Rheumatology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - R Müller
- Division of Rheumatology, Department of Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Division of Rheumatology and Clinical Immunology, Department of Internal Medicine Ludwig-Maximilians-University Munich, Germany
| | - M Niedrig
- Robert Koch-Institut (RKI), Berlin, Germany
| | - J Fehr
- Department of Public Health / Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - P Villiger
- Department of Rheumatology and Clinical Immunology/Allergology, University Hospital of Bern, Bern, Switzerland
| | - L G Visser
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - A W de Visser
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - U A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - C Hatz
- Department of Public Health / Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Department of Medicine and Diagnostics, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Switzerland; Division of Infectious Diseases & Hospital Epidemiology, Kantonsspital St. Gallen, Switzerland
| | - S Bühler
- Department of Public Health / Division of Infectious Diseases, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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29
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Jaeger VK, Walker UA. Raynaud's phenomenon: no net effects of vasodilators in a network analysis. Lancet Rheumatol 2019; 1:e200-e202. [PMID: 38229370 DOI: 10.1016/s2665-9913(19)30109-2] [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] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/04/2019] [Indexed: 01/18/2024]
Affiliation(s)
- Veronika K Jaeger
- Institute of Epidemiology and Social Medicine, University of Münster, 48149 Münster, Germany.
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
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30
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Fasano S, Riccardi A, Messiniti V, Caramaschi P, Rosato E, Maurer B, Smith V, Siegert E, De Langhe E, Riccieri V, Airó P, Mihai C, Avouac J, Zanatta E, Walker UA, Iannone F, García De la Peña Lefebvre P, Distler JHW, Vacca A, Distler O, Kowal-Bielecka O, Allanore Y, Valentini G. Revised European Scleroderma Trials and Research Group Activity Index is the best predictor of short-term severity accrual. Ann Rheum Dis 2019; 78:1681-1685. [PMID: 31422354 DOI: 10.1136/annrheumdis-2019-215787] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 05/28/2019] [Revised: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND The European Scleroderma Trials and Research Group (EUSTAR) recently developed a preliminarily revised activity index (AI) that performed better than the European Scleroderma Study Group Activity Index (EScSG-AI) in systemic sclerosis (SSc). OBJECTIVE To assess the predictive value for short-term disease severity accrual of the EUSTAR-AI, as compared with those of the EScSG-AI and of known adverse prognostic factors. METHODS Patients with SSc from the EUSTAR database with a disease duration from the onset of the first non-Raynaud sign/symptom ≤5 years and a baseline visit between 2003 and 2014 were first extracted. To capture the disease activity variations over time, EUSTAR-AI and EScSG-AI adjusted means were calculated. The primary outcome was disease progression defined as a Δ≥1 in the Medsger's severity score and in distinct items at the 2-year follow-up visit. Logistic regression analysis was carried out to identify predictive factors. RESULTS 549 patients were enrolled. At multivariate analysis, the EUSTAR-AI adjusted mean was the only predictor of any severity accrual and of that of lung and heart, skin and peripheral vascular disease over 2 years. CONCLUSION The adjusted mean EUSTAR-AI has the best predictive value for disease progression and development of severe organ involvement over time in SSc.
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Affiliation(s)
- Serena Fasano
- Department of Precision Medicine, Section of Rheumatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Antonella Riccardi
- Department of Precision Medicine, Section of Rheumatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Valentina Messiniti
- Department of Precision Medicine, Section of Rheumatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Edoardo Rosato
- Dipartimento di Medicina Traslazionale e di Precisione, Sapienza University of Rome, Roma, Italy
| | - Britta Maurer
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Vanessa Smith
- Department of Rheumatology, University Hospital Ghent, Gent, Belgium
| | - Elise Siegert
- Department of Rheumatology, Charit University Hospital, Berlin, Germany
| | - Ellen De Langhe
- Department of Development and Regeneration, Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
| | - Valeria Riccieri
- Clinical Medicine and Therapy, Sapienza University of Rome, Rome, Italy
| | - Paolo Airó
- Rheumatology and Clinical Immunology Department, Spedali Civili di Brescia, Brescia, Italy
| | - Carina Mihai
- Department of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucarest, Romania
| | - Jerome Avouac
- Department of Rheumatology, Paris Descartes University, Rheumatology A and INSER U1016, Cochin Hospital, Paris, France
| | - Elisabetta Zanatta
- Dipartimento di Medicina, DIMED, Universita degli Studi di Padova, Padova, Italy
| | - Ulrich A Walker
- Department of Rheumatology, Basel University, Basel, Switzerland
| | | | | | - Jörg H W Distler
- Department of Internal Medicine III, University of Erlangen, Erlangen, Germany
| | - Alessandra Vacca
- Chair and Rheumatology Unit, University Clinic AOU Cagliari, Monserrato, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Yannick Allanore
- Department of Rheumatology, Paris Descartes University, Rheumatology A and INSER U1016, Cochin Hospital, Paris, France
| | - Gabriele Valentini
- Department of Precision Medicine, Section of Rheumatology, University of Campania Luigi Vanvitelli, Naples, Italy
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Valentini G, Huscher D, Riccardi A, Fasano S, Irace R, Messiniti V, Matucci-Cerinic M, Guiducci S, Distler O, Maurer B, Avouac J, Tarner IH, Frerix M, Riemekasten G, Siegert E, Czirják L, Lóránd V, Denton CP, Nihtyanova S, Walker UA, Jaeger VK, Del Galdo F, Abignano G, Ananieva LP, Gherghe AM, Mihai C, Henes JC, Schmeiser T, Vacca A, Moiseev S, Foeldvari I, Gabrielli A, Krummel-Lorenz B, Rednic S, Allanore Y, Müeller-Ladner U. Vasodilators and low-dose acetylsalicylic acid are associated with a lower incidence of distinct primary myocardial disease manifestations in systemic sclerosis: results of the DeSScipher inception cohort study. Ann Rheum Dis 2019; 78:1576-1582. [PMID: 31391176 DOI: 10.1136/annrheumdis-2019-215486] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/12/2019] [Accepted: 07/31/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the influence of vasodilator drugs on the occurrence of features depending on myocardial ischaemia/fibrosis (ventricular arrhythmias, Q waves, cardiac blocks, pacemaker implantation, left ventricular ejection fraction (LVEF) <55%, and/or congestive heart failure and sudden cardiac death) in systemic sclerosis (SSc). METHODS 601 patients with SSc were enrolled from 1 December 2012 to 30 November 2015 and had a second visit 0.5-4 years apart. 153 received no vasodilators; 448 received vasodilator therapy (ie, calcium channel blockers and/or ACE inhibitors or angiotensin II receptor blockers or combinations of them), 89 of them being also treated with either endothelin receptor antagonists or PDE5 inhibitors or prostanoids. Associations between the occurrence of myocardial disease manifestations and any demographic, disease and therapeutic aspect were investigated by Cox regression analysis. A Cox frailty survival model with centre of enrolment as random effect was performed. RESULTS During 914 follow-up patient-years, 12 ventricular arrhythmias, 5 Q waves, 40 cardiac blocks, 6 pacemaker implantations and 19 reduced LVEF and/or congestive heart failure (CHF) occurred. In multivariate Cox regression analysis, vasodilator therapy was associated with a lower incidence of ventricular arrhythmias (p=0.03); low-dose acetylsalicylic acid (ASA) with a lower incidence of cardiac blocks and/or Q waves and/or pacemaker implantation (p=0.02); active disease with a higher incidence of LVEF <55% and/or CHF and cardiac blocks and/or Q waves and/or pacemaker implantation (p=0.05). CONCLUSIONS The present study might suggest a preventative effect on the occurrence of distinct myocardial manifestations by vasodilator therapy and low-dose ASA.
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Affiliation(s)
- Gabriele Valentini
- Department of Precision Medicine, Section of Rheumatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Dörte Huscher
- Institute of Biostatistics and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Antonella Riccardi
- Department of Precision Medicine, Section of Rheumatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Serena Fasano
- Department of Precision Medicine, Section of Rheumatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Rosaria Irace
- Department of Precision Medicine, Section of Rheumatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Valentina Messiniti
- Department of Precision Medicine, Section of Rheumatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Britta Maurer
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Jérôme Avouac
- Department of Rheumatology, Cochin Hospital, University of Paris Descartes, Paris, France
| | - Ingo H Tarner
- Department of Rheumatology and Clinical Immunology, Justus Liebig Universitat Giessen, Bad Nauheim, Germany
| | - Marc Frerix
- Department of Rheumatology and Clinical Immunology, Justus Liebig Universitat Giessen, Bad Nauheim, Germany
| | - Gabriela Riemekasten
- Department of Rheumatology, Universitatsklinikum Schleswig Holstein-Campus Lubeck, Lübeck, Germany
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité - Universitäetsmedizin Berlin, Berlin, Germany
| | - László Czirják
- Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary
| | - Veronika Lóránd
- Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary
| | - Christopher P Denton
- Department of Rheumatology, University College London, Royal Free Hospital, London, United Kingdom
| | - Svetlana Nihtyanova
- Department of Rheumatology, University College London, Royal Free Hospital, London, United Kingdom
| | - Ulrich A Walker
- Department of Rheumatology, University of Basel, Basel, Switzerland
| | | | - Francesco Del Galdo
- Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom
| | - Giuseppina Abignano
- Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom.,Rheumatology Institute of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
| | - Lidia P Ananieva
- Institute of Rheumatology, Russian Academy of Medical Science, Moscow, Russian Federation
| | - Ana Maria Gherghe
- Internal Medicine and Rheumatology Department, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Carina Mihai
- Internal Medicine and Rheumatology Department, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Joerg Christoph Henes
- Department of Internal Medicine II, University Hospitals Tübingen, Tübingen, Germany
| | - Tim Schmeiser
- Department of Rheumatology and Immunology, Saint Josef Hospital, Wuppertal, Germany
| | | | - Sergey Moiseev
- Sechenov First Moscow State Medical University and Lomonosov Moscow State University, Moscow, Russia
| | - Ivan Foeldvari
- Klinikum Eilbek, Hamburger Zentrum für Kinder- und Jugendrheumatologie, Hamburg, Germany
| | - Armando Gabrielli
- Clinical Medicine, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | | | - Simona Rednic
- Department of Rheumatology, University of Medicine and Pharmacy 'luliu Hatieganu' Cluj, Cluj-Napoca, Romania
| | - Yannick Allanore
- Department of Rheumatology, Cochin Hospital, University of Paris Descartes, Paris, France
| | - Ulf Müeller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus Liebig Universitat Giessen, Bad Nauheim, Germany
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Bratu VA, Häusermann P, Walker UA, Daikeler T, Zubler V, Jaeger VK, Weber U, Studler U. Do Patients With Skin Psoriasis Show Subclinical Axial Inflammation on Magnetic Resonance Imaging of the Sacroiliac Joints and Entire Spine? Arthritis Care Res (Hoboken) 2019; 71:1109-1118. [DOI: 10.1002/acr.23767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/18/2018] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | | | - Ulrich Weber
- King Christian 10th Hospital for Rheumatic Diseases, Gråsten, and University of Southern Denmark Odense Denmark
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33
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Jaeger VK, Lebrecht D, Nicholson AG, Wells A, Bhayani H, Gazdhar A, Tamm M, Venhoff N, Geiser T, Walker UA. Mitochondrial DNA mutations and respiratory chain dysfunction in idiopathic and connective tissue disease-related lung fibrosis. Sci Rep 2019; 9:5500. [PMID: 30940853 PMCID: PMC6445113 DOI: 10.1038/s41598-019-41933-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 09/26/2018] [Accepted: 03/21/2019] [Indexed: 12/23/2022] Open
Abstract
Reactive oxygen species (ROS) are implicated in the aetiology of interstitial lung disease (ILD). We investigated the role of large-scale somatically acquired mutations in mitochondrial DNA (mtDNA) and consecutive respiratory chain dysfunction as a trigger of ROS-formation and lung fibrosis. Mitochondria were analysed in lung biopsies from 30 patients with idiopathic or connective tissue disease (CTD)-related ILD and 13 controls. In 17 patients we had paired biopsies from upper and lower lobes. Control samples were taken from lung cancer resections without interstitial fibrosis. Malondialdehyde, a marker of ROS-formation, was elevated in ILD-biopsies (p = 0.044). The activity of the mitochondrial respiratory chain (cytochrome c-oxidase/succinate dehydrogenase [COX/SDH]-ratio) was depressed in ILD (median = 0.10,) compared with controls (0.12, p < 0.001), as was the expression of mtDNA-encoded COX-subunit-2 protein normalized for the nucleus-encoded COX-subunit-4 (COX2/COX4-ratio; ILD-median = 0.6; controls = 2.2; p < 0.001). Wild-type mtDNA copies were slightly elevated in ILD (p = 0.088). The common mtDNA deletion was only present at low levels in controls (median = 0%) and at high levels in ILD (median = 17%; p < 0.001). In ILD-lungs with paired biopsies, lower lobes contained more malondialdehyde and mtDNA deletions than upper lobes and had lower COX2/COX4-ratios and COX/SDH-ratios (all p < 0.001). Acquired mtDNA-mutations and consecutive respiratory chain dysfunction may both trigger and perpetuate ROS-formation in ILD.
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Affiliation(s)
- Veronika K Jaeger
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Dirk Lebrecht
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
| | - Athol Wells
- National Heart and Lung Institute, Imperial College, London, UK.,Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Harshil Bhayani
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Amiq Gazdhar
- Department of Pulmonary Medicine, University Hospital Bern, Bern, Switzerland
| | - Michael Tamm
- Department of Pneumology, University Hospital Basel, Basel, Switzerland
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Geiser
- Department of Pulmonary Medicine, University Hospital Bern, Bern, Switzerland
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland.
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Osthoff M, Jaeger VK, Heijnen IAFM, Trendelenburg M, Jordan S, Distler O, Walker UA. Role of lectin pathway complement proteins and genetic variants in organ damage and disease severity of systemic sclerosis: a cross-sectional study. Arthritis Res Ther 2019; 21:76. [PMID: 30885245 PMCID: PMC6423822 DOI: 10.1186/s13075-019-1859-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The role of the complement system in the pathogenesis of systemic sclerosis (SSc) is controversial. This study investigated the role of the lectin pathway of complement as a mediator of ischemia/reperfusion injury in SSc. METHODS This is a prospective observational cross-sectional study of 211 SSc patients and 29 patients with Raynaud's phenomenon in undifferentiated connective tissue disease (UCTD) at risk of developing SSc from two outpatient clinics. Serum levels of lectin pathway proteins (FCN-2, FCN-3, MBL, and MASP-2) and eight MBL2 and FCN2 single-nucleotide polymorphisms (SNP) were analyzed by sandwich-type immunoassays and genotyping and examined for their association with disease manifestations. RESULTS Lectin pathway protein levels and SNPs were similar between SSc and UCTD patients. FCN-2 levels were however higher in SSc patients with present evidence of digital ulcers (mean 1.4 vs. 1.0 μg/mL, p = 0.05), pitting scars (mean 1.3 vs. 1.0 μg/mL, p = 0.01), and puffy fingers (mean 1.2 vs. 1.0 μg/mL, p = 0.04). Similarly, higher FCN-2 levels were observed in SSc patients with Scl-70 autoantibodies (mean 1.5 vs. 1.0 μg/mL, p = 0.001), interstitial lung disease (mean 1.2 vs. 0.9 μg/mL, p = 0.02), and a forced vital capacity (FVC) below 80% (mean 1.4 vs. 1.0 μg/mL, p = 0.02). In line, variant alleles in the FCN-2 SNP at position + 6359 were associated with a significantly reduced FVC and diffusion capacity. Furthermore, patients with SSc renal crisis harbored higher MBL levels (mean 2.7 vs. 1.5 μg/mL, p = 0.04). No other lectin pathway protein levels or polymorphisms were associated with disease manifestations, low complement C3 and/or C4 levels, or inflammatory markers. CONCLUSIONS This study does not support a relevant role for several lectin pathway complement proteins in the pathogenesis of SSc. Higher FCN-2 levels were however associated with Scl-70 autoantibody positivity, interstitial lung involvement, and digital vasculopathy. Elevated MBL levels were associated with renal crisis.
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Affiliation(s)
- Michael Osthoff
- Department of Internal Medicine, University Hospital Basel, 4031 Basel, Switzerland
- Department of Biomedicine, University Basel, 4031 Basel, Switzerland
| | - Veronika K. Jaeger
- Department of Rheumatology, University Hospital Basel, 4031 Basel, Switzerland
| | - Ingmar A. F. M. Heijnen
- Division of Medical Immunology, Laboratory Medicine, University Hospital Basel, 4031 Basel, Switzerland
| | - Marten Trendelenburg
- Department of Internal Medicine, University Hospital Basel, 4031 Basel, Switzerland
- Department of Biomedicine, University Basel, 4031 Basel, Switzerland
| | - Suzana Jordan
- Department of Rheumatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Ulrich A. Walker
- Department of Rheumatology, University Hospital Basel, 4031 Basel, Switzerland
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Walker UA, Jaeger VK, Bruppacher KM, Dobrota R, Arlettaz L, Banyai M, Beron J, Chizzolini C, Groechenig E, Mueller RB, Spertini F, Villiger PM, Distler O. Prospective evaluation of the capillaroscopic skin ulcer risk index in systemic sclerosis patients in clinical practice: a longitudinal, multicentre study. Arthritis Res Ther 2018; 20:239. [PMID: 30359309 PMCID: PMC6235233 DOI: 10.1186/s13075-018-1733-6] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/25/2018] [Indexed: 11/18/2022] Open
Abstract
Background Nailfold capillaroscopy (NC) is an important tool for the diagnosis of systemic sclerosis (SSc). The capillaroscopic skin ulcer risk index (CSURI) was suggested to identify patients at risk of developing digital ulcers (DUs). This study aims to assess the reliability of the CSURI across assessors, the CSURI change during follow-up and the value of the CSURI in predicting new DUs. Methods This multicentre, longitudinal study included SSc patients with a history of DUs. NC images of all eight fingers were obtained at baseline and follow-up and were separately analysed by two trained assessors. Results Sixty-one patients were included (median observation time 1.0 year). In about 40% of patients (assessor 1, n = 24, 39%; assessor 2, n = 26, 43%) no megacapillary was detected in any of the baseline or follow-up images; hence the CSURI could not be calculated. In those 34 patients in whom CSURI scores were available from both assessors (26% male; median age 57 years) the median baseline CSURI was 5.3 according to assessor 1 (IQR 2.6–16.3), increasing to 5.9 (IQR 1.3–12.0) at follow-up. According to assessor 2, the CSURI diminished from 6.4 (IQR 2.4–12.5) to 5.0 (IQR 1.7–10.0). The ability of a CSURI ≥ 2.96 category to predict new DUs was low (for both assessors, positive predictive value 38% and negative predictive value 50%) and the inter-assessor agreements for CSURI categories were fair to moderate. Conclusions In this study, around 40% of patients could not be evaluated with the CSURI due to the absence of megacapillaries. Clinical decisions based on the CSURI should be made with caution. Trial registration Current Controlled Trials, ISRCTN04371709. Registered on 18 March 2011. Electronic supplementary material The online version of this article (10.1186/s13075-018-1733-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Petersgraben 4, 4032, Basel, Switzerland.
| | - Veronika K Jaeger
- Department of Rheumatology, University Hospital Basel, Petersgraben 4, 4032, Basel, Switzerland
| | | | - Rucsandra Dobrota
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Jörg Beron
- Actelion Pharma Schweiz AG, Baden, Switzerland
| | - Carlo Chizzolini
- Immunology & Allergy, University Hospital and School of Medicine, Geneva, Switzerland
| | | | | | - François Spertini
- Division of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Peter M Villiger
- Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Bern, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
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Jaeger VK, Valentini G, Hachulla E, Cozzi F, Distler O, Airó P, Czirják L, Allanore Y, Siegert E, Rosato E, Matucci-Cerinic M, Caimmi C, Henes J, Carreira PE, Smith V, Del Galdo F, Denton CP, Ullman S, De Langhe E, Riccieri V, Alegre-Sancho JJ, Rednic S, Müller-Ladner U, Walker UA. Brief Report: Smoking in Systemic Sclerosis: A Longitudinal European Scleroderma Trials and Research Group Study. Arthritis Rheumatol 2018; 70:1829-1834. [PMID: 29781588 DOI: 10.1002/art.40557] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/10/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Data on the role of tobacco exposure in systemic sclerosis (SSc; scleroderma) severity and progression are scarce. We aimed to assess the effects of smoking on the evolution of pulmonary and skin manifestations, based on the European Scleroderma Trials and Research group database. METHODS Adult SSc patients with data on smoking history and a 12-24-month follow-up visit were included. Associations of severity and progression of organ involvement with smoking history and the Comprehensive Smoking Index were assessed using multivariable regression analyses. RESULTS A total of 3,319 patients were included (mean age 57 years, 85% female); 66% were never smokers, 23% were ex-smokers, and 11% were current smokers. Current smokers had a lower percentage of antitopoisomerase autoantibodies than previous or never smokers (31% versus 40% and 45%, respectively). Never smokers had a higher baseline forced expiratory volume in 1 second/forced vital capacity (FEV1 /FVC) ratio than previous and current smokers (P < 0.001). The FEV1 /FVC ratio declined faster in current smokers than in never smokers (P = 0.05) or ex-smokers (P = 0.01). The baseline modified Rodnan skin thickness score (MRSS) and the MRSS decline were comparable across smoking groups. Although heavy smoking (>25 pack-years) increased the odds of digital ulcers by almost 50%, there was no robust adverse association of smoking with digital ulcer development. CONCLUSION The known adverse effect of smoking on bronchial airways and alveoli is also observed in SSc patients; however, robust adverse effects of smoking on the progression of SSc-specific pulmonary or cutaneous manifestations were not observed.
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Affiliation(s)
| | | | - Eric Hachulla
- Service de Médecine Interne, Hôpital Huriez, Université de Lille, Lille, France
| | | | | | | | | | - Yannick Allanore
- Department of Rheumatology A, Paris Descartes University, Cochin Hospital, Paris, France
| | | | | | | | | | - Jörg Henes
- Eberhard-Karls-University Tübingen, Tübingen, Germany
| | | | - Vanessa Smith
- Ghent University and Ghent University Hospital, Ghent, Belgium
| | | | | | - Susanne Ullman
- Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Simona Rednic
- University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ulf Müller-Ladner
- Justus-Liebig-University of Giessen, Kerckhoff-Klinik, Bad Nauheim, Germany
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Lechtenboehmer CA, Jaeger VK, Kyburz D, Walker UA, Hügle T. Brief Report: Influence of Disease Activity in Rheumatoid Arthritis on Radiographic Progression of Concomitant Interphalangeal Joint Osteoarthritis. Arthritis Rheumatol 2018; 71:43-49. [PMID: 30073800 DOI: 10.1002/art.40684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/31/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Distal interphalangeal (DIP) joints are commonly considered to be unaffected by rheumatoid arthritis (RA). Despite synovitis and bone marrow edema being associated with radiographic progression in hand osteoarthritis (OA) and hand RA, radiographic courses differ substantially. This study was undertaken to analyze incidence and progression of radiographically evident DIP joint OA in RA patients, in relation to RA activity and patient characteristics. METHODS In sequential radiographs of 1,988 RA patients in the Swiss Clinical Quality Management in Rheumatic Diseases registry, we evaluated and scored 15,904 DIP joints. Scoring was based on the presence of central erosions and subchondral sclerosis and on the severity of osteophytes and joint space narrowing, according to the modified Kellgren/Lawrence (K/L) grade. The presence of DIP joint OA was defined as ≥1 joint with a K/L grade of ≥2, and progression was defined as an increase in a summed K/L grade. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. RESULTS The median follow-up time was 4.5 years (interquartile range 3.1-7.0), and the mean ± SD age was 56.1 ± 11.1 years. DIP joint OA was present in 60% of patients at baseline. Higher mean age (OR 1.09 [95% CI 1.08-1.10]), female sex (OR 1.37 [95% CI 1.08-1.74]), and higher mean body mass index (OR 1.03 [95% CI 1.00-1.06]) were associated with the presence of DIP joint OA, but neither the presence of anti-citrullinated protein antibodies (ACPAs) (OR 0.72 [95% CI 0.50-1.03]) nor the presence of rheumatoid factor (OR 1.01 [95% CI 0.74-1.38]) were associated with it. Disease Activity Score using the erythrocyte sedimentation rate and metacarpophalangeal (MCP) joint erosions were not associated with DIP joint OA progression. RA disease duration had no relevant effect size associated with DIP joint OA progression (OR 0.97 [95% CI 0.96-0.99]). CONCLUSION Known risk factors for DIP joint OA were replicated in patients with RA. The observation that RA activity, the presence of ACPA, and MCP joint erosions were not associated with the prevalence or progression of DIP joint OA indicates that there are distinct roles of inflammation in the pathogenesis of RA and DIP joint OA.
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Affiliation(s)
| | | | - Diego Kyburz
- University Hospital of Basel, Basel, Switzerland
| | | | - Thomas Hügle
- Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Carreira PE, Carmona L, Joven BE, Loza E, Andreu JL, Riemekasten G, Vettori S, Balbir-Gurman A, Airò P, Walker UA, Damjanov N, Matucci-Cerinic M, Ananieva LP, Rednic S, Czirják L, Distler O, Farge D, Hesselstrand R, Corrado A, Caramaschi P, Tikly M, Allanore Y. Gender differences in early systemic sclerosis patients: a report from the EULAR scleroderma trials and research group (EUSTAR) database. Clin Exp Rheumatol 2018; 36 Suppl 113:68-75. [PMID: 30277860] [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: 04/21/2017] [Accepted: 03/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To describe differences in clinical presentation between men and women in a large group of patients with early (<3 years' duration) systemic sclerosis (SSc) according to disease subsets. METHODS A cross-sectional analysis of the prospective EULAR Scleroderma Trial and Research database (EUSTAR) was performed. Patients fulfilling preliminary ACR 1980 classification criteria for SSc, with less than 3 years from the first non-Raynaud's symptom at first entry, were selected. A group of patients with less than 3 years from the first SSc symptom, including Raynaud's phenomenon, was also analysed. SSc related variables, including antibodies, SSc subsets, disease activity and organ involvement were included. Descriptive and bivariate analyses were performed. RESULTS A total of 1,027 patients were included, 90% Caucasian, 80% women, and 40% with diffuse cutaneous disease. In early stages of SSc, men showed more frequently than women active disease, diffuse cutaneous subset, anti-Scl-70 antibodies, elevated acute phase reactants, muscular and pulmonary involvement. Differences between men and women were confirmed in the limited, but not in the diffuse SSc subset. The results were similar when 650 patients with less than three years from the first SSc symptom, including Raynaud's phenomenon, were analysed. CONCLUSIONS In early stages of SSc, men present signs and symptoms of more severe disease. In the limited disease subset, men might appear with clinical features and organ involvement similar to those of the diffuse subgroup. In clinical practice, the identification of such differences might help to select the appropriate management for each particular patient.
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MESH Headings
- Acute-Phase Proteins/analysis
- Autoantibodies/blood
- Biomarkers/blood
- Cross-Sectional Studies
- DNA Topoisomerases, Type I
- Databases, Factual
- Disease Progression
- Female
- Health Status Disparities
- Humans
- Lung Diseases/diagnosis
- Lung Diseases/etiology
- Male
- Nuclear Proteins/immunology
- Prognosis
- Raynaud Disease/diagnosis
- Raynaud Disease/etiology
- Risk Factors
- Scleroderma, Diffuse/blood
- Scleroderma, Diffuse/complications
- Scleroderma, Diffuse/diagnosis
- Scleroderma, Diffuse/immunology
- Scleroderma, Limited/blood
- Scleroderma, Limited/complications
- Scleroderma, Limited/diagnosis
- Scleroderma, Limited/immunology
- Severity of Illness Index
- Sex Factors
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Affiliation(s)
- Patricia E Carreira
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain.
| | | | - Beatriz E Joven
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain
| | | | - Jose Luis Andreu
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - Serena Vettori
- U.O.C. di Reumatologia, Dipartimento di Internistica Clinica e Sperimentale "F.Magrassi-A-Lanzara", Seconda Università degli Studi di Napoli, Italy
| | - Alexandra Balbir-Gurman
- B. Shine Rheumatology Unit, Rambam Health Care Campus and Rappaport Faculty of Medicine-Technion, Haifa, Israel
| | - Paolo Airò
- U.O. Reumatologia e Immunologia Clinica. Spedali Civili, Brescia, Italy
| | - Ulrich A Walker
- Rheumatologische Universitätsklinik, Felix Platter Spital, Basel, Switzerland
| | - Nemanja Damjanov
- University of Belgrade School of Medicine, Institute of Rheumatology Belgrade, Serbia
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Lidia P Ananieva
- Institute of Rheumatology, Russian Academy of Medical Science, Moscow, Russia
| | - Simona Rednic
- Clinica Reumatologie, University of Medicine & Pharmacy 'Iuliu Hatieganu', Cluj-Napoca, Romania
| | - László Czirják
- Department of Immunology and Rheumatology, Faculty of Medicine, University of Pécs, Hungary
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zürich, Switzerland
| | - Dominique Farge
- Department of Internal Medicine, Hopital Saint-Louis, Paris, France
| | | | - Ada Corrado
- U.O. Reumatologia-Università degli Studi di Foggia, Ospedale 'Col. D'Avanzo', Foggia, Italy
| | | | - Mohammed Tikly
- Rheumatology Unit, Department of Medicine Chris Hani Bardgwanath, Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Yannick Allanore
- Rheumatology A Department, Cochin Hospital, APHP, Paris Descartes University, Paris, France
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Walker UA, Saketkoo LA, Distler O. Haematopoietic stem cell transplantation in systemic sclerosis. RMD Open 2018; 4:e000533. [PMID: 30018796 PMCID: PMC6045702 DOI: 10.1136/rmdopen-2017-000533] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 01/30/2018] [Revised: 05/23/2018] [Accepted: 06/04/2018] [Indexed: 12/29/2022] Open
Abstract
Three randomised controlled trials of haematopoietic stem cell transplantation (HSCT) in systemic sclerosis (SSc) demonstrated long-term survival benefits, induction of clinically meaningful, sustained improvement of forced vital capacity with improvements in skin thickening, vasculopathy and health-related quality of life, in contrast to a clinical decline in standard of care control groups. These benefits, however, must be weighed against the increased risk of transplant-related mortality. Further, with disease progression, severe extensive internal organ involvement and damage ensues, constituting an exclusion criterion for safety reasons, leaving a limited window whereby patients with SSc are eligible for HSCT. Although autologous HSCT offers the possibility of drug-free remission, relapse can occur, requiring re-initiation of disease modifying antirheumatic drugs. HSCT is also associated with secondary autoimmune diseases and gonadal failure. HSCT should be proposed for carefully selected patients with early rapidly progressive diffuse SSc whose clinical picture portends a poor prognosis for survival, but yet lacks advanced organ involvement.
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Affiliation(s)
- Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Lesley Ann Saketkoo
- Tulane University School of Medicine Lung Center, New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, University Medical Center - Comprehensive Pulmonary Hypertension Center, New Orleans, Louisiana, USA
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
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Walker UA, Luetke Volksbeck S, Kuemmerle-Deschner J. Flare of a Cryopyrin-associated Periodic Syndrome Following Vaccination with Neisseria Meningitidis Polysaccharides. J Rheumatol 2018; 45:878-879. [PMID: 29858461 DOI: 10.3899/jrheum.171037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Ulrich A Walker
- Unispital Basel, Department of Rheumatology, Basel, Switzerland;
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Jaeger VK, Distler O, Maurer B, Czirják L, Lóránd V, Valentini G, Vettori S, Del Galdo F, Abignano G, Denton C, Nihtyanova S, Allanore Y, Avouac J, Riemekasten G, Siegert E, Huscher D, Matucci-Cerinic M, Guiducci S, Frerix M, Tarner IH, Garay Toth B, Fankhauser B, Umbricht J, Zakharova A, Mihai C, Cozzi F, Yavuz S, Hunzelmann N, Rednic S, Vacca A, Schmeiser T, Riccieri V, García de la Peña Lefebvre P, Gabrielli A, Krummel-Lorenz B, Martinovic D, Ancuta C, Smith V, Müller-Ladner U, Walker UA. Functional disability and its predictors in systemic sclerosis: a study from the DeSScipher project within the EUSTAR group. Rheumatology (Oxford) 2018; 57:441-450. [PMID: 28499034 DOI: 10.1093/rheumatology/kex182] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Indexed: 11/12/2022] Open
Abstract
Objectives The multisystem manifestations of SSc can greatly impact patients' quality of life. The aim of this study was to identify factors associated with disability in SSc. Methods SSc patients from the prospective DeSScipher cohort who had completed the scleroderma health assessment questionnaire (SHAQ), a disability score that combines the health assessment questionnaire and five visual analogue scales, were included in this analysis. The effect of factors possibly associated with disability was analysed with multiple linear regressions. Results The mean SHAQ and HAQ scores of the 944 patients included were 0.87 (s.d. = 0.66) and 0.92 (s.d. = 0.78); 59% of the patients were in the mild to moderate difficulty SHAQ category (0 ⩽ SHAQ < 1), 34% in the moderate to severe disability category (1 ⩽ SHAQ < 2) and 7% in the severe to very severe disability category (2 ⩽ SHAQ ⩽ 3). The means of the visual analogue scales scores were in order of magnitude: overall disease severity (37 mm), RP (31 mm), pulmonary symptoms (24 mm), gastrointestinal symptoms (20 mm) and digital ulcers (19 mm). In multiple regression, the main factors associated with high SHAQ scores were the presence of dyspnoea [modified New York Heart Association (NYHA) class IV (regression coefficient B = 0.62), modified NYHA class III (B = 0.53) and modified NYHA class II (B = 0.21; all vs modified NYHA class I)], FM (B = 0.37), muscle weakness (B = 0.27), digital ulcers (B = 0.20) and gastrointestinal symptoms (oesophageal symptoms, B = 0.16; stomach symptoms, B = 0.15; intestinal symptoms, B = 0.15). Conclusion SSc patients perceive dyspnoea, pain, digital ulcers, muscle weakness and gastrointestinal symptoms as the main factors driving their level of disability, unlike physicians who emphasize objective measures of disability.
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Affiliation(s)
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Britta Maurer
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Laszlo Czirják
- Department of Rheumatology and Immunology, Medical Center, University of Pécs, Pécs, Hungary
| | - Veronika Lóránd
- Department of Rheumatology and Immunology, Medical Center, University of Pécs, Pécs, Hungary
| | | | - Serena Vettori
- Department of Rheumatology, Second University of Naples, Naples, Italy
| | - Francesco Del Galdo
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Giuseppina Abignano
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds
| | - Christopher Denton
- Department of Rheumatology, University College London, Royal Free Hospital, London, UK
| | - Svetlana Nihtyanova
- Department of Rheumatology, University College London, Royal Free Hospital, London, UK
| | - Yannick Allanore
- Department of Rheumatology, University of Paris Descartes, Paris, France
| | - Jerome Avouac
- Department of Rheumatology, University of Paris Descartes, Paris, France
| | | | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, University Hospital Charité
| | | | | | - Serena Guiducci
- Department of Rheumatology, University of Florence, Florence, Italy
| | - Marc Frerix
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | - Ingo H Tarner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | - Beata Garay Toth
- Federation of European Scleroderma Associations Aisbl, Budapest, Hungary
| | | | | | | | - Carina Mihai
- Department of Internal Medicine and Rheumatology, Dr Ion Cantacuzino Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Franco Cozzi
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Sule Yavuz
- Department of Rheumatology, University of Marmara, Altunizade-Istanbul, Turkey
| | | | - Simona Rednic
- Clinica Reumatologie, University of Medicine & Pharmacy, Cluj-Napoca, Romania
| | - Alessandra Vacca
- II Chair of Rheumatology, University of Cagliari-Policlinico Universitario, Monserrato, Italy
| | - Tim Schmeiser
- Department of Rheumatology and Immunology, Krankenhaus St Josef, Wuppertal, Germany
| | - Valeria Riccieri
- Divisione di Reumatologia, Università di Roma La Sapienza, Roma, Italy
| | | | - Armando Gabrielli
- Istituto di Clinica Medica Generale, Ematologia ed Immunologia Clinica, Università Politecnica delle Marche, Ancona, Italy
| | | | - Duska Martinovic
- Division of Rheumatology, University Hospital of Split, Split, Croatia
| | - Codrina Ancuta
- Rheumatology 2 Department, Clinical Rehabilitation Hospital, University of Medicine and Pharmacy 'Grigore T. Popa', Iasi, Romania
| | - Vanessa Smith
- Faculty of Internal Medicine, Ghent University, Ghent, Belgium
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic Bad Nauheim, Bad Nauheim, Germany
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel
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Adler S, Huscher D, Siegert E, Allanore Y, Czirják L, DelGaldo F, Denton CP, Distler O, Frerix M, Matucci-Cerinic M, Mueller-Ladner U, Tarner IH, Valentini G, Walker UA, Villiger PM, Riemekasten G. Systemic sclerosis associated interstitial lung disease - individualized immunosuppressive therapy and course of lung function: results of the EUSTAR group. Arthritis Res Ther 2018; 20:17. [PMID: 29382380 PMCID: PMC5791165 DOI: 10.1186/s13075-018-1517-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 01/11/2018] [Indexed: 12/27/2022] Open
Abstract
Background Interstitial lung disease in systemic sclerosis (SSc-ILD) is a major cause of SSc-related death. Imunosuppressive treatment (IS) is used in patients with SSc for various organ manifestations mainly to ameliorate progression of SSc-ILD. Data on everyday IS prescription patterns and clinical courses of lung function during and after therapy are scarce. Methods We analysed patients fulfilling American College of Rheumatology (ACR)/European League against Rheumatism (EULAR) 2013 criteria for SSc-ILD and at least one report of IS. Types of IS, pulmonary function tests (PFT) and PFT courses during IS treatment were evaluated. Results EUSTAR contains 3778/11,496 patients with SSc-ILD (33%), with IS in 2681/3,778 (71%). Glucocorticoid (GC) monotherapy was prescribed in 30.6% patients with GC combinations plus cyclophosphamide (CYC) (11.9%), azathioprine (AZA) (9.2%), methotrexate (MTX) (8.7%), or mycophenolate mofetil (MMF) (7.3%). Intensive IS (MMF + GC, CYC or CYC + GC) was started in patients with the worst PFTs and ground glass opacifications on imaging. Patients without IS showed slightly less worsening in forced vital capacity (FVC) when starting with FVC 50–75% or >75%. GC showed negative trends when starting with FVC <50%. Regarding diffusing capacity for carbon monoxide (DLCO), negative DLCO trends were found in patients with MMF. Conclusions IS is broadly prescribed in SSc-ILD. Clusters of clinical and functional characteristics guide individualised treatment. Data favour distinguished decision-making, pointing to either watchful waiting and close monitoring in the early stages or start of immunosuppressive treatment in moderately impaired lung function. Advantages of specific IS are difficult to depict due to confounding by indication. Data do not support liberal use of GC in SSc-ILD. Electronic supplementary material The online version of this article (10.1186/s13075-018-1517-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sabine Adler
- Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland.
| | - Dörte Huscher
- German Rheumatism Research Center, A Leibniz Institute, Berlin, Germany.,Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - Yannick Allanore
- Department of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
| | - László Czirják
- Department of Rheumatology and Immunology, University of Pecs, Pecs, Hungary
| | | | - Christopher P Denton
- UCL Division of Medicine, Centre for Rheumatology, Royal Free Hospital, London, UK
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Marc Frerix
- Department of Rheumatology and Clinical Immunology, Osteology and Physical Therapy, Justus-Liebig-University Giessen, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Marco Matucci-Cerinic
- Department Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Osteology and Physical Therapy, Justus-Liebig-University Giessen, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Ingo-Helmut Tarner
- Department of Rheumatology and Clinical Immunology, Osteology and Physical Therapy, Justus-Liebig-University Giessen, Kerckhoff Klinik, Bad Nauheim, Germany
| | | | - Ulrich A Walker
- Department of Rheumatology, University of Basel, Basel, Switzerland
| | - Peter M Villiger
- Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland
| | - Gabriela Riemekasten
- Department of Rheumatology, University Medical Center Schleswig-Holstein, Kiel, Germany
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Walker UA, Clements PJ, Allanore Y, Distler O, Oddis CV, Khanna D, Furst DE. Muscle involvement in systemic sclerosis: points to consider in clinical trials. Rheumatology (Oxford) 2017; 56:v38-v44. [PMID: 28992167 DOI: 10.1093/rheumatology/kex196] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Indexed: 11/13/2022] Open
Abstract
SSc is clinically and pathogenetically heterogeneous. Consensus standards for trial design and outcome measures are needed. International experts experienced in SSc clinical trial design and a researcher experienced in systematic literature review screened the PubMed and Cochrane Central Register of Controlled Trials in order to develop points to consider when planning a clinical trial for muscle involvement in SSc. The experts conclude that SSc-associated muscle involvement is heterogeneous and lacks a universally accepted gold-standard for measuring therapeutic response. Although outcome studies are currently limited by the inability to clearly distinguish active, reversible muscle inflammation from irreversible muscle damage and extramuscular organ involvement, strong consideration should be given to enrolling patients with a myopathy that features several elements of likely reversibility such as muscle weakness, biopsy-proven active inflammation, an MRI indicating muscle inflammation and a baseline serum creatinine kinase above three times the upper limit of normal to prevent floor effect. Randomized controlled trials are preferred, with a duration of at least 24 weeks. Outcome measures should include a combination of elements that are likely to be reversible, such as muscle weakness, biopsy-proven active inflammation, creatinine kinase/aldolase and a quality of life questionnaire. The individual measurements might require a short pre-study for further validation. A biological sample repository is recommended.
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Affiliation(s)
- Ulrich A Walker
- Department of Rheumatology, Basel University, Basel, Switzerland
| | - Philip J Clements
- Department of Rheumatology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - Yannick Allanore
- Department of Rheumatology and INSERM U1016, Descartes University, Cochin Hospital, Paris, France
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Chester V Oddis
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Dinesh Khanna
- Department of Medicine, University of Michigan, University of Michigan Scleroderma Program, Ann Arbor, MI, USA
| | - Daniel E Furst
- Department of Rheumatology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
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Allanore Y, Distler O, Walker UA, Khanna D, Furst DE, Meune C. Points to consider when doing a trial primarily involving the heart. Rheumatology (Oxford) 2017; 56:v12-v16. [PMID: 28992169 DOI: 10.1093/rheumatology/kex198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Indexed: 12/13/2022] Open
Abstract
Cardiac involvement contributes to the severity of SSc and should carefully be investigated and managed in SSc patients. Although it is commonly sub-clinical, once symptomatic it has a poor prognosis. Several complementary tools (circulating biomarkers, electrocardiography, echocardiography, scintigraphy or MRI) allow the assessment of all the various cardiac structures (endocardium, myocardium and pericardium) and heart function. Treatment remains empirical but cardiac trials in SSc can add data to the treatment of this complication.
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Affiliation(s)
- Yannick Allanore
- Department of Rheumatology A, Cochin Hospital and Cochin Institute, AP-HP, Paris-Descartes University, Paris, France
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich
| | - Ulrich A Walker
- Rheumatology Department, University of Basel, Basel, Switzerland
| | - Dinesh Khanna
- Department of Medicine, University of Michigan, University of Michigan Scleroderma Program, Ann Arbor, MI
| | - Daniel E Furst
- Department of Rheumatology, David Geffen School of Medicine, University of California in Los Angeles, Los Angeles, CA, USA
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Johnson SR, Soowamber ML, Fransen J, Khanna D, Van Den Hoogen F, Baron M, Matucci-Cerinic M, Denton CP, Medsger TA, Carreira PE, Riemekasten G, Distler J, Gabrielli A, Steen V, Chung L, Silver R, Varga J, Müller-Ladner U, Vonk MC, Walker UA, Wollheim FA, Herrick A, Furst DE, Czirjak L, Kowal-Bielecka O, Del Galdo F, Cutolo M, Hunzelmann N, Murray CD, Foeldvari I, Mouthon L, Damjanov N, Kahaleh B, Frech T, Assassi S, Saketkoo LA, Pope JE. There is a need for new systemic sclerosis subset criteria. A content analytic approach. Scand J Rheumatol 2017; 47:62-70. [DOI: 10.1080/03009742.2017.1299793] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- SR Johnson
- Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - ML Soowamber
- Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - J Fransen
- The Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - D Khanna
- Division of Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, USA
| | - F Van Den Hoogen
- The Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - M Baron
- Division of Rheumatology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - M Matucci-Cerinic
- Department of Rheumatology AVC, Department of BioMedicine, Division of Rheumatology AOUC, Department of Medicine and Denothe Centre, University of Florence, Florence, Italy
| | - CP Denton
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, London, UK
| | - TA Medsger
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - PE Carreira
- Department of Rheumatology, University Hospital 12 de Octubre, Madrid, Spain
| | - G Riemekasten
- Department of Rheumatology, University of Lübeck, Lung Research Center Borstel, a Leibniz institute, Lübeck, Germany
| | - J Distler
- Department of Internal Medicine 3 and Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - A Gabrielli
- Department of Molecular and Clinical Sciences, Clinical Medicine, University of Marche, Ancona, Italy
| | - V Steen
- Department of Medicine, Division of Rheumatology, Clinical Immunology and Allergy, Georgetown University School of Medicine, Washington, DC, USA
| | - L Chung
- Department of Medicine and Dermatology, Division of Immunology and Rheumatology, Stanford University, Stanford, CA, USA
| | - R Silver
- Department of Medicine, Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, SC, USA
| | - J Varga
- Department of Medicine, Division of Rheumatology, Clinical Immunology and Allergy, Northwestern University, Chicago, IL, USA
| | - U Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic, Bad Nauheim, Germany
| | - MC Vonk
- Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - UA Walker
- Department of Rheumatology, University of Basel, Basel, Switzerland
| | - FA Wollheim
- Department of Rheumatology, Lund University Hospital, Lund, Sweden
| | - A Herrick
- Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - DE Furst
- Division of Rheumatology, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - L Czirjak
- Department of Rheumatology and Immunology, University of Pécs, Clinical Center, Pécs, Hungary
| | - O Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Białystok, Poland
| | - F Del Galdo
- Scleroderma Programme, Leeds Institute of Rheumatic and Musculoskeletal Medicine, LMBRU, University of Leeds, Leeds, UK
| | - M Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, University of Genova, IRCCS AOU S Martino, Genova, Italy
| | - N Hunzelmann
- Department of Dermatology, University of Cologne, Cologne, Germany
| | - CD Murray
- Inflammatory Bowel Disease Unit, Royal Free London NHS Foundation Trust, London, UK
| | - I Foeldvari
- Hamburg Center for Paediatric Rheumatology, Eilbek Clinic, Hamburg, Germany
| | - L Mouthon
- Department of Internal Medicine, Paris Descartes University, the Public Hospitals of Paris, Paris, France
| | - N Damjanov
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia
| | - B Kahaleh
- Division of Rheumatology, Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - T Frech
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - S Assassi
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - LA Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, Tulane University Lung Center, New Orleans, LA, USA
| | - JE Pope
- Division of Rheumatology, Department of Medicine, St Joseph Health Care, University of Western Ontario, London, ON, Canada
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Walker UA, Mueller RB, Jaeger VK, Theiler R, Forster A, Dufner P, Ganz F, Kyburz D. Disease activity dynamics in rheumatoid arthritis: patients' self-assessment of disease activity via WebApp. Rheumatology (Oxford) 2017; 56:1707-1712. [PMID: 28957553 PMCID: PMC5873216 DOI: 10.1093/rheumatology/kex229] [Citation(s) in RCA: 25] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Indexed: 11/15/2022] Open
Abstract
Objectives The aim was to evaluate patient self-assessment of RA disease activity in terms of Routine Assessment of Patient Index Data (RAPID) scores via a Web-based smartphone application (WebApp). Methods In this prospective, multicentre study, adult RA patients were examined by a rheumatologist at baseline and after 3 months. Patients were asked to complete WebApp questionnaires weekly. The time course of patient-assessed RAPID3/4 scores and their correlations with rheumatologist-assessed DAS28, as well as Clinical and Simplified Disease Activity Indices (CDAI/SDAI), were evaluated. Results Eighty patients were included in the analysis (median RA duration, 4.5 years; age, 57 years; 59% female). At baseline, there was a moderate to strong correlation between RAPID3 and DAS28 (r = 0.63), CDAI (r = 0.65) and SDAI (r = 0.61) scores. Similar or stronger correlations were seen at the 3-month follow-up visit (DAS28 r = 0.66, CDAI r = 0.71 and SDAI r = 0.61). Similar correlations were seen between RAPID4 and rheumatologist assessments. Correlations were not influenced by demographics or RA treatment. In the 3-month period, the RAPID3 score changed into a higher severity category than the category at baseline at least once in 47% of patients. When DAS28 scores were predicted from the RAPID3, 11% of patients had an increase of > 1 DAS28 unit during the 3-month observation period. Conclusion Web-based patient assessments were strongly correlated with rheumatologist assessments of RA activity and showed considerable variation during follow-up. This provides a rationale for further exploration of their use as cost-effective tools to monitor RA activity between outpatient visits and to optimize tight control strategies.
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Affiliation(s)
- Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel
| | - Ruediger B Mueller
- Division of Rheumatology, Department of Internal Medicine, Kantonsspital St Gallen, St Gallen
| | | | | | - Adrian Forster
- Department of Rheumatology, Klinik St Katharinental, Diessenhofen
| | | | | | - Diego Kyburz
- Department of Rheumatology, University Hospital Basel, Basel
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48
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Carreira PE, Carmona L, Joven BE, Loza E, Andreu JL, Riemekasten G, Vettori S, Allanore Y, Balbir-Gurman A, Airò P, Walker UA, Damjanov N, Ananieva LP, Rednic S, Czirják L, Distler O, Farge D, Hesselstrand R, Corrado A, Caramaschi P, Tikly M, Matucci-Cerinic M. Clinical determinants of elevated systolic pulmonary artery pressure measured by transthoracic Doppler echocardiography in early systemic sclerosis. Clin Exp Rheumatol 2017; 35 Suppl 106:114-121. [PMID: 28664832] [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: 06/24/2016] [Accepted: 10/26/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To explore the prevalence and clinical associations of elevated systolic pulmonary artery pressure (sPAP), measured by Transthoracic Doppler-echocardiography (TTE) in patients with early systemic sclerosis (SSc). METHODS A cross-sectional analysis of the prospective EULAR Scleroderma Trial and Research (EUSTAR) database was performed. SSc patients with <3 years from the first non-Raynaud's phenomenon (RP) symptom at baseline EUSTAR visit, were selected. Elevated sPAP was defined as sPAP>40 mmHg on baseline TTE. First visit SSc related variables, including disease subsets, antibodies and visceral involvement, were examined. RESULTS From 1,188 patients, 81% were women. Mean (SD) age at first non-RP symptom was 50 (14) years, 55% had limited cutaneous SSc (lcSSc) and 42% active disease. Elevated sPAP was found in 17% of patients, both lcSSc and diffuse cutaneous SSc (dcSSc). In lcSSc, older age at first non-RP symptom, ACA positivity, joint contractures, restrictive defect and lower DLCO, were independently associated with elevated sPAP. In dcSSc, older age at first non-RP symptom, longer time between RP onset and first non-RP symptom, digital ulcers, cardiac blocks, and proteinuria were associated with elevated sPAP. CONCLUSIONS The prevalence of elevated sPAP on TTE in early SSc patients is considerable. Association with cardiac, lung and renal involvement suggests that, although some patients might have pulmonary arterial hypertension, others may present pulmonary hypertension secondary to lung or heart involvement. Our findings emphasize the need to consider right heart catheterisation in selected early SSc patients with PH suspicion, to clearly determine the cause of PH.
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Affiliation(s)
- Patricia E Carreira
- Servicio de Reumatología, Hospital Universitario12 de Octubre, Madrid, Spain.
| | | | - Beatriz E Joven
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Jose Luis Andreu
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - Serena Vettori
- UOC di Reumatologia, Dipartimento di Internistica Clinica e Sperimentale "F-Magrassi-A-Lanzara", Seconda Università di Napoli, Italy
| | - Yannick Allanore
- Rheumatology A Department, Cochin Hospital, APHP, Paris Descartes University, France
| | - Alexandra Balbir-Gurman
- B.Shine Rheumatology Unit, Rambam Health Care Campus and Rappaport Faculty of Medicine-Technion, Haifa, Israel
| | - Paolo Airò
- UO Reumatologia ed Immunologia Clinica, Spedali Civili, Brescia, Italy
| | | | - Nemanja Damjanov
- University of Belgrade School of Medicine, Institute of Rheumatology, Belgrade, Serbia
| | - Lidia P Ananieva
- Institute of Rheumatology, Russian Academy of Medical Science, Moscow, Russia
| | - Simona Rednic
- Clinica Reumatologie, University of Medicine & Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - László Czirják
- Department of Immunology and Rheumatology, Faculty of Medicine, University of Pécs, Hungary
| | - Oliver Distler
- Division of Rheumatology, University Hospital Zurich, Switzerland
| | - Dominique Farge
- Department of Internal Medicine, Hopital Saint-Louis, Paris, France
| | | | - Ada Corrado
- UO Reumatologia-Università degli Studi di Foggia, Ospedale "Col. D'Avanzo", Foggia, Italy
| | | | - Mohammed Tikly
- Rheumatology Unit, Department of Medicine Chris Hani Baragwanath, Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Florence, Italy
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49
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Elhai M, Meune C, Boubaya M, Avouac J, Hachulla E, Balbir-Gurman A, Riemekasten G, Airò P, Joven B, Vettori S, Cozzi F, Ullman S, Czirják L, Tikly M, Müller-Ladner U, Caramaschi P, Distler O, Iannone F, Ananieva LP, Hesselstrand R, Becvar R, Gabrielli A, Damjanov N, Salvador MJ, Riccieri V, Mihai C, Szücs G, Walker UA, Hunzelmann N, Martinovic D, Smith V, Müller CDS, Montecucco CM, Opris D, Ingegnoli F, Vlachoyiannopoulos PG, Stamenkovic B, Rosato E, Heitmann S, Distler JHW, Zenone T, Seidel M, Vacca A, Langhe ED, Novak S, Cutolo M, Mouthon L, Henes J, Chizzolini C, Mühlen CAV, Solanki K, Rednic S, Stamp L, Anic B, Santamaria VO, De Santis M, Yavuz S, Sifuentes-Giraldo WA, Chatelus E, Stork J, Laar JV, Loyo E, García de la Peña Lefebvre P, Eyerich K, Cosentino V, Alegre-Sancho JJ, Kowal-Bielecka O, Rey G, Matucci-Cerinic M, Allanore Y. Mapping and predicting mortality from systemic sclerosis. Ann Rheum Dis 2017; 76:1897-1905. [PMID: 28835464 DOI: 10.1136/annrheumdis-2017-211448] [Citation(s) in RCA: 343] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/21/2017] [Accepted: 07/18/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine the causes of death and risk factors in systemic sclerosis (SSc). METHODS Between 2000 and 2011, we examined the death certificates of all French patients with SSc to determine causes of death. Then we examined causes of death and developed a score associated with all-cause mortality from the international European Scleroderma Trials and Research (EUSTAR) database. Candidate prognostic factors were tested by Cox proportional hazards regression model by single variable analysis, followed by a multiple variable model stratified by centres. The bootstrapping technique was used for internal validation. RESULTS We identified 2719 French certificates of deaths related to SSc, mainly from cardiac (31%) and respiratory (18%) causes, and an increase in SSc-specific mortality over time. Over a median follow-up of 2.3 years, 1072 (9.6%) of 11 193 patients from the EUSTAR sample died, from cardiac disease in 27% and respiratory causes in 17%. By multiple variable analysis, a risk score was developed, which accurately predicted the 3-year mortality, with an area under the curve of 0.82. The 3-year survival of patients in the upper quartile was 53%, in contrast with 98% in the first quartile. CONCLUSION Combining two complementary and detailed databases enabled the collection of an unprecedented 3700 deaths, revealing the major contribution of the cardiopulmonary system to SSc mortality. We also developed a robust score to risk-stratify these patients and estimate their 3-year survival. With the emergence of new therapies, these important observations should help caregivers plan and refine the monitoring and management to prolong these patients' survival.
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Affiliation(s)
- Muriel Elhai
- Rheumatology A department, Paris Descartes University, INSERM U1016, Sorbonne Paris Cité, Cochin Hospital, Paris, France
| | - Christophe Meune
- Department of Cardiology, Paris XIII University, INSERM UMR S-942, Bobigny Hospital, Paris, France
| | - Marouane Boubaya
- Unit of Clinical Research, Paris Seine Saint Denis University, Bobigny, France
| | - Jérôme Avouac
- Rheumatology A department, Paris Descartes University, INSERM U1016, Sorbonne Paris Cité, Cochin Hospital, Paris, France
| | - Eric Hachulla
- Department of Internal Medicine, Hôpital Claude Huriez, University Lille Nord-de-France, Lille Cedex, Lille, France
| | - Alexandra Balbir-Gurman
- B Shine Rheumatology Unit, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
| | | | - Paolo Airò
- UO Reumatologia ed Immunologia Clinica Spedali Civili Brescia, Brescia, Italy
| | - Beatriz Joven
- Servicio de Reumatologia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Serena Vettori
- Department of Clinical and Experimental Medicine, 'F-Magrassi' II, Naples, Italy
| | - Franco Cozzi
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Susanne Ullman
- Department of Dermatology, University Hospital of Copenhagen, Hospital Bispebjerg, Copenhagen, Denmark
| | - László Czirják
- Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary
| | - Mohammed Tikly
- Chris Hani Baragwanath Academic Hospital University of the Witwatersrand, Johannesburg, South Africa
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Paola Caramaschi
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Florenzo Iannone
- Interdisciplinary Department of Medicine-Rheumatology Unit, Policlinico, University of Bari, Bari, Italy
| | - Lidia P Ananieva
- VA Nasonova Institute of Rheumatology, Moscow, Russian Federation
| | - Roger Hesselstrand
- Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Radim Becvar
- Institute of Rheumatology, 1st Medical School, Charles University, Praha, Czech Republic
| | - Armando Gabrielli
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy
| | - Nemanja Damjanov
- Institute of Rheumatology, University of Belgrade Medical School, Belgrade, Serbia
| | - Maria J Salvador
- Rheumatology Department, Hospitais da Universidade, Coimbra, Portugal
| | - Valeria Riccieri
- Department of Internal Medicine and Medical Specialities, 'Sapienza', University of Rome, Italy, Rome, Italy
| | - Carina Mihai
- Department of Internal Medicine and Rheumatology Clinic, Ion Cantacuzino Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Gabriella Szücs
- Department of Internal Medicine, Division of Rheumatology, University of Debrecen, Debrecen, Hungary
| | - Ulrich A Walker
- Department of Rheumatology, Basel University, Unispital Basel, Basel, Switzerland
| | - Nicolas Hunzelmann
- Department of Dermatology, University Hospital Cologne, Cologne, Germany
| | - Duska Martinovic
- Department of Internal Medicine, Clinical Hospital of Split, Split, Croatia
| | - Vanessa Smith
- Department of Rheumatology, University of Ghent, Ghent, Belgium
| | | | | | - Daniela Opris
- Department of Rheumatology, St Maria Hospital, Carol Davila, University of Medicine and Pharmacy, Bucharest, Romania
| | - Francesca Ingegnoli
- Dipartimento e Cattedra di Reumatologia, Università degli Studi di Milano, Istituto Ortopedico 'Gaetano Pini', Milano, Italy
| | | | - Bojana Stamenkovic
- Institute for Prevention, Treatment and Rehabilitation of Rheumatic and Cardiovascular Diseases, Niska Banja, Serbia and Montenegro
| | - Edoardo Rosato
- Dipartimento di Medicina Clinica, Centro per la Sclerosi Sistemica, Università La Sapienza, Policlinico Umberto I, Roma, Italy
| | - Stefan Heitmann
- Department of Rheumatology, Marienhospital Stuttgart, Stuttgart, Germany
| | - Jörg H W Distler
- Department of Internal Medicine 3, University Hospital Erlangen, Erlangen, Germany
| | - Thierry Zenone
- Department of Medicine, Unit of Internal Medicine, Valence cedex, France
| | - Matthias Seidel
- Medizinische Klinik III, University Hospital of Bonn, Bonn, Germany
| | - Alessandra Vacca
- Rheumatology Unit, University Hospital of Cagliari, Monserrato, Italy
| | - Ellen De Langhe
- Division of Rheumatology and Department of Development and Regeneration, University Hospital Leuven and Laboratory Tissue Homeostasis and Disease, Leuven, Belgium
| | - Srdan Novak
- Department of Rheumatology and Clinical Immunology, Internal Medicine, KBC Rijeka, Rijeka, Croatia
| | - Maurizio Cutolo
- Research Laboratory and Division of Rheumatology Department of Internal Medicine, University of Genova, Genova, Italy
| | - Luc Mouthon
- Department of Internal Medicine, Hôpital Cochin, Paris, France
| | - Jörg Henes
- Medizinische Universitätsklinik, Abt II (Onkologie, Hämatologie, Rheumatologie, Immunologie, Pulmonologie), Tübingen, Germany
| | - Carlo Chizzolini
- Department of Immunology and Allergy, University Hospital, Geneva, Switzerland
| | | | - Kamal Solanki
- Rheumatology Unit, Waikato University Hospital, Hamilton City, Hamilton, New Zealand
| | - Simona Rednic
- Department of Rheumatology, University of Medicine and Pharmacy 'Iuliu Hatieganu' Cluj, Cluj-Napoca, Romania
| | - Lisa Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Branimir Anic
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Sule Yavuz
- Department of Rheumatology, University of Marmara, Istanbul, Turkey
| | | | - Emmanuel Chatelus
- Department of Rheumatology, University Hospital of Strasbourg-, Hôpital de Hautepierre, Service de Rhumatologie, Strasbourg, France
| | - Jiri Stork
- Department of Dermatology, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jacob van Laar
- Department of Rheumatology and Clinical Immunology, James Cook University Hospital, Middlesbrough, UK
| | - Esthela Loyo
- Reumatologia e Inmunologia Clinica, Hospital Regional Universitario Jose Ma Cabral y Baez, Clinica Corominas, Santiago, Dominican Republic
| | | | - Kilian Eyerich
- Department of Dermatology and Allergy of the TU Munich, Munich, Germany
| | - Vanesa Cosentino
- Department of Rheumatology and Collagenopathies, Osteoarticular Diseases and Osteoporosis Centre, Pharmacology and Clinical Pharmacological Research Centre, School of Medicine-University of Buenos Aires, Ramos Mejía Hospital, Buenos Aires, Argentina
| | | | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Grégoire Rey
- INSERM, CépiDc, Le Kremlin- Bicêtre, Le Kremlin-Bicêtre, France
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Section of Internal Medicine and Division of Rheumatology, Azienda Ospedaliero-Universitaria Careggi (AOUC), University of Florence, Florence, Italy
| | - Yannick Allanore
- Rheumatology A department, Paris Descartes University, INSERM U1016, Sorbonne Paris Cité, Cochin Hospital, Paris, France
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50
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Alpizar-Rodriguez D, Mueller RB, Möller B, Dudler J, Ciurea A, Zufferey P, Kyburz D, Walker UA, von Mühlenen I, Roux-Lombard P, Mahler M, Lamacchia C, Courvoisier DS, Gabay C, Finckh A. Female hormonal factors and the development of anti-citrullinated protein antibodies in women at risk of rheumatoid arthritis. Rheumatology (Oxford) 2017; 56:1579-1585. [DOI: 10.1093/rheumatology/kex239] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Indexed: 12/13/2022] Open
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