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Khanna D, Huang S, Lin CJF, Spino C. New composite endpoint in early diffuse cutaneous systemic sclerosis: revisiting the provisional American College of Rheumatology Composite Response Index in Systemic Sclerosis. Ann Rheum Dis 2021; 80:641-650. [PMID: 33257497 PMCID: PMC10750249 DOI: 10.1136/annrheumdis-2020-219100] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/28/2020] [Accepted: 11/06/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES American College of Rheumatology Composite Response Index in Systemic Sclerosis (ACR-CRISS) is a composite endpoint to assess the likelihood of improvement in diffuse systemic sclerosis. ACR-CRISS is a weighted score and includes five core set measures: modified Rodnan skin score, FVC% predicted, health assessment questionnaire-disability index, and patient and clinician global assessments. METHODS We analysed core set measures from 354 participants who participated in three placebo-controlled trials. We generated 10 development datasets, randomly selected from 2/3 of the participants, stratified by study and treatment group. The remaining participants (1/3 of the participants) formed the validation sets. Risk differences (RDs) between active and placebo treatments were calculated by averaging over the replicate datasets; bootstrap 95% CIs for the RDs to estimate the magnitude of treatment effects. RESULTS In the development sets (n=237), the proportion of participants in the active group had statistically higher improvement in >1 of 5 core set measures versus the placebo group. For example, the proportion who improved by ≥20% in ≥3 core set measures was 49.4% in the active versus338.9% in the placebo; RD: 10.5%, 95% CI4.9 % to 16.1%. In the validation sets (n=117), the proportion who improved by ≥20% in ≥3 core set measures was 50.3% in the active versus35.63% in the placebo (RD:114.8%, 95% CI 3.1% to225.7%). Similar trends were seen with larger percentage cut-offs. CONCLUSION Revised CRISS, as assessed by the proportion of participants who improved by a certain percentage in ≥3 of 5 core set measures, is a potential new composite outcome measure.
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Affiliation(s)
- Dinesh Khanna
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Suiyuan Huang
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Cathie Spino
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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Boumaza X, Lelièvre L, Guenounou S, Borel C, Huynh A, Beziat G, Delavigne K, Guinault D, Garric M, Piel-Julian M, Paricaud K, Moulis G, Astudillo L, Sailler L, Farge D, Pugnet G. Pulmonary mucormycosis following autologous hematopoietic stem cell transplantation for rapidly progressive diffuse cutaneous systemic sclerosis: A case report. Medicine (Baltimore) 2020; 99:e21431. [PMID: 32756151 PMCID: PMC7402716 DOI: 10.1097/md.0000000000021431] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
RATIONALE The use of autologous hematopoietic stem cell transplantation (AHSCT) for autoimmune diseases has become the first indication for transplant in nonmalignant disease. Mucormycosis is a rare invasive infection with increasing incidence in patients treated with AHSCT. We report the first case of pulmonary mucormycosis following AHSCT for systemic sclerosis (SSc). PATIENT CONCERNS A 24-year-old woman with rapidly progressive diffuse cutaneous SSc presented with an acute respiratory distress syndrome 6 days after AHSCT. DIAGNOSES The results of clinical and computed tomography scan were consistent with pulmonary mucormycosis and the diagnosis was confirmed by a positive Mucorales Polymerase Chain Reaction on a peripheral blood sample. INTERVENTIONS AND OUTCOMES Early antifungal therapy by intravenous amphotericin B provided rapid improvement within 4 days and sustained recovery after 2 years of follow-up. LESSONS With the progressively increasing use of AHSCT and other stem cell therapy for treatment of severe SSc and other autoimmune diseases, the potential onset of rare post-transplant fungal infections, such as mucormycosis, requires careful patient monitoring and better awareness of early initiation of adequate therapy.
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Affiliation(s)
| | - Lucie Lelièvre
- Department of infectious and tropical diseases, Toulouse University Hospital
| | | | | | | | | | - Karen Delavigne
- Department of Internal Medicine, Institut Universitaire du Cancer de Toulouse - Oncopole
| | | | | | | | | | - Guillaume Moulis
- Department of Internal Medicine
- Clinical Investigation Center, Toulouse University Hospital
- UMR 1027 INSERM, University of Toulouse, Toulouse
| | | | - Laurent Sailler
- Department of Internal Medicine
- Clinical Investigation Center, Toulouse University Hospital
- UMR 1027 INSERM, University of Toulouse, Toulouse
| | - Dominique Farge
- Unité de Médecine Interne: Maladies Auto-immunes et Pathologie Vasculaire (UF 04), Hôpital St-Louis, AP-HP, 1 Avenue Claude Vellefaux
- Centre de Référence des Maladies auto-immunes Systémiques Rares d’Ile-de-France
- EA 3518, Université Denis Diderot, Paris, France
- Department of Internal Medicine, McGill University, Montréal, Canada
| | - Grégory Pugnet
- Department of Internal Medicine
- Clinical Investigation Center, Toulouse University Hospital
- UMR 1027 INSERM, University of Toulouse, Toulouse
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Patschan S, Tampe D, Müller C, Seitz C, Herink C, Müller GA, Zeisberg E, Zeisberg M, Henze E, Patschan D. Early Endothelial Progenitor Cells (eEPCs) in systemic sclerosis (SSc) - dynamics of cellular regeneration and mesenchymal transdifferentiation. BMC Musculoskelet Disord 2016; 17:339. [PMID: 27519706 PMCID: PMC4983068 DOI: 10.1186/s12891-016-1197-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/30/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Patients with systemic sclerosis (SSc) are endagered by tissue fibrosis and by microvasculopathy, with the latter caused by endothelial cell expansion/proliferation. SSc-associated fibrosis potentially results from mesenchymal transdifferentiation of endothelial cells. Early Endothelial Progenitor Cells (eEPCs) act proangiogenic under diverse conditions. Aim of the study was to analyze eEPC regeneration and mesenchymal transdifferentiation in patients with limited and diffuse SSs (lSSc and dSSc). METHODS Patients with both, lSSc and dSSc were included into the study. The following parameters were evaluated: eEPC numbers and regeneration, concentrations of vasomodulatory mediators, mesenchymal properties of blood-derived eEPC. Serum samples of healthy subjects and SS patients were used for stimulation of cultured human eEPC, subsequently followed by analysis of mesenchymal cell characteristics and mobility. RESULTS Twenty-nine patients were included into the study. Regenerative activity of blood-derived eEPCs did not differ between Controls and patients. Circulating eEPC were significantly lower in all patients with SSc, and in limited and diffuse SSc (lSSc/dSSc). Serum concentrations of promesenchymal TGF-b was elevated in all patients with SSc. Cultured mononuclear cells from SS patients displayed higher abundances of CD31 and of CD31 and aSMA combined. Finally, serum from SSc patients inhibited migration of cultured eEPCs and the cells showed lower sensitivity towards the endothelin antagonist Bosentan. CONCLUSIONS The eEPC system, which represents an essential element of the endogenous vascular repair machinery is affected in SSc. The increased appearance of mesenchymal properties in eEPC may indicate that alterations of the cells potentially contribute to the accumulation of connective tissue and to vascular malfunction.
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Affiliation(s)
- S. Patschan
- Clinic of Nephrology and Rheumatology, University Hospital of Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - D. Tampe
- Clinic of Nephrology and Rheumatology, University Hospital of Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - C. Müller
- Clinic of Nephrology and Rheumatology, University Hospital of Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - C. Seitz
- Clinic of Dermatology, University Hospital of Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - C. Herink
- Clinic of Dermatology, University Hospital of Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - G. A. Müller
- Clinic of Nephrology and Rheumatology, University Hospital of Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - E. Zeisberg
- Clinic of Nephrology and Rheumatology, University Hospital of Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - M. Zeisberg
- Clinic of Nephrology and Rheumatology, University Hospital of Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - E. Henze
- Clinic of Nephrology and Rheumatology, University Hospital of Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
| | - D. Patschan
- Clinic of Nephrology and Rheumatology, University Hospital of Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
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Cheung ST, Khair OA, Maheshwari MB, Abdullah A. Fatal outcome of generalized morphoea with bronchiolitis obliterans organizing pneumonia. Clin Exp Dermatol 2006; 31:722-3. [PMID: 16901325 DOI: 10.1111/j.1365-2230.2006.02190.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Relaxin is a peptide hormone with anti-fibrotic properties. To investigate the long-term effects of relaxin deficiency on the ageing skin, we compared structural changes in the skin of ageing relaxin-deficient (RLX-/-) and normal (RLX+/+) mice, by biochemical, histological, and magnetic resonance imaging analyses. Skin biopsies from RLX+/+ and RLX-/- mice were obtained at different ages and analyzed for changes in collagen expression and distribution. We demonstrated an age-related progression of dermal fibrosis and thickening in male and female RLX-/- mice, associated with marked increases in types I and III collagen. The increased collagen was observed primarily in the dermis of RLX-/- mice by 1 mo of age, and eventually superseded the hypodermal layer. Additionally, fibroblasts from the dermis of RLX-/- mice were shown to produce increased collagen in vitro. Recombinant human gene-2 (H2) relaxin treatment of RLX-/- mice resulted in the complete reversal of dermal fibrosis, when applied to the early onset of disease, but was ineffective when applied to more established stages of dermal scarring. These combined findings demonstrate that relaxin provides a means to regulate excessive collagen deposition in disease states characterized by dermal fibrosis and with our previously published work demonstrate the relaxin-null mouse as a model of progressive scleroderma.
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Affiliation(s)
- Chrishan S Samuel
- Relaxin Group, Howard Florey Institute of Experimental Physiology & Medicine, The University of Melbourne, Victoria, Australia.
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Kuwata S. [Analysis of HLA chimerism]. Nihon Rinsho 2005; 63 Suppl 7:757-60. [PMID: 16111387] [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] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Shoji Kuwata
- Third Department of Internal Medicine, Teikyo University School of Medicine
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Trad S, Amoura Z, Haroche J, Huong Du Boutin LT, Wechsler B, Leblond V, Piette JC. Fatal progressive systemic sclerosis following autologous stem cell transplantation and high-dose chemotherapy. Rheumatology (Oxford) 2005; 44:951-3. [PMID: 15814574 DOI: 10.1093/rheumatology/keh637] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Nacoulma EWC, Niamba P, Ouedraogo D, Tieno H, Traoré R, Ouedraogo C, Drabo J. [What is your diagnosis? Hypochromic microcytic anemia with Evans syndrome or autoimmune thrombocytopenic purpura?]. Sante 2005; 15:133-6. [PMID: 16061453] [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] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
We report a case of Evans syndrome associated with scleroderma in a 50-year-old woman admitted to the department of internal medicine of Yalgado Ouedraogo National Teaching Hospital in Burkina Faso. The interest of this case lies in on its mode of revelation: chronic bleeding that led to hypochromic microcytic anemia. The indirect antiglobulin test was positive. Corticosteroid treatment has been successful. Nonetheless, because autoimmune cytopenia may indicate underlying disorders, particularly lymphoid tissue malignancies, rigorous monitoring of this patient is essential.
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Affiliation(s)
- Eric William Camille Nacoulma
- Service de médecine interne, Centre hospitalier national Yalgado Ouedraogo, 01 BP 2251, Ouagadougou 01, Burkina Faso.
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Manneschi LI, Del Rosso A, Milia AF, Tani A, Nosi D, Pignone A, Generini S, Giacomelli R, Cerinic MM. Damage of cutaneous peripheral nervous system evolves differently according to the disease phase and subset of systemic sclerosis. Rheumatology (Oxford) 2005; 44:607-13. [PMID: 15728417 DOI: 10.1093/rheumatology/keh559] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Evidence shows that peripheral nervous system (PNS) is involved in systemic sclerosis (SSc), but few morphological studies have assessed the ultrastructural pathological modifications. The aim was to study ultrastructural modifications of skin PNS fibres in SSc according to subsets [limited SSc (lSSc) and diffuse SSc (dSSc)] and phases (early and advanced) of the disease. METHODS Skin biopsies were taken from the forearms of 23 SSc patients (11 lSSc and 12 dSSc) and 10 controls. Each biopsy was processed for transmission electron microscopy (TEM). RESULTS At TEM, observation in skin from early lSSc, signs of inflammation were evident, while PNS fibres were not damaged. The microvascular wall showed hypertrophic endothelial cells bulging into the lumen. In advanced lSSc, fibrosis prevailed on inflammation and slight ultrastructural alterations of PNS fibres were evident in the papillary derma. In early dSSc, ultrastructural alterations of PNS fibres, similar to those observed in the advanced phase of lSSc, were found together with signs of inflammation and fibrosis. In advanced dSSc, in the papillary and reticular dermis PNS fibres were reduced and showed relevant ultrastructural alterations. CONCLUSIONS In SSc, PNS ultrastructure damage is linked to the progression and severity of skin involvement. The alterations evolve from the early to the advanced phase mainly in the diffuse subset. In particular, the severe PNS lesions found in advanced lSSc are already present and widely diffuse in early dSSc and the microvascular involvement in early lSSc seems to precede the modification of the PNS in the skin. Thus, an early therapeutic approach can be useful to reduce the progression of PNS and skin damage in SSc patients.
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Affiliation(s)
- L Ibba Manneschi
- Department of Anatomy, Histology and Forensic Medicine, University of Florence, Viale Morgagni, 85, 50134, Florence, Italy.
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Ratanatharathorn V, Ayash L, Reynolds C, Silver S, Reddy P, Becker M, Ferrara JLM, Uberti JP. Treatment of chronic graft-versus-host disease with anti-CD20 chimeric monoclonal antibody. Biol Blood Marrow Transplant 2003; 9:505-11. [PMID: 12931119 DOI: 10.1016/s1083-8791(03)00216-7] [Citation(s) in RCA: 158] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We reviewed the clinical outcome of 8 patients with steroid-refractory chronic graft-versus-host disease (GVHD) who received an anti-CD20 chimeric monoclonal antibody (rituximab). Rituximab was given by intravenous infusion at a weekly dose of 375 mg/m(2) for 4 weeks. All patients had received extensive treatment with various immunosuppressive agents; 6 patients had also received extracorporeal photopheresis. All patients had extensive chronic GVHD with diffuse or localized sclerodermoid GVHD and xerophthalmia. Other extracutaneous involvements included cold agglutinin disease with the Raynaud phenomenon, membranous glomerulonephritis, and restrictive or obstructive lung disease. Four patients responded to treatment with ongoing resolution or improvement ranging from 265 to 846 days after therapy, despite recovery of B cells in 3 patients. Rituximab seems to have significant activity in the treatment of refractory chronic GVHD and should be considered for further study in patients with early disease. This study suggests a participating role of B cells in the pathogenesis of chronic GVHD.
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Affiliation(s)
- Voravit Ratanatharathorn
- Blood and Marrow Stem Cell Transplantation Program, University of Michigan Health System, Ann Arbor, USA.
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Abstract
We report a rare case of sclerodermatous chronic graft-versus-host disease (GVHD) in a 6-year-old boy that occurred after bone marrow transplantation for his aplastic anemia. The clinical manifestation and histopathologic findings were typical of scleroderma. Although various kinds of treatment have been tried for scleroderma, no established therapy exists. Furthermore, treating this disease is even more difficult in children. In the future, clarification of the pathogenesis of chronic GVHD and establishment of therapy will be necessary.
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Affiliation(s)
- Kenjiro Terasaki
- Department of Dermatology, Kagoshima University, Faculty of Medicine, Kagoshima, Japan.
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