1
|
Pieklarz B, Gińdzieńska-Sieśkiewicz E, Zawadzka I, Bagrowska M, Daniluk J, Palewski M, Zonenberg A, Kowal-Bielecka O, Konopińska J, Dmuchowska DA. Macular choroidal thickness, volume, and vascularity index in patients with systemic sclerosis. Graefes Arch Clin Exp Ophthalmol 2024; 262:1475-1487. [PMID: 38133798 PMCID: PMC11031445 DOI: 10.1007/s00417-023-06342-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 11/26/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE The aim of this study was to investigate choroidal parameters in patients with systemic sclerosis (SSc) using enhanced depth imaging spectral-domain optical coherence tomography (EDI-SD-OCT) and to determine their relationships with clinical variables and ocular features. METHODS Thirty-three patients with SSc and 40 controls were enrolled. The groups did not differ with regard to age, sex, and axial length. The mean choroidal thickness and volume were obtained in each conventional Early Treatment of Diabetic Retinopathy Study grid subfield. The choroidal vascularity index (CVI), which provides a quantitative analysis of vasculature by calculating the proportion of the luminal area (LA) to the total choroidal area (TCA), was determined. RESULTS Lower choroidal thickness and volume were observed in the SSc group. The CVI was significantly higher in SSc patients, whereas the TCA, LA, and stromal area were significantly lower in the SSc group; however, the significant difference of the stromal component was more pronounced than that of the luminal component. Regression analyses did not identify any clinical factors associated with the CVI (except Ca-blocker use), central macular thickness, or volume. No significant differences in choroidal parameters were found within the SSc subtypes (diffuse cutaneous systemic sclerosis (dcSSc) vs. limited cutaneous systemic sclerosis (lcSSc)), or between eyes stratified according to SSc pattern (early, active, or late) using nailfold capillaroscopy (p > 0.05 for all). CONCLUSION Our results, with notably higher CVI values, may shed new light on choroidal impairment in patients with SSc. Stromal involvement appeared to dominate the vascular component.
Collapse
Affiliation(s)
- Barbara Pieklarz
- Ophthalmology Department, Medical University of Bialystok, 24a M.Sklodowskiej-Curie, 15-276, Bialystok, Poland.
| | - Ewa Gińdzieńska-Sieśkiewicz
- Department of Rheumatology and Internal Diseases, Medical University of Bialystok, 24a M. Sklodowskiej-Curie, 15-276, Bialystok, Poland
| | - Izabela Zawadzka
- Ophthalmology Department, Medical University of Bialystok, 24a M.Sklodowskiej-Curie, 15-276, Bialystok, Poland
| | - Magdalena Bagrowska
- Department of Rheumatology and Internal Diseases, Medical University of Bialystok, 24a M. Sklodowskiej-Curie, 15-276, Bialystok, Poland
| | - Joanna Daniluk
- Department of Rheumatology and Internal Diseases, Medical University of Bialystok, 24a M. Sklodowskiej-Curie, 15-276, Bialystok, Poland
| | - Marcin Palewski
- Ophthalmology Department, Medical University of Bialystok, 24a M.Sklodowskiej-Curie, 15-276, Bialystok, Poland
| | - Agnieszka Zonenberg
- Ophthalmology Department, Medical University of Bialystok, 24a M.Sklodowskiej-Curie, 15-276, Bialystok, Poland
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Diseases, Medical University of Bialystok, 24a M. Sklodowskiej-Curie, 15-276, Bialystok, Poland
| | - Joanna Konopińska
- Ophthalmology Department, Medical University of Bialystok, 24a M.Sklodowskiej-Curie, 15-276, Bialystok, Poland
| | - Diana Anna Dmuchowska
- Ophthalmology Department, Medical University of Bialystok, 24a M.Sklodowskiej-Curie, 15-276, Bialystok, Poland.
| |
Collapse
|
2
|
Pieklarz B, Gińdzieńska-Sieśkiewicz E, Zawadzka I, Bagrowska M, Daniluk J, Sidorczuk P, Kowal-Bielecka O, Konopińska J, Dmuchowska DA. Peripapillary choroidal vascularity index and thickness in patients with systemic sclerosis. Front Med (Lausanne) 2023; 10:1273438. [PMID: 37915331 PMCID: PMC10617027 DOI: 10.3389/fmed.2023.1273438] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/29/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction Patients with systemic sclerosis (SSc) present an increased risk of developing glaucomatous optic neuropathy (GON). We investigated peripapillary choroidal parameters and peripapillary retinal nerve fiber layer (RNFL) thickness using spectral domain optical coherence tomography (SD-OCT) to determine the relationships of these factors with clinical variables. Methods A total of 33 patients with SSc were enrolled and compared to 40 controls. After obtaining circular scans around the optic disc, the global and quadrant peripapillary choroidal thickness (pCT) and RNFL thickness were measured. Additionally, the peripapillary choroidal vascularity index (pCVI), which allows for a quantitative analysis of the choroidal vasculature, was determined. Results No significant differences were found in pCT and RNFL thickness between patients with SSc and controls, or within SSc subtypes (diffuse cutaneous systemic sclerosis (dcSSc) compared to limited cutaneous systemic sclerosis (lcSSc)) (p > 0.05). The pCVI was significantly lower in patients with SSc than in control subjects (64.25 ± 1.94 vs.65.73 ± 2.12, p < 0.001). Conclusion Our results suggest that the statistically significant decrease in pCVI in patients with SSc compared to the control group is probably due to a decrease in the vascular layer, which would partially explain an increased risk of GON in patients with SSc.
Collapse
Affiliation(s)
- Barbara Pieklarz
- Ophthalmology Department, Medical University of Białystok, Białystok, Poland
| | | | - Izabela Zawadzka
- Ophthalmology Department, Medical University of Białystok, Białystok, Poland
| | - Magdalena Bagrowska
- Department of Rheumatology and Internal Diseases, Medical University of Białystok, Białystok, Poland
| | - Joanna Daniluk
- Department of Rheumatology and Internal Diseases, Medical University of Białystok, Białystok, Poland
| | - Patryk Sidorczuk
- Ophthalmology Department, Medical University of Białystok, Białystok, Poland
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Diseases, Medical University of Białystok, Białystok, Poland
| | - Joanna Konopińska
- Ophthalmology Department, Medical University of Białystok, Białystok, Poland
| | | |
Collapse
|
3
|
Hoffmann-Vold AM, Brunborg C, Airò P, Ananyeva LP, Czirják L, Guiducci S, Hachulla E, Li M, Mihai C, Riemekasten G, Sfikakis PP, Valentini G, Kowal-Bielecka O, Allanore Y, Distler O. Cohort Enrichment Strategies for Progressive Interstitial Lung Disease in Systemic Sclerosis From European Scleroderma Trials and Research. Chest 2023; 163:586-598. [PMID: 36244404 DOI: 10.1016/j.chest.2022.09.044] [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: 06/07/2022] [Revised: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Enrichment strategies from clinical trials for progressive systemic sclerosis-associated interstitial lung disease (SSc-ILD) have not been tested in a real-life cohort. RESEARCH QUESTION Do enrichment strategies for progressive ILD impact efficacy, representativeness, and feasibility in patients with SSc-ILD from the European Scleroderma Trials and Research (EUSTAR) database? STUDY DESIGN AND METHODS We applied the inclusion criteria of major recent SSc-ILD trials (Study of the Efficacy and Safety of Tocilizumab in Participants With Systemic Sclerosis [focuSSced], Scleroderma Lung Study II [SLS II], and Safety and Efficacy of Nintedanib in Systemic Sclerosis [SENSCIS]) and assessed progressive ILD, which was defined as absolute change in FVC and as significant progression (FVC decline ≥10%). Data were compared with all patients and with patients who did not fulfill any inclusion criteria. RESULTS In total, 2,258 patients with SSc-ILD were included: 31.2% of the patients met SENSCIS criteria; 5.8% of the patients met SLS II criteria; 1.6% of the patients met focuSSced criteria, and 67.7% (1,529) of the patients did not meet any criteria. In the first 12 ± 3 months, the absolute FVC decline in all patients and in patients who fulfilled criteria from SENSCIS was -0.1%, in patients who fulfilled criteria from focuSSced was -3.7%, and in patients who fulfilled criteria from SLS II was 2.3%, with accompanying more progressors in focuSSced. The patient populations that fulfilled the different study inclusion criteria significantly differed in various clinical parameters. In the second 12-month period, SENSCIS-enriched patients had a further absolute FVC% decline as described for the total cohort. In contrast, patients who fulfilled the focuSSced and SLS II criteria showed numeric improvement of lung function. There were no significant associations of enrichment criteria and ILD progression. INTERPRETATION The application of enrichment criteria from previous clinical trials showed enrichment for progression with variable success, which led to selected patient populations reducing feasibility of recruitment. These findings are important for future clinical trial design and interpretation of the results of published trials.
Collapse
Affiliation(s)
- Anna-Maria Hoffmann-Vold
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway; Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics & Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Paolo Airò
- UO Reumatologia e Immunologia Clinica, Spedali Civili di Brescia, Brescia, Italy
| | - Lidia P Ananyeva
- VA Nasonova Institute of Rheumatology, Moscow, Russian Federation
| | - László Czirják
- Department of Rheumatology and Immunology, Medical school of Pécs, Pécs, Hungary
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Firenze, Azienda Ospedaliera Careggi, Firenze, Italy
| | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, Hôpital Claude Huriez, University of Lille, Lille, France
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital (West Campus), Beijing, China
| | - Carina Mihai
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, University of Medical Center Schleswig-Holstein, Kiel/Lübeck, Germany
| | - Petros P Sfikakis
- Joint Rheumatology Programme, National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - Gabriele Valentini
- Dipartimento di Medicina di Precisione, Università della Campania "Luigi Vanvitelli," Napoli, Italy
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Yannick Allanore
- Department of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | |
Collapse
|
4
|
Garaiman A, Steigmiller K, Gebhard C, Mihai C, Dobrota R, Bruni C, Matucci-Cerinic M, Henes J, de Vries-Bouwstra J, Smith V, Doria A, Allanore Y, Dagna L, Anić B, Montecucco C, Kowal-Bielecka O, Martin M, Tanaka Y, Hoffmann-Vold AM, Held U, Distler O, Becker MO. Use of platelet inhibitors for digital ulcers related to systemic sclerosis: EUSTAR study on derivation and validation of the DU-VASC model. Rheumatology (Oxford) 2023; 62:SI91-SI100. [PMID: 35904554 DOI: 10.1093/rheumatology/keac405] [Citation(s) in RCA: 1] [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] [Received: 02/22/2022] [Revised: 06/09/2022] [Accepted: 07/11/2022] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To develop and validate the prognostic prediction model DU-VASC to assist the clinicians in decision-making regarding the use of platelet inhibitors (PIs) for the management of digital ulcers in patients with systemic sclerosis. Secondly, to assess the incremental value of PIs as predictor. METHODS We analysed patient data from the European Scleroderma Trials and Research group registry (one time point assessed). Three sets of derivation/validation cohorts were obtained from the original cohort. Using logistic regression, we developed a model for prediction of digital ulcers (DUs). C-Statistics and calibration plots were calculated to evaluate the prediction performance. Variable importance plots and the decrease in C-statistics were used to address the importance of the predictors. RESULTS Of 3710 patients in the original cohort, 487 had DUs and 90 were exposed to PIs. For the DU-VASC model, which includes 27 predictors, we observed good calibration and discrimination in all cohorts (C-statistic = 81.1% [95% CI: 78.9%, 83.4%] for the derivation and 82.3% [95% CI: 779.3%, 85.3%] for the independent temporal validation cohort). Exposure to PIs was associated with absence of DUs and was the most important therapeutic predictor. Further important factors associated with absence of DUs were lower modified Rodnan skin score, anti-Scl-70 negativity and normal CRP. Conversely, the exposure to phosphodiesterase-5 inhibitor, prostacyclin analogues or endothelin receptor antagonists seemed to be associated with the occurrence of DUs. Nonetheless, previous DUs remains the most impactful predictor of DUs. CONCLUSION The DU-VASC model, with good calibration and discrimination ability, revealed that PI treatment was the most important therapy-related predictor associated with reduced DU occurrence.
Collapse
Affiliation(s)
| | - Klaus Steigmiller
- Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Carina Mihai
- Department of Rheumatology, University Hospital Zurich
| | | | - Cosimo Bruni
- Department of Rheumatology, University Hospital Zurich.,Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Scleroderma Unit, AOUC, Florence
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Scleroderma Unit, AOUC, Florence.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute.,Faculty of Medicine and Surgery of the Vita-Salute San Raffaele University, Milan, Italy
| | - Joerg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases and Department of Internal Medicine II (Hematology, Oncology, Immunology and Rheumatology), University Hospital Tuebingen, Tuebingen, Germany
| | | | - Vanessa Smith
- Department of Internal Medicine, Ghent University.,Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Yannick Allanore
- Department of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute.,Faculty of Medicine and Surgery of the Vita-Salute San Raffaele University, Milan, Italy
| | - Branimir Anić
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University Hospital Centre Zagreb and University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Carlomaurizio Montecucco
- Department of Rheumatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Mickael Martin
- Internal Medicine, Poitiers University Hospital, Poitiers, France
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, Japan
| | | | - Ulrike Held
- Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics
| | | | | | | |
Collapse
|
5
|
Piotrowski WJ, Martusewicz-Boros MM, Białas AJ, Barczyk A, Batko B, Błasińska K, Boros PW, Górska K, Grzanka P, Jassem E, Jastrzębski D, Kaczyńska J, Kowal-Bielecka O, Kucharz E, Kuś J, Kuźnar-Kamińska B, Kwiatkowska B, Langfort R, Lewandowska K, Mackiewicz B, Majewski S, Makowska J, Miłkowska-Dymanowska J, Puścińska E, Siemińska A, Sobiecka M, Soroka-Dąda RA, Szołkowska M, Wiatr E, Ziora D, Śliwiński P. Guidelines of the Polish Respiratory Society on the Diagnosis and Treatment of Progressive Fibrosing Interstitial Lung Diseases Other than Idiopathic Pulmonary Fibrosis. Adv Respir Med 2022; 90:425-450. [PMID: 36285980 PMCID: PMC9717335 DOI: 10.3390/arm90050052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 08/22/2022] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2023]
Abstract
The recommendations were developed as answers to previously formulated questions concerning everyday diagnostic and therapeutic challenges. They were developed based on a review of the current literature using the GRADE methodology. The experts suggest that PF-ILD be diagnosed based on a combination of different criteria, such as the aggravation of symptoms, progression of radiological lesions, and worsening of lung function test parameters. The experts recommend a precise diagnosis of an underlying disease, with serological testing for an autoimmune disease always being included. The final diagnosis should be worked out by a multidisciplinary team (MDT). Patients with an interstitial lung disease other than IPF who do not meet the criteria for the progressive fibrosis phenotype should be monitored for progression, and those with systemic autoimmune diseases should be regularly monitored for signs of interstitial lung disease. In managing patients with interstitial lung disease associated with autoimmune diseases, an opinion of an MDT should be considered. Nintedanib rather than pirfenidon should be introduced in the event of the ineffectiveness of the therapy recommended for the treatment of the underlying disease, but in some instances, it is possible to start antifibrotic treatment without earlier immunomodulatory therapy. It is also admissible to use immunomodulatory and antifibrotic drugs simultaneously. No recommendations were made for or against termination of anti-fibrotic therapy in the case of noted progression during treatment of a PF-ILD other than IPF. The experts recommend that the same principles of non-pharmacological and palliative treatment and eligibility for lung transplantation should be applied to patients with an interstitial lung disease other than IPF with progressive fibrosis as in patients with IPF.
Collapse
Affiliation(s)
| | - Magdalena M. Martusewicz-Boros
- 3rd Lung Diseases and Oncology Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Adam J. Białas
- Department of Pathobiology of Respiratory Diseases, Medical University of Lodz, 90-153 Lodz, Poland
| | - Adam Barczyk
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland
| | - Bogdan Batko
- Department of Rheumatology and Immunology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, 30-705 Krakow, Poland
| | - Katarzyna Błasińska
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Piotr W. Boros
- Lung Pathophysiology Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Katarzyna Górska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Piotr Grzanka
- Department of Radiology, Voivodeship Hospital in Opole, 45-061 Opole, Poland
| | - Ewa Jassem
- Department of Allergology and Pneumonology, Medical University of Gdansk, 80-214 Gdańsk, Poland
| | - Dariusz Jastrzębski
- Department of Lung Diseases and Tuberculosis, Medical University of Silesia, 41-803 Zabrze, Poland
| | | | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Białystok, 15-276 Białystok, Poland
| | - Eugeniusz Kucharz
- Department of Internal Medicine, Rheumatology and Clinical Immunology, Medical University of Silesia, 40-635 Katowice, Poland
| | - Jan Kuś
- 1st Lung Diseases Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Barbara Kuźnar-Kamińska
- Department of Pulmonology, Allergology and Respiratory Oncology, University of Medical Sciences in Poznan, 61-701 Poznan, Poland
| | - Brygida Kwiatkowska
- Department of Rheumatology, Eleonora Reicher Rheumatology Institute, 02-637 Warszawa, Poland
| | - Renata Langfort
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warszawa, Poland
| | - Katarzyna Lewandowska
- 1st Lung Diseases Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Barbara Mackiewicz
- Department of Pneumonology, Oncology and Allergology, Medical University, Lublin, 20-090 Lublin, Poland
| | - Sebastian Majewski
- Department of Pneumology, Medical University of Lodz, 90-153 Lodz, Poland
| | - Joanna Makowska
- Department of Rheumatology, Medical University of Lodz, 92-213 Lodz, Poland
| | | | - Elżbieta Puścińska
- 2nd Department of Respiratory Medicine, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Alicja Siemińska
- Department of Allergology, Medical University of Gdańsk, 80-214 Gdansk, Poland
| | - Małgorzata Sobiecka
- 1st Lung Diseases Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | | | - Małgorzata Szołkowska
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warszawa, Poland
| | - Elżbieta Wiatr
- 3rd Lung Diseases and Oncology Department, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| | - Dariusz Ziora
- Department of Lung Diseases and Tuberculosis, Medical University of Silesia, 41-803 Zabrze, Poland
| | - Paweł Śliwiński
- 2nd Department of Respiratory Medicine, National Tuberculosis and Lung Diseases Research Institute in Warsaw, 01-138 Warsaw, Poland
| |
Collapse
|
6
|
Hoffmann-Vold AM, Brunborg C, Airò P, Ananyeva LP, Czirják L, Guiducci S, Hachulla E, Li M, Mihai C, Riemekasten G, Sfikakis P, Valentini G, Kowal-Bielecka O, Allanore Y, Distler O. POS0063 PROGRESSIVE INTERSTITIAL LUNG DISEASE IS FREQUENT ALSO IN LATE DISEASE STAGES IN SYSTEMIC SCLEROSIS PATIENTS FROM EUSTAR. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundShort disease duration is a predictor for progressive systemic sclerosis-associated interstitial lung disease (SSc-ILD), but studies assessing ILD progression in later disease stages are lacking. To individually tailor management of ILD in SSc patients in clinical practice it is, however, of high importance to understand disease behaviour also in patients with late disease.ObjectivesAnalyse ILD progression in SSc-ILD patients from the EUSTAR cohort segregated by subgroups of disease duration.MethodsWe segregated SSc-ILD patients into four categories of disease duration (≤3 years, >3- ≤7 years, >7- ≤15 years and >15 years after onset of Raynaud’s phenomenon). We assessed progressive ILD, defined as forced vital capacity (FVC) decline >10% or FVC decline ≥10% and FVC decline 5–10% and diffusing capacity of the lungs for carbon monoxide (DLCO) decline ≥15% (composite decline) over the first and second 12+/-3 months period after first registration (baseline) into EUSTAR. Clinical characteristics, pulmonary involvement, treatment at first registration and ILD progression were evaluated by descriptive statistics.ResultsIn total, 2258 SSc-ILD patients were included, with 469 (20.8%) having a disease duration ≤3 years, 550 (24.4%) between >3- ≤7 years, 752 (33.3%) between >7- ≤15 years and 488 (21.6%) of >15 years (Table 1). Baseline characteristics and treatment patterns differed between the four subgroups, with more younger male patients with diffuse cutaneous SSc, anti-topoisomerase I antibody and higher Rodnan skin score having ≤3 years disease duration. Lung function with FVC and DLCO were similar between the four groups (Table 1). Notably, in the first and second 12+/-3 months periods after first registration in the EUSTAR database, there were no significant difference in FVC decline >10% or composite FVC and DLCO decline within the four subgroups. For example, patients with disease duration >7- ≤15 years and >15 years frequently showed disease progression of FVC >10%: 41/347 (11.8%) and 32/228 (14%) compared to 38/244 (15.6%) and 33/273 (15.6%) for disease duration ≤3 years and >3- ≤7 years (P=0.529), respectively (Figure 1).Table 1.Demographics and baseline clinical characteristics of EUSTAR patientsDisease duration≤ years(n=460)>3- ≤7 years(n=550)>7- ≤15 years(n=752)>15 years(n=488)p-valueAge, years (SD)55 (13.5)55 (14.1)57 (13.1)61 (11.5)<0.001Male, n (%)123 (26.2)115 (20.9)112 (14.9)38 (7.8)<0.001DcSSc, n (%)228 (56.4)262 (45.8)311 (45.4)163 (31.2)<0.001ATA, n (%)236 (53.4)293 (55.9)374 (52.8)218 (48.0)0.099mRSS, mean (SD)12.3(10.1)10.4 (8.3)9.4 (8.1)8.7 (7.7)<0.001GERD, n/N (%)273 (58.7)353 (64.4)482 (64.4)344 (71.2)0.001ESR, mean (SD)26.9(21.7)24.2 (19.5)26.2 (19.9)28.3 (21.2)0.022MMF, n/N (%)33 (16.6)43 (25.2)37 (20.4)14 (9.3)0.002MTX, n/N (%)19 (10)17 (10.1)19 (10.6)8 (5.2)0.296Any IS, n/N (%)81 (38.6)89 (47.1)82 (40.8)46 (28.7)0.006FVC % pred, mean (SD)86 (20.9)87 (21.6)86 (21.4)87 (22.8)0.770DLCO % pred, mean (SD)58 (19.3)59 (19.3)59 (19.9)58 (19.7)0.405NYHA class 3&4, n (%)84 (18.6)78 (14.6)125 (17.5)22.6 (7.0)0.090Figure 1.FVC decline >10% and composite FVC and DLCO decline in the first and second 12+/-3 months within the four subgroups segregated by disease durationConclusionIt was long believed that ILD burned out in late disease stages. In our analysis of ILD progression by four disease duration categories, we showed that ILD frequently progressed also in late disease stages. This has important implications for clinical practise, as SSc patients need to be regularly monitored for ILD progression independent of disease duration.Disclosure of InterestsAnna-Maria Hoffmann-Vold Speakers bureau: Actelion, Boehringer Ingelheim, Jansen, Lilly, Medscape, Merck Sharp & Dohme, Roche, Consultant of: Actelion, ARXX, Bayer, Boehringer Ingelheim, Jansen, Lilly, Medscape, Merck Sharp & Dohme, Roche, Grant/research support from: Boehringer Ingelheim, Cathrine Brunborg: None declared, Paolo Airò Speakers bureau: Bristol-Myers-Squibb, Boehringer Ingelheim, Consultant of: Bristol-Myers-Squibb, Grant/research support from: Bristol-Myers-Squibb, Roche, Jannsen, CSL Behring, Lidia P. Ananyeva Speakers bureau: Boehringer Ingelheim, Grant/research support from: Boehringer Ingelheim, László Czirják Speakers bureau: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Actelion (now GSK), MSD, Novartis, Pfizer, Roche, Lilly, Grant/research support from: Boehringer Ingelheim, Actelion (now GSK), MSD, Novartis, Pfizer, Serena Guiducci: None declared, Eric Hachulla Speakers bureau: GSK, Roche-Chugai, Johnson & Johnson, Boehringer Ingelheim, Consultant of: CSL Behring, GSK, Roche-Chugai, Johnson & Johnson, Boehringer Ingelheim, Grant/research support from: CSL Behring, Boehringer Ingelheim, GSK, Roche-Chugai, Sanofi Genzyme, Mengtao Li: None declared, Carina Mihai Speakers bureau: MEDtalks Switzerland, Mepha, Grant/research support from: Roche, Boehringer Ingelheim, Janssen, Gabriela Riemekasten Speakers bureau: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Petros Sfikakis Consultant of: Boehringer Ingelheim, Gabriele Valentini Consultant of: Boehringer Ingelheim, Grant/research support from: Sanofi/BMS, Otylia Kowal-Bielecka Speakers bureau: Boehringer Ingelheim, Novartis, Pfizer, Gilead Sciences, Janssen-Cilag, MEDAC, MSD, Abbvie, Sandoz, Consultant of: Boehringer Ingelheim, Health Care system Navigator, CSL Behring, MSD, Novartis, Grant/research support from: CSL Behring, Boehringer Ingelheim, Abbvie, Roche, MEDAC, Yannick Allanore Speakers bureau: Boehringer, Abbvie, Consultant of: Boehringer, Bayer, Astra-Zeneca, Prometheus, Sanofi, Genentech/Roche, Boehringer, Grant/research support from: Alpine Immunosciences, OSE Immunotherapeutics, Medsenic, Oliver Distler Speakers bureau: Bayer, Boehringer Ingelheim, Janssen, Medscape, Consultant of: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, 4P Science, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur, Grant/research support from: Kymera, Mitsubishi Tanabe, Boehringer Ingelheim
Collapse
|
7
|
Hoffmann-Vold AM, Brunborg C, Airò P, Ananyeva LP, Czirják L, Guiducci S, Hachulla E, Li M, Mihai C, Riemekasten G, Sfikakis P, Valentini G, Kowal-Bielecka O, Allanore Y, Distler O. OP0158 COHORT ENRICHMENT STRATEGIES FOR PROGRESSIVE INTERSTITIAL LUNG DISEASE IN SYSTEMIC SCLEROSIS FROM EUSTAR. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundEnrichment strategies from clinical trials for progressive systemic sclerosis-associated interstitial lung disease (SSc-ILD) have been partly successful but have not been tested in a real life cohort.ObjectivesAnalyse the efficacy, representativeness and feasibility of enrichment strategies in SSc-ILD patients from the EUSTAR cohort.MethodsWe applied the inclusion criteria of major recent SSc-ILD trials (focuSSced, SLS II and SENSCIS) in SSc-ILD patients and assessed progressive ILD, defined as absolute change in forced vital capacity (FVC) and as significant progression (FVC decline >10%) over time. Data were compared to all patients and patients not fulfilling any inclusion criteria.ResultsIn total, 2258 SSc-ILD patients were included, with 31.2% meeting SENSCIS, 5.8% SLS II, 1.6% focuSSced criteria and 1529 (67.7%) not meeting any criteria (Table 1). In the first 12+/-3 months, a slow FVC% decline of –0.1% was seen in the total, unselected cohort and in patients fulfilling SENSCIS criteria. Patients fulfilling criteria from focuSSced showed a strong FVC decline of –3.7%. Notably, patients enriched for SLS II criteria showed FVC improvement of +2.3% (Figure 1). Similarly, compared to the total unselected cohort, the number of significant progressive events was numerically higher in patients fulfilling focuSSced criteria, the same for SENSCIS criteria and even slightly lower for patients fulfilling the SLS2 criteria.Table 1.Demographics and baseline clinical characteristics of EUSTAR patientsNot fulfilling any criteria (n=1529)focuSSced (n=36)SLS II (n=132)SENSCIS (n=704)Age, years (SD)58.4 (2.9)51.5 (12.2)†51.2 (12.7) †54.2 (13.8) †Male, n (%)231 (15.1)7 (19)35 (27)**156 (21)*Disease duration, months (SD)156.3 (99.4)16.1 (13.9)†40.7 (25.2) †39.4 (23.9) †DcSSc, n (%)597 (43.8)36 (100) †85 (65) †35 (52) †ATA, n (%)735 (51.1)24 (67)*85 (69) †370 (56)mRSS, mean (SD)9.5 (8.3)21 (6.5)*13 (9.6)*11 (9.2)GERD, n (%)1002 (65.9)25 (69)92 (70)430 (62)ESR, mean (SD)27 (20.5)43.1 (23) †29.6 (19.6) †24.7 (20.7)MMF, n (%)75 (16.5)0 (0) †0 (0) †52 (22) †MTX, n (%)42 (9.2)0 (0) †2 (5)20 (9)FVC % predicted, mean (SD)85.7 (22.5)88 (13.6)*66 (9.1) †88 (19.8)DLCO% predicted, mean (SD)58.9 (21.5)61 (12.7)49(14.6)†59 (14.2)NYHA class, n (%)3261 (17.8)6 (19)28 (21)72 (10)*440 (2.7)0 (0)3 (2)4 (1)**P-value: 0.001–0.05; †P<0.001, between focuSSced, SENSCIS or SLS compared with not fulfilling any study criteria.In the second 12 months period, SENSCIS enriched patients had a further absolute FVC% decline as described for the total cohort. In contrast, patients fulfilling the focuSSced and SLS II inclusion criteria showed numerical improvement of lung function in the second period (Figure 1). There were no significant associations of enrichment criteria and ILD progression in the second period.Over the mean observation period of 2.3 years, patients not fulfilling any inclusion criteria showed the same FVC decline of –0.9 (12.1) as observed for the total cohort (–0.9% (12.6)). There were numerical differences in FVC changes in the enriched patient cohorts, varying from –2.8% FVC decline in patients fulfilling the focuSSced criteria to +3.4% FVC improvement with SLS II criteria.ConclusionApplication of enrichment criteria from previous clinical trials showed enrichment for progression with variable success but led to selected patient populations reducing feasibility of recruitment. These findings are important for future clinical trial design and interpretation of the results of published trials.AcknowledgementsWe thank all EUSTAR collaborators.Disclosure of InterestsAnna-Maria Hoffmann-Vold Speakers bureau: Actelion, Boehringer Ingelheim, Jansen, Lilly, Medscape, Merck Sharp & Dohme, Roche, Consultant of: Actelion, ARXX, Bayer, Boehringer Ingelheim, Jansen, Lilly, Medscape, Merck Sharp & Dohme, Roche, Grant/research support from: Boehringer Ingelheim, Cathrine Brunborg: None declared, Paolo Airò Speakers bureau: Bristol-Myers-Squibb, Boehringer Ingelheim, Consultant of: Bristol-Myers-Squibb, Grant/research support from: Bristol-Myers-Squibb, Roche, Jannsen, CSL Behring, Lidia P. Ananyeva Speakers bureau: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, László Czirják Speakers bureau: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Actelion (now GSK), MSD, Novartis, Pfizer, Roche, Lilly, Grant/research support from: Boehringer Ingelheim, Actelion (now GSK), MSD, Novartis, Pfizer, Serena Guiducci: None declared, Eric Hachulla Speakers bureau: GSK, Roche-Chugai, Johnson & Johnson, Boehringer Ingelheim, Consultant of: CSL Behring, GSK, Roche-Chugai, Johnson & Johnson, Boehringer Ingelheim, Grant/research support from: CSL Behring, Boehringer Ingelheim, GSK, Roche-Chugai, Sanofi Genzyme, Mengtao Li: None declared, Carina Mihai Speakers bureau: MEDtalks Switzerland, Mepha, Grant/research support from: Roche, Boehringer Ingelheim, Janssen, Gabriela Riemekasten Speakers bureau: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Petros Sfikakis Consultant of: Boehringer Ingelheim, Gabriele Valentini Consultant of: Boehringer Ingelheim, Sanofi, Grant/research support from: BMS, Otylia Kowal-Bielecka Speakers bureau: Boehringer Ingelheim, Novartis, Pfizer, Gilead Sciences, Janssen-Cilag, MEDAC, MSD, Abbvie, Sandoz, Consultant of: Boehringer Ingelheim, Health Care system Navigator, CSL Behring, MSD, Novartis, Grant/research support from: CSL Behring, Boehringer Ingelheim, Abbvie, Roche, MEDAC, Yannick Allanore Speakers bureau: Boehringer, Abbvie, Consultant of: Boehringer, Bayer, Astra-Zeneca, Prometheus, Sanofi, Genentech/Roche, Boehringer, Grant/research support from: Alpine Immunosciences, OSE Immunotherapeutics, Medsenic, Oliver Distler Speakers bureau: Bayer, Boehringer Ingelheim, Janssen, Medscape, Consultant of: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, 4P Science, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur, Grant/research support from: Kymera, Mitsubishi Tanabe, Boehringer Ingelheim
Collapse
|
8
|
Saketkoo LA, Escorpizo R, Varga J, Keen KJ, Fligelstone K, Birring SS, Alexanderson H, Pettersson H, Chaudhry HA, Poole JL, Regardt M, LeSage D, Sarver C, Lanario J, Renzoni E, Scholand MB, Lammi MR, Kowal-Bielecka O, Distler O, Frech T, Shapiro L, Varju C, Volkmann ER, Bernstein EJ, Drent M, Obi ON, Patterson KC, Russell AM. World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) Core Set Development for Interstitial Lung Disease. Front Pharmacol 2022; 13:979788. [PMID: 36313333 PMCID: PMC9615472 DOI: 10.3389/fphar.2022.979788] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/13/2022] [Indexed: 12/13/2022] Open
Abstract
Background: The World Health Organization (WHO) introduced the International Classification of Functioning, Disability, and Health (ICF) as a scientific method of disability data collection comprised of >1,200 categories describing the spectrum of impairment types (functional, symptoms-based and anatomical) under the bio-psycho-social model with consideration of environmental and personal factors (pf). ICF Core Sets and ICF Checklists are streamlined disease-specific resources for clinical use, service provision, and for use in health economics and health policy. ICF can disclose strengths and weaknesses across multiple patient-reported outcome measures (PROMs) and help consolidate best-fitting question-items from multiple PROMs. Interstitial lung diseases (ILDs), are generally progressive, with restrictive physiology sometimes occurring in the context of multi-organ autoimmunity/inflammatory conditions such as connective tissue diseases (CTDs). In spite of significant associated morbidity and potential disability, ILD has yet to be linked to the ICF. Methods: Each instrument and their question-items within the consensus-recommended core sets for clinical trials in ILD were deconstructed to single concept units, and then linked per updated ICF linkage rules. Inter-linker agreement was established. Three additional subsequently validated measures were also included. Results: One-hundred-eleven ICF categories were identified for ten PROMs and three traditional objective measures that were amenable to ICF linkage. The proportion of agreement ranged from 0.79 (95% CI: 0.62, 0.91) to 0.93 (0.76, 0.99) with the overall proportion of inter-linker agreement being very high 0.86 (0.82, 0.89) for the initial instruments, with 94-100% for the three additional PROMs. Thirty-four new 'Personal Factors' emerged to capture disease-specific qualities not elsewhere described in ICF, e.g. 'pf_embarrassed by cough' or 'pf_panic/afraid when can't get a breath'. Conclusion: This first known effort in ICF linkage of ILD has provided important revelations on the current utility of the ICF in lung disease. Results have indicated areas for meaningful assessment of ICF descriptors for lung impairment. The mapping across PROMs provides insight into possibilities of developing more streamline and precise instrumentation. Finally, familiarity with the ICF in ILD may enable clinicians to experience a smoother transition with the imminent harmonization of ICD and ICF, ICD-11.
Collapse
Affiliation(s)
- Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, United States
- University Medical Center—Comprehensive Pulmonary Hypertension Center & Interstitial Lung Disease Clinic Programs, New Orleans, LA, United States
- Tulane University School of Medicine, New Orleans, LA, United States
- Louisiana State University Health Sciences Center, Division of Pulmonary Medicine—New Orleans, New Orleans, LA, United States
- *Correspondence: Lesley Ann Saketkoo, ; Anne-Marie Russell,
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, The University of Vermont, Burlington, VT, United States
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Janos Varga
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Kevin John Keen
- Department of Mathematics and Statistics and Health Research Institute, University of Northern British Columbia, Prince George, BC, Canada
- Department of Medicine, University of British Columbia & Centre for Heart Lung Innovation, Providence Research, Vancouver, BC, Canada
| | - Kim Fligelstone
- Patient Research Partner Scleroderma & Raynaud Society, UK (SRUK) and Federation of European Scleroderma Associations, London, United Kingdom
- Royal Free Hospital Scleroderma Unit, London, United Kingdom
| | - Surinder S. Birring
- Division of Asthma, Allergy and Lung Biology, King’s College London, London, United Kingdom
| | - Helene Alexanderson
- Women’s Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicin, Division of Rheumatology, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Pettersson
- Women’s Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicin, Division of Rheumatology, Karolinska Institutet, Stockholm, Sweden
| | - Humza Ahmad Chaudhry
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, United States
- University Medical Center—Comprehensive Pulmonary Hypertension Center & Interstitial Lung Disease Clinic Programs, New Orleans, LA, United States
- Tulane University School of Medicine, New Orleans, LA, United States
| | - Janet L. Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, NM, United States
| | - Malin Regardt
- Women’s Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicin, Division of Rheumatology, Karolinska Institutet, Stockholm, Sweden
| | - Daphne LeSage
- Patient Research Partner, New Orleans, LA, United States
| | | | - Joseph Lanario
- Research Fellow in Respiratory Health—Exeter Respiratory Institute Royal Devon University Hospitals NHS Foundation Trust, Exeter, United Kingdom
| | - Elisabetta Renzoni
- Royal Brompton Hospital, National Heart and Lung Institute, London, United Kingdom
| | - Mary Beth Scholand
- Pulmonary Medicine, University of Utah, Salt Lake City, UT, United States
| | - Matthew R. Lammi
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, United States
- University Medical Center—Comprehensive Pulmonary Hypertension Center & Interstitial Lung Disease Clinic Programs, New Orleans, LA, United States
- Louisiana State University Health Sciences Center, Division of Pulmonary Medicine—New Orleans, New Orleans, LA, United States
| | | | - Oliver Distler
- Division of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Tracy Frech
- Division of Rheumatology Vanderbilt University School of Medicine, Nashville, TN, United States
- Pulmonary Medicine, University of Utah, Salt Lake City, UT, United States
| | - Lee Shapiro
- Division of Rheumatology, Albany Medical Center, Albany, NY, United States
- Steffens Scleroderma Foundation, Albany, NY, United States
| | - Cecilia Varju
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Pecs, Hungary
| | - Elizabeth R. Volkmann
- Department of Medicine, David Geffen School of Medicine, UCLA Scleroderma Program and UCLA CTD-ILD Program, Division of Rheumatology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Elana J. Bernstein
- Department of Medicine, Columbia University/New York-Presbyterian Scleroderma Program, Division of Rheumatology, Columbia University College of Physician2s and Surgeons, New York, NY, United States
| | - Marjolein Drent
- Department of Pulmonology, Interstitial Lung Diseases (ILD) Center of Excellence, St. Antonius Hospital, Nieuwegein, Netherlands
- Department of Pharmacology and Toxicology, Faculty of Health and Life Sciences, Maastricht University, Nieuwegein, Netherlands
| | - Ogugua Ndili Obi
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Karen C. Patterson
- Department of Clinical & Experimental Medicine, Brighton & Sussex Medical School, Falmer, United Kingdom
- Division Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Anne-Marie Russell
- Respiratory Institute to Exeter Respiratory Innovation Center, University of Exeter, Exeter, United Kingdom
- Respiratory Medicine, Royal Devon University Healthcare NHS Foundation Trust, London, United Kingdom
- *Correspondence: Lesley Ann Saketkoo, ; Anne-Marie Russell,
| | | |
Collapse
|
9
|
Becker MO, Dobrota R, Garaiman A, Debelak R, Fligelstone K, Tyrrell Kennedy A, Roennow A, Allanore Y, Carreira PE, Czirják L, Denton CP, Hesselstrand R, Sandqvist G, Kowal-Bielecka O, Bruni C, Matucci-Cerinic M, Mihai C, Gheorghiu AM, Mueller-Ladner U, Sexton J, Kvien TK, Heiberg T, Distler O. Development and validation of a patient-reported outcome measure for systemic sclerosis: the EULAR Systemic Sclerosis Impact of Disease (ScleroID) questionnaire. Ann Rheum Dis 2021; 81:507-515. [PMID: 34824049 DOI: 10.1136/annrheumdis-2021-220702] [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: 05/05/2021] [Accepted: 11/09/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Patient-reported outcome measures (PROMs) are important for clinical practice and research. Given the high unmet need, our aim was to develop a comprehensive PROM for systemic sclerosis (SSc), jointly with patient experts. METHODS This European Alliance of Associations for Rheumatology (EULAR)-endorsed project involved 11 European SSc centres. Relevant health dimensions were chosen and prioritised by patients. The resulting Systemic Sclerosis Impact of Disease (ScleroID) questionnaire was subsequently weighted and validated by Outcome Measures in Rheumatology criteria in an observational cohort study, cross-sectionally and longitudinally. As comparators, SSc-Health Assessment Questionnaire (HAQ), EuroQol Five Dimensional (EQ-5D), Short Form-36 (SF-36) were included. RESULTS Initially, 17 health dimensions were selected and prioritised. The top 10 health dimensions were selected for the ScleroID questionnaire. Importantly, Raynaud's phenomenon, impaired hand function, pain and fatigue had the highest patient-reported disease impact. The validation cohort study included 472 patients with a baseline visit, from which 109 had a test-retest reliability visit and 113 had a follow-up visit (85% female, 38% diffuse SSc, mean age 58 years, mean disease duration 9 years). The total ScleroID score showed strong Pearson correlation coefficients with comparators (SSc-HAQ, 0.73; Patient's global assessment, Visual Analogue Scale 0.77; HAQ-Disability Index, 0.62; SF-36 physical score, -0.62; each p<0.001). The internal consistency was strong: Cronbach's alpha was 0.87, similar to SSc-HAQ (0.88) and higher than EQ-5D (0.77). The ScleroID had excellent reliability and good sensitivity to change, superior to all comparators (intraclass correlation coefficient 0.84; standardised response mean 0.57). CONCLUSIONS We have developed and validated the EULAR ScleroID, which is a novel, brief, disease-specific, patient-derived, disease impact PROM, suitable for research and clinical use in SSc.
Collapse
Affiliation(s)
- Mike O Becker
- Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | - Rucsandra Dobrota
- Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | - Alexandru Garaiman
- Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | - Rudolf Debelak
- Department of Psychology, Psychological Methods, Evaluation and Statistics, University of Zurich, Zurich, Switzerland.,Department of Psychology, Psychological Methodology, University of Leipzig, Leipzig, Germany
| | | | - Ann Tyrrell Kennedy
- Federation of the European Scleroderma Associations (FESCA) aisbl, Tournai, Belgium
| | - Annelise Roennow
- Federation of European Scleroderma Associations (FESCA), Saint Maur, Belgium
| | - Yannick Allanore
- Department of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
| | - Patricia E Carreira
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - László Czirják
- Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary
| | - Christopher P Denton
- Centre for Rheumatology, University College London, Royal Free Campus, London, UK
| | | | | | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy.,IRCCS San Raffaele Hospital, Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), Milan, Italy
| | - Carina Mihai
- Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland.,Department of Internal Medicine and Rheumatology, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ana Maria Gheorghiu
- Department of Internal Medicine and Rheumatology, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Joseph Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Tore K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Turid Heiberg
- Regional Research Support, Oslo University Hospital, Oslo, Norway
| | - Oliver Distler
- Department of Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| |
Collapse
|
10
|
Saketkoo LA, Frech T, Varjú C, Domsic R, Farrell J, Gordon JK, Mihai C, Sandorfi N, Shapiro L, Poole J, Volkmann ER, Lammi M, McAnally K, Alexanderson H, Pettersson H, Hant F, Kuwana M, Shah AA, Smith V, Hsu V, Kowal-Bielecka O, Assassi S, Cutolo M, Kayser C, Shanmugam VK, Vonk MC, Fligelstone K, Baldwin N, Connolly K, Ronnow A, Toth B, Suave M, Farrington S, Bernstein EJ, Crofford LJ, Czirják L, Jensen K, Hinchclif M, Hudson M, Lammi MR, Mansour J, Morgan ND, Mendoza F, Nikpour M, Pauling J, Riemekasten G, Russell AM, Scholand MB, Seigart E, Rodriguez-Reyna TS, Hummers L, Walker U, Steen V. A comprehensive framework for navigating patient care in systemic sclerosis: A global response to the need for improving the practice of diagnostic and preventive strategies in SSc. Best Pract Res Clin Rheumatol 2021; 35:101707. [PMID: 34538573 PMCID: PMC8670736 DOI: 10.1016/j.berh.2021.101707] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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] [Indexed: 12/14/2022]
Abstract
Systemic sclerosis (SSc), the most lethal of rheumatologic conditions, is the cause of death in >50% of SSc cases, led by pulmonary fibrosis followed by pulmonary hypertension and then scleroderma renal crisis (SRC). Multiple other preventable and treatable SSc-related vascular, cardiac, gastrointestinal, nutritional and musculoskeletal complications can lead to disability and death. Vascular injury with subsequent inflammation transforming to irreversible fibrosis and permanent damage characterizes SSc. Organ involvement is often present early in the disease course of SSc, but requires careful history-taking and vigilance in screening to detect. Inflammation is potentially reversible provided that treatment intensity quells inflammation and other immune mechanisms. In any SSc phenotype, opportunities for early treatment are prone to be under-utilized, especially in slowly progressive phenotypes that, in contrast to severe progressive ILD, indolently accrue irreversible organ damage resulting in later-stage life-limiting complications such as pulmonary hypertension, cardiac involvement, and malnutrition. A single SSc patient visit often requires much more physician and staff time, organization, vigilance, and direct management for multiple organ systems compared to other rheumatic or pulmonary diseases. Efficiency and efficacy of comprehensive SSc care enlists trending of symptoms and bio-data. Financial sustainability of SSc care benefits from understanding insurance reimbursement and health system allocation policies for complex patients. Sharing care between recognised SSc centers and local cardiology/pulmonary/rheumatology/gastroenterology colleagues may prevent complications and poor outcomes, while providing support to local specialists. As scleroderma specialists, we offer a practical framework with tools to facilitate an optimal, comprehensive and sustainable approach to SSc care. Improved health outcomes in SSc relies upon recogntion, management and, to the extent possible, prevention of SSc and treatment-related complications.
Collapse
Affiliation(s)
- Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; Tulane University School of Medicine, New Orleans, USA; Louisiana State University School of Medicine, Section of Pulmonary Medicine, New Orleans, USA; University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, USA.
| | - Tracy Frech
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cecília Varjú
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Pécs, Hungary
| | | | - Jessica Farrell
- Albany College of Pharmacy and Health Sciences, Albany, NY, USA; Steffens Scleroderma Foundation, Albany, NY, USA
| | - Jessica K Gordon
- Department of Rheumatology at Hospital for Special Surgery, New York, NY, USA
| | - Carina Mihai
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Lee Shapiro
- Steffens Scleroderma Foundation, Albany, NY, USA; Division of Rheumatology, Albany Medical Center, Albany, NY, USA
| | - Janet Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, NM, USA
| | - Elizabeth R Volkmann
- University of California, David Geffen School of Medicine, UCLA Scleroderma Program and UCLA CTD-ILD Program, Division of Rheumatology, Department of Medicine, Los Angeles, CA, USA
| | | | - Kendra McAnally
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Centre, Phoenix, AZ, USA
| | - Helene Alexanderson
- Function Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Department of Medicin, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Pettersson
- Function Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Department of Medicin, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Faye Hant
- Division of Rheumatology, Medical University of South Caroline, SC, USA
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Ami A Shah
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, and Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Vivien Hsu
- Rutgers- RWJ Scleroderma Program, New Brunswick, NJ, USA
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Shervin Assassi
- Rheumatology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic San Martino Hospital, Genova, Italy
| | - Cristiane Kayser
- Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP) São Paulo, SP, Brazil
| | - Victoria K Shanmugam
- Department of Rheumatology, George Washington University, School of Medicine and Health Sciences, Washington, DC, USA
| | - Madelon C Vonk
- Department of the rheumatic diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kim Fligelstone
- Patient Research Partner, Scleroderma & Raynaud Society UK (SRUK), London, UK; Royal Free Hospital, London, UK
| | - Nancy Baldwin
- Patient Research Partner, Scleroderma Foundation, Chicago, IL, USA
| | | | - Anneliese Ronnow
- Federation of European Scleroderma Associations, Copenhagen, Denmark; Federation of European Scleroderma Associations, Budapest, Hungary; Federation of European Scleroderma Associations, London, UK
| | - Beata Toth
- Federation of European Scleroderma Associations, Copenhagen, Denmark; Federation of European Scleroderma Associations, Budapest, Hungary; Federation of European Scleroderma Associations, London, UK
| | | | - Sue Farrington
- Patient Research Partner, Scleroderma & Raynaud Society UK (SRUK), London, UK; Federation of European Scleroderma Associations, Copenhagen, Denmark; Federation of European Scleroderma Associations, Budapest, Hungary; Federation of European Scleroderma Associations, London, UK
| | - Elana J Bernstein
- Columbia University/New York-Presbyterian Scleroderma Program, Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | - László Czirják
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Pécs, Hungary
| | - Kelly Jensen
- Tulane University School of Medicine, New Orleans, USA; Oregon Health and Science University, Portland, OR, USA
| | - Monique Hinchclif
- Yale School of Medicine, Department of Internal Medicine, Section of Rheumatology, Allergy & Immunology, USA
| | - Marie Hudson
- Division of heumatology and Department of Medicine, Jewish General Hospital and McGill University, Montreal, QC, Canada
| | - Matthew R Lammi
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; Louisiana State University School of Medicine, Section of Pulmonary Medicine, New Orleans, USA; University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, USA
| | | | - Nadia D Morgan
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Fabian Mendoza
- Rheumatology Division, Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mandana Nikpour
- Jefferson Institute of Molecular Medicine and Scleroderma Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - John Pauling
- University of Melbourne, Melbourne at St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Gabriela Riemekasten
- Royal National Hospital for Rheumatic Diseases, Bath, UK; University of Lübeck, University Clinic of Schleswig-Holstein, Dept Rheumatology and Clinical Immunology, Lübeck, Germany
| | | | - Mary Beth Scholand
- University of Utah, Division of Pulmonary Medicine, Pulmonary Fibrosis Center, Salt Lake City, UT, USA
| | - Elise Seigart
- Department of Rheumatology and Clinical Immunology Charité - Universitätsmedizin Berlin and Berlin Institute of Health, Berlin, Germany
| | | | - Laura Hummers
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ulrich Walker
- Dept. of Rheumatology, Basel University Hospital, Basel, Switzerland
| | - Virginia Steen
- Division of Rheumatology, Department of Medicine, Georgetown University, Washington, DC, USA
| |
Collapse
|
11
|
Garaiman A, Steigmiller K, Gebhard C, Mihai C, Dobrota R, Matucci-Cerinic M, Henes J, De Vries-Bouwstra J, Smith V, Doria A, Allanore Y, Dagna L, Anic B, Montecucco C, Kowal-Bielecka O, Martin M, Tanaka Y, Hoffmann-Vold AM, Held U, Distler O, Becker MO. POS0877 THE EFFECT OF PLATELET INHIBITORS ON DIGITAL ULCERS IN SYSTEMIC SCLEROSIS - A DERIVATION AND VALIDATION EUSTAR STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Digital ulcers (DUs) affect half of the patients with systemic sclerosis (SSc) and can be complicated by gangrene and amputation. The direct involvement of platelets in the development of DUs has been suggested by in vitro studies, which encouraged physicians to consider platelet inhibitors as a therapeutic option in the management of DUs. However, until now, there is no clinical study to assess the efficacy of platelet inhibitors for DUs in SSc patients.Objectives:To demonstrate a possible relationship between treatment with platelet inhibitors and the occurrence of DUs at the next follow-up visit in patients with SSc.Methods:This study used prospectively collected data from the European Scleroderma Trials and Research group (EUSTAR) registry. Patients fulfilling the 2013 ACR/EULAR SSc classification criteria with complete longitudinal data on the presence of DUs and platelet inhibitors were included in the analysis. Multiple imputation using a random forest algorithm was implemented to handle missing values.The dataset was split into a derivation and validation cohort. To investigate the response for the binary dependent variable of DUs, a generalized linear mixed model (GLMM) was developed in the derivation cohort and validated using ROC analysis and Brier scores to address discrimination and calibration, respectively.Results:Of 3,463 patients (2,961 in the derivation cohort, 722 in the validation cohort), 453 had current DUs at the baseline and 245 were exposed to platelet inhibitors (table 1).Our GLMM revealed that the exposure to platelet inhibitors is associated with a reduced risk of DUs at the next follow up visit (OR = 0.33, 95% CI = [0.13 to 0.82]). Further factors associated with absence or presence of DUs at the next follow-up visit are shown in figure 1. This confirmed the previously identified risk factors for the presence of DUs, supporting the overall robustness and the validity of our model.The performance was evaluated by ROC curve analysis and showed an AUC = 97.97% (95% CI = [96.93% to 97.67%]) for the derivation cohort and AUC = 77.3% (95% CI = [74.01% to 81.39%]) for the validation cohort, respectively, showing an acceptable discrimination. The Brier score was 0.05 in the derivation cohort and 0.07 in the validation cohort, suggesting a good calibration of the model.Conclusion:Our model, with acceptable discrimination and good calibration, suggests a positive treatment effect of platelet inhibitors on DUs in clinical practice.Table 1.Baseline characteristics of patients before imputationCharacteristicsOverallDerivation setValidation setn3,4632,691772Age (median [IQR])56.00 [47.00, 66.00]56.00 [47.00, 65.00] 57.00 [48.00, 67.00]Disease duration (median [IQR]) 9.00 [4.00, 16.00] 9.00 [4.00, 16.00] 8.00 [4.00, 15.00]Disease subset = Limited cutaneous SSc (%) 1562 (65.2) 1164 (64.6) 398 (66.9)DUs (%): Current 453 (13.1) 378 (14.0) 75 (9.7)DUs (%): Never 1783 (51.5) 1326 (49.3) 457 (59.2)DUs (%): Previously 1227 (35.4) 987 (36.7) 240 (31.1)mRSS (median [IQR]) 5.00 [2.00, 11.00] 6.00 [2.00, 12.00] 4.00 [1.00, 11.00]Joint Contractures = Yes (%) 881 (26.8) 770 (29.4) 111 (16.5)LVEF (median [IQR])62.00 [60.00, 65.00]60.00 [60.00, 65.00] 65.00 [60.00, 67.00]Dyspnea NYHA III and IV (%)300 (9.5)214 (8.6)86 (12.7)Pulmonary hypertension = Yes (%) 244 (10.7) 200 (11.3) 44 (8.4)Lung fibrosis on HRCT = Yes (%) 685 (46.6) 600 (47.7) 85 (39.7)FVC % predicted (median [IQR])97.00 [82.00, 111.00]95.00 [81.00, 110.00]101.00 [85.00, 115.00]Serum creatinine mg/dl (median [IQR]) 0.70 [0.60, 0.90] 0.70 [0.60, 0.90] 0.70 [0.70, 0.90]Anti-Scl-70 positive = Yes (%) 1147 (33.1) 958 (35.6) 189 (24.5)CRP elevation = Yes (%) 639 (21.1) 490 (20.8) 149 (22.1)Platelet inhibitors therapy = Yes (%) 245 (7.1) 206 (7.7) 39 (5.1)Oral anti-coagulants therapy = Yes (%) 53 (1.5) 50 (1.9) 3 (0.4)Disclosure of Interests:None declared
Collapse
|
12
|
Cylwik B, Gruszewska E, Gindzienska-Sieskiewicz E, Kowal-Bielecka O, Chrostek L. Comparison of hyaluronic acid in patients with rheumatoid arthritis, systemic sclerosis and systemic lupus erythematosus. Biochem Med (Zagreb) 2021; 31:020701. [PMID: 33927551 PMCID: PMC8047789 DOI: 10.11613/bm.2021.020701] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 01/30/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction The aim of the present study was to determine and compare the concentration of hyaluronic acid (HA) in rheumatoid arthritis (RA), systemic sclerosis (SSc) and systemic lupus erythematosus (SLE), and its correlation with parameters of disease activity and duration. The hypothesis was that HA should be increased in rheumatic diseases. We also expected that HA could be a marker of disease activity and inflammation in some of these diseases. Materials and methods The study group comprised 149 patients with RA, SSc and SLE hospitalized in the Department of Rheumatology and Internal Diseases, Medical University of Bialystok (Bialystok, Poland) and 30 healthy controls. The concentrations of HA, C-reactive protein (CRP) and rheumatoid factor (RF) were measured using Architect ci8200; haemoglobin, platelets on Sysmex XS-800i; and erythrocyte sedimentation rate (ESR) on Sediplus S 2000 analysers. Statistical analysis was performed using Statistica 13.3 PL. Results Hyaluronic acid was increased in RA, SLE and SSc when compared to controls (P < 0.001, P = 0.011, and P = 0.015, respectively). There were no differences in HA between rheumatic diseases (P = 0.840). Hyaluronic acid positively correlated with SLE activity (P = 0.025). In RA, HA positively correlated with ESR (P = 0.028) and CRP (P = 0.009). However, HA was not found to correlate with the duration of rheumatic diseases. Conclusions Hyaluronic acid concentration undergoes changes in rheumatic diseases with no difference between RA, SLE and SSc. In RA, HA concentration can be a marker of inflammation, while in SLE patients an indicator of disease activity.
Collapse
Affiliation(s)
- Bogdan Cylwik
- Department of Pediatric Laboratory Diagnostics, Medical University of Bialystok, Bialystok, Poland
| | - Ewa Gruszewska
- Department of Biochemical Diagnostics, Medical University of Bialystok, Bialystok, Poland
| | | | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Diseases, Medical University of Bialystok, Bialystok, Poland
| | - Lech Chrostek
- Department of Biochemical Diagnostics, Medical University of Bialystok, Bialystok, Poland
| |
Collapse
|
13
|
Hoffmann-Vold AM, Allanore Y, Alves M, Brunborg C, Airó P, Ananieva LP, Czirják L, Guiducci S, Hachulla E, Li M, Mihai C, Riemekasten G, Sfikakis PP, Kowal-Bielecka O, Riccardi A, Distler O. Progressive interstitial lung disease in patients with systemic sclerosis-associated interstitial lung disease in the EUSTAR database. Ann Rheum Dis 2021; 80:219-227. [PMID: 32988845 PMCID: PMC7815627 DOI: 10.1136/annrheumdis-2020-217455] [Citation(s) in RCA: 137] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/24/2020] [Accepted: 08/18/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To identify overall disease course, progression patterns and risk factors predictive for progressive interstitial lung disease (ILD) in patients with systemic sclerosis-associated ILD (SSc-ILD), using data from the European Scleroderma Trials And Research (EUSTAR) database over long-term follow-up. METHODS Eligible patients with SSc-ILD were registered in the EUSTAR database and had measurements of forced vital capacity (FVC) at baseline and after 12±3 months. Long-term progressive ILD and progression patterns were assessed in patients with multiple FVC measurements. Potential predictors of ILD progression were analysed using multivariable mixed-effect models. RESULTS 826 patients with SSc-ILD were included. Over 12±3 months, 219 (27%) showed progressive ILD: either moderate (FVC decline 5% to 10%) or significant (FVC decline >10%). A total of 535 (65%) patients had multiple FVC measurements available over mean 5-year follow-up. In each 12-month period, 23% to 27% of SSc-ILD patients showed progressive ILD, but only a minority of patients showed progression in consecutive periods. Most patients with progressive ILD (58%) had a pattern of slow lung function decline, with more periods of stability/improvement than decline, whereas only 8% showed rapid, continuously declining FVC; 178 (33%) experienced no episode of FVC decline. The strongest predictive factors for FVC decline over 5 years were male sex, higher modified Rodnan skin score and reflux/dysphagia symptoms. CONCLUSION SSc-ILD shows a heterogeneous and variable disease course, and thus monitoring all patients closely is important. Novel treatment concepts, with treatment initiation before FVC decline occurs, should aim for prevention of progression to avoid irreversible organ damage.
Collapse
Affiliation(s)
| | - Yannick Allanore
- Department of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
| | - Margarida Alves
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Paolo Airó
- UO Reumatologia e Immunologia Clinica, Spedali Civili di Brescia, Brescia, Italy
| | - Lidia P Ananieva
- VA Nasonova Institute of Rheumatology, Moscow, Russian Federation
| | - László Czirják
- Department of Rheumatology and Immunology, Medical School, University of Pécs, Pécs, Hungary
| | - Serena Guiducci
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Firenze, Italy
| | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, Hôpital Claude Huriez, University of Lille, Lille, France
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital (West Campus), Beijing, China
| | - Carina Mihai
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Petros P Sfikakis
- Joint Rheumatology Programme, National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Antonella Riccardi
- Department of Precision Medicine, Section of Rheumatology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
14
|
Bielecki P, Gindzienska-Sieskiewicz E, Reszeć J, Piszczatowski B, Rogowski M, Kowal-Bielecka O, Kowal K, Sieskiewicz A. Expression of LIGHT/TNFSF14 and Its Receptors, HVEM and LTβR, Correlates with the Severity of Fibrosis in Lacrimal Sacs from Patients with Lacrimal Duct Obstruction. Ophthalmol Ther 2020; 10:63-74. [PMID: 33188486 PMCID: PMC7665092 DOI: 10.1007/s40123-020-00320-3] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/31/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Fibrosis is one of the factors contributing to the development of primary acquired lacrimal duct obstruction (LDO). LIGHT (homologous to lymphotoxins, exhibiting inducible expression and competing with herpes simplex virus glycoprotein D for herpes virus entry mediator [HVEM]), a receptor expressed by T lymphocytes, has recently emerged as a new regulator of connective tissue remodeling and fibrotic response. The purpose of this study was to evaluate the role of LIGHT in the pathogenesis of LDO through: (1) assessment of expression of LIGHT and its two receptors, HVEM and LTβR (lymphotoxin β receptor), and (2) investigation of potential relationships between expression of LIGHT and its receptors and clinical and histopathologic features. Methods Lacrimal sacs of 30 patients undergoing endoscopic dacryocystorhinostomy because of LDO were assessed intraoperatively and histopathologically with respect to inflammation and fibrosis. Expression of LIGHT, HVEM and LTβR was assessed by immunohistochemistry using specific antibodies and evaluated semiquantitatively using a four-grade scoring system. Results All investigated molecules, LIGHT/TNFSF14, HVEM and LTβR, were expressed in biopsies from all patients. The most prominent expression was seen within inflammatory infiltrates. Expression of LIGH, HVEM and LTβR correlated significantly with the intensity of fibrosis and duration of the disease. In multivariate analysis only LIGHT showed a significant relationship with fibrosis (β coefficient = 0.759, p = 0.02). There was no significant correlation between expression of any molecule and other demographic or clinical features. Conclusion We assume that LIGHT along with its receptors may be a factor contributing to fibrosis and synechiae formation in the lacrimal sac. This assumption needs to be proven in a future study in a group of patients who fail to improve after the first operation.
Collapse
Affiliation(s)
- Pawel Bielecki
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland
| | | | - Joanna Reszeć
- Department of Medical Pathomorphology, Medical University of Bialystok, Bialystok, Poland
| | | | - Marek Rogowski
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Krzysztof Kowal
- Department of Allergology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
- Department of Experimental Allergology and Immunology, Medical University of Bialystok, Bialystok, Poland
| | - Andrzej Sieskiewicz
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland.
| |
Collapse
|
15
|
Gruszewska E, Cylwik B, Gińdzieńska-Sieśkiewicz E, Kowal-Bielecka O, Mroczko B, Chrostek L. Diagnostic Power of Galectin-3 in Rheumatic Diseases. J Clin Med 2020; 9:jcm9103312. [PMID: 33076422 PMCID: PMC7602543 DOI: 10.3390/jcm9103312] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 09/12/2020] [Revised: 10/01/2020] [Accepted: 10/13/2020] [Indexed: 12/21/2022] Open
Abstract
Background: The purpose of our study was to assess the diagnostic power of galectin-3 and compare its between rheumatic diseases and with routinely used tests such as CRP and ESR. Methods: Eighty-two patients with rheumatoid arthritis (RA), 49 patients with systemic sclerosis (SSc), and 18 patients with systemic lupus erythematosus (SLE) were enrolled in this study. The control group comprised 30 healthy controls. Serum galectin-3 concentration was measured using immunochemical method. Results: The galectin-3 concentration were significantly elevated in the RA, SSc, and SLE in comparison to the controls (p = 0.000, p = 0.000, p < 0.001; respectively). However, there were no significant differences in the serum galectin-3 levels between rheumatic diseases (H = 0.395, p = 0.821). In RA and SSc patients, galectin-3 positively correlated with erythrocyte sedimentation rate (R = 0.332, p = 0.004; R = 0.384, p = 0.009; respectively). ROC analysis revealed that galectin-3 had an excellent diagnostic power in RA (AUC = 0.911) and SSc (AUC = 0.903) and very good for SLE (AUC = 0.859). Conclusion: We concluded that diagnostic power of serum galectin-3 is as great as CRP and ESR in rheumatic diseases and it can be a very good laboratory marker in RA and SSc patients and a useful tool in the diagnosis of SLE.
Collapse
Affiliation(s)
- Ewa Gruszewska
- Department of Biochemical Diagnostics, Medical University of Bialystok, Waszyngtona St. 15A, 15-269 Bialystok, Poland; (B.M.); (L.C.)
- Correspondence: ; Tel.: +48-85-831-85-87
| | - Bogdan Cylwik
- Department of Pediatric Laboratory Diagnostics, Medical University of Bialystok, Waszyngtona St. 17, 15-274 Bialystok, Poland;
| | - Ewa Gińdzieńska-Sieśkiewicz
- Department of Rheumatology and Internal Diseases, Medical University of Bialystok, Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland; (E.G.-S.); (O.K.-B.)
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Diseases, Medical University of Bialystok, Sklodowskiej-Curie 24A, 15-276 Bialystok, Poland; (E.G.-S.); (O.K.-B.)
| | - Barbara Mroczko
- Department of Biochemical Diagnostics, Medical University of Bialystok, Waszyngtona St. 15A, 15-269 Bialystok, Poland; (B.M.); (L.C.)
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, Waszyngtona St. 15A, 15-269 Bialystok, Poland
| | - Lech Chrostek
- Department of Biochemical Diagnostics, Medical University of Bialystok, Waszyngtona St. 15A, 15-269 Bialystok, Poland; (B.M.); (L.C.)
| |
Collapse
|
16
|
Chrostek L, Gindzieńska-Sieśkiewicz E, Gruszewska E, Kowal-Bielecka O, Cylwik B. Transferrin isoforms analysis by capillary electrophoresis in systemic lupus erythematosus and systemic sclerosis. Scand J Clin Lab Invest 2020; 80:567-570. [PMID: 32820969 DOI: 10.1080/00365513.2020.1804611] [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] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) are a diseases in which disturbances in plasma proteins glycosylation exist. The aim of the study was to compare the serum profile of transferrin isoforms between SLE and SSc. The study was carried out in 38 patients with SLE and 43 patients with SSc. Transferrin isoforms were analyzed by capillary electrophoresis method. Among the transferrin isoforms only the level of pentasialotransferrin in SLE patients was significantly higher than in SSc patients (p = .014). The median concentrations of trisialotransferrin and pentasialotransferrin were significantly lower in SLE patients (p < .001, p = .042; respectively) and SSc (p = .001, p < .001; respectively) than in the healthy subjects. In contrast, the level of tetrasialotransferrin manifested significant increase in comparison to the controls (p < .001 for all comparisons). The serum profile of transferrin isoforms alters in SLE and SSc but only level of pentasialotransferrin differs between SLE and SSc patients. We confirm that the serum profile of transferrin isoforms in SLE and SSc is unique to these diseases.
Collapse
Affiliation(s)
- Lech Chrostek
- Department of Biochemical Diagnostics, Medical University of Bialystok, Bialystok, Poland
| | | | - Ewa Gruszewska
- Department of Biochemical Diagnostics, Medical University of Bialystok, Bialystok, Poland
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Bogdan Cylwik
- Department of Pediatric Laboratory Diagnostics, Medical University of Bialystok, Bialystok, Poland
| |
Collapse
|
17
|
Łebkowska A, Krentowska A, Adamska A, Lipińska D, Piasecka B, Kowal-Bielecka O, Górska M, Semple RK, Kowalska I. Type B insulin resistance syndrome associated with connective tissue disease and psoriasis. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200027. [PMID: 32755965 PMCID: PMC7424346 DOI: 10.1530/edm-20-0027] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/13/2020] [Indexed: 12/21/2022] Open
Abstract
SUMMARY Type B insulin resistance syndrome (TBIR) is characterised by the rapid onset of severe insulin resistance due to circulating anti-insulin receptor antibodies (AIRAs). Widespread acanthosis nigricans is normally seen, and co-occurrence with other autoimmune diseases is common. We report a 27-year-old Caucasian man with psoriasis and connective tissue disease who presented with unexplained rapid weight loss, severe acanthosis nigricans, and hyperglycaemia punctuated by fasting hypoglycaemia. Severe insulin resistance was confirmed by hyperinsulinaemic euglycaemic clamping, and immunoprecipitation assay demonstrated AIRAs, confirming TBIR. Treatment with corticosteroids, metformin and hydroxychloroquine allowed withdrawal of insulin therapy, with stabilisation of glycaemia and diminished signs of insulin resistance; however, morning fasting hypoglycaemic episodes persisted. Over three years of follow-up, metabolic control remained satisfactory on a regimen of metformin, hydroxychloroquine and methotrexate; however, psoriatic arthritis developed. This case illustrates TBIR as a rare but severe form of acquired insulin resistance and describes an effective multidisciplinary approach to treatment. LEARNING POINTS We describe an unusual case of type B insulin resistance syndrome (TBIR) in association with mixed connective tissue disease and psoriasis. Clinical evidence of severe insulin resistance was corroborated by euglycaemic hyperinsulinaemic clamp, and anti-insulin receptor autoantibodies were confirmed by immunoprecipitation assay. Treatment with metformin, hydroxychloroquine and methotrexate ameliorated extreme insulin resistance.
Collapse
Affiliation(s)
- Agnieszka Łebkowska
- Department of Internal Medicine and Metabolic Diseases, Diabetology and Internal Medicine
| | - Anna Krentowska
- Department of Internal Medicine and Metabolic Diseases, Diabetology and Internal Medicine
| | | | - Danuta Lipińska
- Department of Endocrinology, Diabetology and Internal Medicine
| | - Beata Piasecka
- Department of Endocrinology, Diabetology and Internal Medicine
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Diseases, Medical University of Bialystok, Bialystok, Poland
| | - Maria Górska
- Department of Endocrinology, Diabetology and Internal Medicine
| | - Robert K Semple
- Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Irina Kowalska
- Department of Internal Medicine and Metabolic Diseases, Diabetology and Internal Medicine
| |
Collapse
|
18
|
Distler O, Highland K, Hoffmann-Vold AM, Kowal-Bielecka O, Walker U, Del Galdo F, Vonk M, Hummers L, Erhardt E, Quaresma M, Alves M, Smith V. SAT0313 CORRELATION BETWEEN PROGRESSION OF SKIN FIBROSIS AND PROGRESSION OF INTERSTITIAL LUNG DISEASE (ILD) IN PATIENTS WITH SSC-ILD: DATA FROM THE SENSCIS TRIAL. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:In the SENSCIS trial in patients with SSc-ILD, nintedanib reduced the rate of decline in FVC over 52 weeks vs placebo, with no difference between groups in change in mRSS.Objectives:Analyse correlation between progression of skin fibrosis and progression of SSc-ILD in the SENSCIS trial.Methods:Patients with SSc-ILD were randomised to receive nintedanib or placebo until the last patient reached week 52 but for ≤100 weeks. We calculated Spearman correlation coefficients between FVC (mL) at baseline and change from baseline in mRSS, mRSS at baseline and change from baseline in FVC (mL), and changes from baseline in mRSS and FVC at weeks 52 and 100 in all patients. We analysed the rate of decline in FVC (mL/year) in patients who did and did not have progression of skin fibrosis (relative change from baseline in mRSS >25% and absolute change from baseline >5 points) at week 52.Results:In the nintedanib (n=288) and placebo (n=288) groups, respectively, mean (SD) baseline FVC (mL) was 2459 (736) and 2541 (816) and mRSS was 11.3 (9.2) and 10.9 (8.8); 53.1% and 50.7% had dcSSc;18.4% and 16.0% had progression of mRSS at week 52. No meaningful correlations were observed in analyses between mRSS and FVC (Table). The mean (SE) annual rate of decline in FVC in the placebo group was similar in patients who did and did not have progression of mRSS (-95.2 [27.1] and -91.4 [15.7] mL/year, respectively). The effect of nintedanib vs placebo on reducing the rate of decline in FVC was numerically more pronounced in patients who did not have progression of mRSS vs those who did (difference [95% CI] 44.3 mL/year [0.6, 88.1] vs 24.6 [-53.7, 102.9]), but the interaction p-value (0.66) did not indicate heterogeneity in treatment effect between subgroups.Conclusion:In the SENSCIS trial, the proportion of patients who had progression of skin fibrosis over 52 weeks was low, without significant differences between placebo and nintedanib. No meaningful correlations were observed between skin fibrosis at baseline or progression of skin fibrosis and progression of SSc-ILD. The rate of decline in FVC was similar between patients who did and did not have progression of mRSS. These findings suggest that in the overall patient population in the SENSCIS trial, progression of skin fibrosis and progression of ILD were distinct manifestations of disease progression.Table:FVC at baseline and change from baseline in mRSSmRSS at baseline and change from baseline in FVCChanges from baseline in mRSS and FVCNCorrelation*NCorrelation*NCorrelation*Week 52Nintedanib2470.11 (-0.01, 0.23)241-0.08 (-0.20, 0.05)238-0.07 (-0.19, 0.06)Placebo2540.12 (-0.00, 0.24)257-0.15 (-0.27, -0.03)2520.03 (-0.09, 0.15)Week 100Nintedanib730.21 (-0.02, 0.42)73-0.06 (-0.29, 0.17)700.06 (-0.17, 0.30)Placebo660.28 (0.04, 0.49)730.04 (-0.19, 0.27)66-0.14 (-0.37, 0.10)*Spearman correlation coefficient (95% CI)Disclosure of Interests:Oliver Distler Grant/research support from: Grants/Research support from Actelion, Bayer, Boehringer Ingelheim, Competitive Drug Development International Ltd. and Mitsubishi Tanabe; he also holds the issued Patent on mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143)., Consultant of: Consultancy fees from Actelion, Acceleron Pharma, AnaMar, Bayer, Baecon Discovery, Blade Therapeutics, Boehringer, CSL Behring, Catenion, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Sanofi and UCB, Speakers bureau: Speaker fees from Actelion, Bayer, Boehringer Ingelheim, Medscape, Pfizer and Roche, Kristin Highland Grant/research support from: Boehringer Ingelheim - PI for SENSCIS and SENSCIS-ON trials (paid to my institution), Consultant of: Kristin Highland has acted as a consultant to Boehringer Ingelheim. She was a member of the SENSCIS trial Steering Committee (Boehringer Ingelheim), Speakers bureau: Kristin Highland reports speaker fees from Boehringer Ingelheim, Anna-Maria Hoffmann-Vold Grant/research support from: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Actelion, Bayer, GlaxoSmithKline, Speakers bureau: Boehringer Ingelheim, Actelion, Roche, Otylia Kowal-Bielecka Grant/research support from: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Inventiva, MSD, Novartis, Speakers bureau: Boehringer Ingelheim, Medac, Novartis, Roche, Sandoz, Ulrich Walker Grant/research support from: Ulrich Walker has received an unrestricted research grant from Abbvie, Consultant of: Ulrich Walker has act as a consultant for Abbvie, Actelion, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, MSD, Novartis, Pfizer, Phadia, Roche, Sandoz, Sanofi, and ThermoFisher, Paid instructor for: Abbvie, Novartis, and Roche, Speakers bureau: Abbvie, Actelion, Bristol-Myers Squibb, Celgene, MSD, Novartis, Pfizer, Phadia, Roche, Sandoz, and ThermoFisher, Francesco Del Galdo: None declared, Madelon Vonk Grant/research support from: Janssen and Ferrer, Consultant of: Boehringer Ingelheim, Janssen and GSK, Speakers bureau: Boehringer Ingelheim, BMS and Roche, Laura Hummers Grant/research support from: Boehringer Ingleheim, Corbus pharmaceuticals, CSL Behring, Cumberland Pharmaceuticals, and GlaxoSmithKline, Consultant of: Boehringer Ingleheim, Corbus pharmaceuticals, and CSL Behring, Elvira Erhardt Employee of: Employee of Boehringer Ingelheim, Manuel Quaresma Employee of: Employee of Boehringer Ingelheim, Margarida Alves Employee of: Employee of Boehringer Ingelheim, Vanessa Smith Grant/research support from: The affiliated company received grants from Research Foundation - Flanders (FWO), Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer Ingelheim Pharma GmbH & Co and Janssen-Cilag NV, Consultant of: Boehringer-Ingelheim Pharma GmbH & Co, Speakers bureau: Actelion Pharmaceuticals Ltd, Boehringer-Ingelheim Pharma GmbH & Co and UCB Biopharma Sprl
Collapse
|
19
|
Becker MO, Dobrota R, Fligelstone K, Roennow A, Allanore Y, Carreira P, Czirják L, Denton C, Hesselstrand R, Sandqvist G, Kowal-Bielecka O, Bruni C, Matucci Cerinic M, Mihai C, Gheorghiu AM, Müller-Ladner U, Sexton J, Heiberg T, Distler O. OP0251 THE EULAR SYSTEMIC SCLEROSIS IMPACT OF DISEASE (SCLEROID) SCORE – A NEW PATIENT-REPORTED OUTCOME MEASURE FOR PATIENTS WITH SYSTEMIC SCLEROSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Patient reported outcome measures (PROM) are important for clinical practice and research. Given the unmet need for a comprehensive PROM for systemic sclerosis (SSc), the ScleroID questionnaire was developed by a joint team of patients with SSc and medical experts. This is intended as a brief, specific, patient-derived, disease impact score for research and clinical use in SSc.Objectives:Here, we present the validation and final version of the ScleroID.Methods:This EULAR-endorsed project involves 9 European expert SSc centers. Patients fulfilling the ACR/EULAR 2013 criteria were prospectively included since 05/16 in a large observational cohort study. Patients completed the ScleroID and comparators SHAQ, EQ5D, SF36. They also weighted the 10 dimensions of the ScleroID by distributing 100 points according to the perceived impact on their health. The final score calculation is based on the ranking of the weights. The validation study included a reliability arm and a longitudinal arm, looking at sensitivity to change at follow-up.Results:Of the 472 patients included at baseline, 109 patients also had a reliability visit and 113 patients a follow-up visit. 84.5% of patients were female, 29.8% had diffuse SSc, mean age was 54.6 years, and mean disease duration 9.5 years. The highest weights were assigned by the patients to Raynaud`s phenomenon, fatigue, hand function and pain, confirming our previous results. The total ScleroID score showed good Spearman correlation coefficients with the comparators (SHAQ, 0.73; EQ5D -0.48; Patient’s global assessment, VAS 0.77; HAQ-DI 0.62; SF36 physical score -0.62; each p<0.001). The internal consistency was good: Crohnbach’s alpha 0.866, similar to SS-HAQ (0.88) and higher than EQ5D (0.77). The ScleroID had a very good reliability: intra-class correlation coefficient 0.839 (ranging 0.608 to 0.788 for the individual items), superior to all comparators. Twenty of 113 patients reported a change in their disease status at follow up. Sensitivity to change: the standardized response mean was 0.34 for the total ScleroID score and highest for lower GI (0.633) and life choices domains (0.521), superior to all other PROM. Figure 1 shows the final ScleroID.Figure 1.Conclusion:The EULAR ScleroID is a novel PROM designed for use in clinical practice and clinical trials to reflect the disease impact of SSc, showing good performance in the validation study. Importantly, Raynaud syndrome, impaired hand function, pain and fatigue were the main patient reported drivers of disease impact.Disclosure of Interests:Mike O. Becker: None declared, Rucsandra Dobrota: None declared, Kim Fligelstone: None declared, Annelise Roennow: None declared, Yannick Allanore Grant/research support from: BMS, Inventiva, Roche, Sanofi, Consultant of: Actelion, Bayer AG, BMS, BI, Patricia Carreira Grant/research support from: Actelion, Roche, MSD, Consultant of: GlaxoSmithKline, VivaCell Biotechnology, Emerald Health Pharmaceuticals, Boehringer Ingelheim, Roche, Speakers bureau: Actelion, GlaxoSmithKline, Roche, László Czirják Consultant of: Actelion, BI, Roche-Genentech, Lilly, Medac, Novartis, Pfizer, Bayer AG, Christopher Denton Grant/research support from: GlaxoSmithKline, CSL Behring, and Inventiva, Consultant of: Medscape, Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Corbus Pharmaceuticals, Acceleron, Curzion and Bayer, Roger Hesselstrand: None declared, Gunnel Sandqvist: None declared, Otylia Kowal-Bielecka Consultant of: Bayer, Boehringer Ingelheim, Inventiva, MSD, Medac, Novartis, Roche and Sandoz, Speakers bureau: Bayer, Boehringer Ingelheim, Inventiva, MSD, Medac, Novartis, Roche and Sandoz, Cosimo Bruni Speakers bureau: Actelion, Eli Lilly, Marco Matucci Cerinic: None declared, Carina Mihai: None declared, Ana Maria Gheorghiu: None declared, Ulf Müller-Ladner Speakers bureau: Biogen, Joe Sexton: None declared, Turid Heiberg: None declared, Oliver Distler Grant/research support from: Grants/Research support from Actelion, Bayer, Boehringer Ingelheim, Competitive Drug Development International Ltd. and Mitsubishi Tanabe; he also holds the issued Patent on mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143)., Consultant of: Consultancy fees from Actelion, Acceleron Pharma, AnaMar, Bayer, Baecon Discovery, Blade Therapeutics, Boehringer, CSL Behring, Catenion, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Sanofi and UCB, Speakers bureau: Speaker fees from Actelion, Bayer, Boehringer Ingelheim, Medscape, Pfizer and Roche
Collapse
|
20
|
Bütikofer L, Varisco PA, Distler O, Kowal-Bielecka O, Allanore Y, Riemekasten G, Villiger PM, Adler S. ACE inhibitors in SSc patients display a risk factor for scleroderma renal crisis-a EUSTAR analysis. Arthritis Res Ther 2020; 22:59. [PMID: 32209135 PMCID: PMC7093969 DOI: 10.1186/s13075-020-2141-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 09/17/2019] [Accepted: 03/05/2020] [Indexed: 11/22/2022] Open
Abstract
Objectives To investigate the effect of ACE inhibitors (ACEi) on the incidence of scleroderma renal crisis (SRC) when given prior to SRC in the prospectively collected cohort from the European Scleroderma Trial and Research Group (EUSTAR). Methods SSc patients without prior SRC and at least one follow-up visit were included and analyzed regarding SRC, arterial hypertension, and medication focusing on antihypertensive medication and glucocorticoids (GC). Results Out of 14,524 patients in the database, we identified 7648 patients with at least one follow-up. In 27,450 person-years (py), 102 patients developed SRC representing an incidence of 3.72 (3.06–4.51) per 1000 py. In a multivariable time-to-event analysis adjusted for age, sex, disease severity, and onset, 88 of 6521 patients developed SRC. The use of ACEi displayed an increased risk for the development of SRC with a hazard ratio (HR) of 2.55 (95% confidence interval (CI) 1.65–3.95). Adjusting for arterial hypertension resulted in a HR of 2.04 (95%CI 1.29–3.24). There was no evidence for an interaction of ACEi and arterial hypertension (HR 0.83, 95%CI 0.32–2.13, p = 0.69). Calcium channel blockers (CCB), angiotensin receptor blockers (ARB), endothelin receptor antagonists, and GC—mostly in daily dosages below 15 mg of prednisolone—did not influence the hazard for SRC. Conclusions ACEi in SSc patients with concomitant arterial hypertension display an independent risk factor for the development of SRC but are still first choice in SRC treatment. ARBs might be a safe alternative, yet the overall safety of alternative antihypertensive drugs in SSc patients needs to be further studied.
Collapse
Affiliation(s)
- Lukas Bütikofer
- CTU Bern and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | - O Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - O Kowal-Bielecka
- Medical University of Bialystok, Jana Kilińskiego 1, 15-089, Białystok, Poland
| | - Y Allanore
- Warsaw Medical University, Warsaw, Poland
| | | | - P M Villiger
- University Hospital Schleswig-Holstein, Lübeck, Germany.,Department of Rheumatology, Immunology and Allergology, University Hospital Bern, CH3010, Bern, Switzerland
| | - S Adler
- University Hospital Schleswig-Holstein, Lübeck, Germany. .,Department of Rheumatology, Immunology and Allergology, University Hospital Bern, CH3010, Bern, Switzerland. .,Department of Rheumatology, Helios Klinikum Erfurt, Erfurt, Germany.
| | | |
Collapse
|
21
|
Gindzienska-Sieskiewicz E, Distler O, Reszec J, Jordan S, Bielecki P, Sieskiewicz A, Sulik A, Lukasik M, Bielecki M, Kowal K, Kowal-Bielecka O. Increased expression of the TNF superfamily member LIGHT/TNFSF14 and its receptors (HVEM and LTßR) in patients with systemic sclerosis. Rheumatology (Oxford) 2020; 58:502-510. [PMID: 30508197 DOI: 10.1093/rheumatology/key348] [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: 03/27/2018] [Accepted: 10/18/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study aimed to assess the potential role of the TNF superfamily member lymphocyte T-related inducible ligand that competes for glycoprotein D binding to herpesvirus entry mediator on T cells (LIGHT) in SSc through evaluation of: skin expression of LIGHT and its receptors, herpesvirus entry mediator and lymphotoxin ß-related receptor, and serum concentration of LIGHT in SSc patients. METHODS Expression of LIGHT and its receptors was investigated by immunohistochemistry and evaluated semi-quantitatively in skin biopsies from 19 SSc patients and 9 healthy controls. Serum levels of LIGHT were measured using ELISA in 329 patients with SSc and 50 control subjects. RESULTS Expression of LIGHT and both receptors was higher in SSc patients compared with controls (P < 0.05 for all comparisons). Patients with early SSc (⩽ 3 years from the first non-Raynaud's phenomenon symptom) showed higher expression of LIGHT and herpesvirus entry mediator compared with patients with longer disease duration (P < 0.05 for both comparisons). The mean serum concentration of LIGHT was significantly higher in SSc patients compared with the controls (P < 0.05). High serum concentration of LIGHT was associated with male sex, presence of digital ulcers, muscle involvement (defined by elevated serum creatine kinase levels), steroid treatment and lack of ACA. However, in multivariate regression analysis only presence of digital ulcers and creatine kinase elevation were independently associated with serum concentration of LIGHT. CONCLUSION These data provide the first evidence of overexpression of LIGHT and its receptors in SSc and suggest that the LIGHT axis might contribute to the pathogenesis of SSc. Increased serum concentrations of LIGHT seem to reflect vascular injury in SSc.
Collapse
Affiliation(s)
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Joanna Reszec
- Department of Medical Pathomorphology, Medical University of Bialystok, Bialystok, Poland
| | - Suzana Jordan
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Pawel Bielecki
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland
| | - Andrzej Sieskiewicz
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland
| | - Agnieszka Sulik
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Malgorzata Lukasik
- Department of Medical Pathomorphology, Medical University of Bialystok, Bialystok, Poland
| | - Marek Bielecki
- Department of Orthopedics and Traumatology, Medical University of Bialystok, Bialystok, Poland
| | - Krzysztof Kowal
- Department of Allergology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland.,Department of Experimental Allergology and Immunology, Medical University of Bialystok, Bialystok, Poland
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| |
Collapse
|
22
|
Frantz C, Huscher D, Avouac J, Hachulla E, Balbir-Gurman A, Riemekasten G, Siegert E, Lazzaroni MG, Carreira PE, Vettori S, Zanatta E, Ullman S, Czirjàk L, Kowal-Bielecka O, Distler O, Matucci-Cerinic M, Allanore Y. Outcomes of limited cutaneous systemic sclerosis patients: Results on more than 12,000 patients from the EUSTAR database. Autoimmun Rev 2019; 19:102452. [PMID: 31838157 DOI: 10.1016/j.autrev.2019.102452] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 08/11/2019] [Accepted: 08/17/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Limited cutaneous systemic sclerosis (LcSSc) is the most common subset of SSc but it has been overlooked in the past years. At a time at which clinical trials focus on diffuse cutaneous SSc (DcSSc) we aimed at clarifying the outcomes of LcSSc and at evaluating whether potential drug positioned in DcSSc may also be used in LcSSc. METHODS The EUSTAR database was used to investigate skin, lung and peripheral vasculopathy outcomes in LcSSc. Worsening of skin fibrosis, ILD and peripheral vasculopathy were defined by an increase in modified Rodnan skin score (mRSS) > 3.5 points, a decrease of FVC > 10% in patients with ILD at baseline, and by the development of new digital ulcers (DU) in patients without DU at baseline. RESULTS 8013 LcSSc and 4786 DcSSc patients were included. In contrast to DcSSc, skin disease was remarkably stable in the majority of LcSSc patients with >80% having a change lower than ±4 units of mRSS at 12, 24 and 36 months follow-up. Conversely, FVC changes over time were very similar between LcSSc and DcSSc. Regarding DU, numbers of patients with new DU over time seemed to be almost similar between the two subsets. CONCLUSIONS LcSSc patients have a low mRSS at baseline with marginal changes with time. Conversely, SSc-ILD can be as progressive as in DcSSc supporting the inclusion of LcSSc patients in SSc-ILD trials and suggesting potential benefit of any anti-ILD drugs. Similarly, although slightly less common, DU should receive the same attention in the two subsets.
Collapse
Affiliation(s)
- Camelia Frantz
- Rheumatology A Department, Cochin Hospital, Paris Descartes University, Paris, France
| | - Dorte Huscher
- Institute for Biometry and Clinical Epidemiology, Berlin Institute of Health, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Jérôme Avouac
- Rheumatology A Department, Cochin Hospital, Paris Descartes University, Paris, France
| | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, Hôpital Claude Huriez, Lille University, Lille, France
| | | | | | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - Maria-Grazia Lazzaroni
- Rheumatology and Clinical Immunology, Department of Molecular and Tanslational Medicine, Spedali Civili and University of Brescia, Brescia, Italy
| | - Patricia E Carreira
- Servicio de Reumatologia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Serena Vettori
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Elisabetta Zanatta
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Susanne Ullman
- Department of Dermatology, University Hospital of Copenhagen, Hospital Bispebjerg, Copenhagen, Denmark
| | - Laszlo Czirjàk
- Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence and Division of Rheumatology AOUC, Florence, Italy
| | - Yannick Allanore
- Rheumatology A Department, Cochin Hospital, Paris Descartes University, Paris, France.
| | | |
Collapse
|
23
|
Cylwik B, Gruszewska E, Gindzienska-Sieskiewicz E, Kowal-Bielecka O, Chrostek L. Serum profile of transferrin isoforms in rheumatoid arthritis treated with biological drugs. Clin Biochem 2019; 74:31-35. [PMID: 31672652 DOI: 10.1016/j.clinbiochem.2019.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 02/26/2019] [Revised: 08/14/2019] [Accepted: 10/08/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND In the chronic inflammation process in the course of rheumatoid arthritis (RA), many alterations in the expression of plasma proteins, as well as their posttranslational modifications (including glycosylation) can occur. Taking into account the disturbances in protein glycosylation and the emerging new treatment regimens, the aim of this study was to assess the serum profile of transferrin isoforms in RA patients treated with biological drugs. METHODS The study included 20 patients (16 females and 4 males; mean age: 53.4 years; range: 24-67) with rheumatoid arthritis treated with rituximab. Serum samples were taken 3 times: before and 3 and 6 months during treatment. The isoforms of transferrin were separated by capillary electrophoresis (MINICAP electrophoretic system, Sebia, France) into five major fractions: asialo-, disialo-, trisialo-, tetrasialo- and pentasialotransferrin. The results were calculated as relative concentrations of each fraction. RESULTS The median trisialotransferrin relative concentrations after 3 and 6 months treatment (4.40% and 4.10%, respectively) were significantly higher (p = 0.013, p = 0.009, respectively) than before treatment (3.50%). The levels of serum pentasialotransferrin were also increased 3 and 6 months following treatment (16.5% and 17.7%, p = 0.005 and p = 0.006, respectively) as compared to those before therapy (14.5%), while tetrasialotransferrin concentrations were lower (80.3% and 78.4%, p = 0.009 and p = 0.008, respectively) than before treatment (81.5%). Trisialotransferrin relative concentration correlated with Hb (p = 0.019), whereas pentasialotransferrin with PLT (p = 0.036) after treatment. CONCLUSIONS This study indicates that treatment with rituximab of RA patients alters the serum profile of transferrin isoforms. Tri-, tetra- and pentasialotransferrin relative concentrations measurements can be a useful tool to monitor therapy.
Collapse
Affiliation(s)
- Bogdan Cylwik
- Department of Paediatric Laboratory Diagnostics, Medical University of Bialystok, Waszyngtona 17 Street, 15-274 Bialystok, Poland.
| | - Ewa Gruszewska
- Department of Biochemical Diagnostics, Medical University of Bialystok, Waszyngtona 15A Street, 15-269 Bialystok, Poland
| | - Ewa Gindzienska-Sieskiewicz
- Department of Rheumatology and Internal Diseases, Medical University of Bialystok, Sklodowska-Curie 24A Street, 15-276 Bialystok, Poland
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Diseases, Medical University of Bialystok, Sklodowska-Curie 24A Street, 15-276 Bialystok, Poland
| | - Lech Chrostek
- Department of Biochemical Diagnostics, Medical University of Bialystok, Waszyngtona 15A Street, 15-269 Bialystok, Poland
| |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Hoffmann-Vold AM, Distler O, Murray B, Kowal-Bielecka O, Khanna D, Allanore Y. Setting the international standard for longitudinal follow-up of patients with systemic sclerosis: a Delphi-based expert consensus on core clinical features. RMD Open 2019; 5:e000826. [PMID: 30997150 PMCID: PMC6446182 DOI: 10.1136/rmdopen-2018-000826] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 09/25/2018] [Revised: 11/28/2018] [Accepted: 12/17/2018] [Indexed: 12/12/2022] Open
Abstract
Background Systemic sclerosis (SSc) is a severe, progressive multiorgan disease but to date, there are no established standardised international guidelines for follow-up of patients with SSc. The goal of this project was to develop an expert consensus for annual systematic investigations in patients with SSc to enhance their standard-of-care. Material and methods The Delphi method was applied. All SSc experts from the European Scleroderma Trials and Research group network and the Scleroderma Clinical Trial Consortium were invited to participate. All experts were asked to answer questionnaires in five Delphi steps to determine the domains of interest and tools for each domain for an annual systematic assessment of patients with SSc. Each item was rated on a scale between 0% and 100% (not and very important), and parameters rated >80% by more than 75% of the experts were regarded as acceptable. Results In total, 157 experts worldwide participated with 71.3% experts seeing >50 patients with SSc annually. In the first round, 23 domains and 204 tools were suggested. After five Delphi steps, experts agreed on 10 domains including (1) Raynaud's phenomenon; (2) Digital ulcers; (3) Skin and mucosa; (4) Lung; (5); Heart; (6) GI domain, (7) Renal; (8) Musculoskeletal; (9) Laboratory and (10) Treatment. Overall, 55 tools were identified including clinical assessments, laboratory measurements and imaging or functional investigations. Conclusion Through five Delphi steps with world leading experts, a consensus was established on strongly suggested tools for a minimum annual systemic assessment of organ involvement in SSc. This work should enhance the standardisation and homogenisation of the practices.
Collapse
Affiliation(s)
| | - Oliver Distler
- Department of Rheumatology, University of Zurich, Zurich, Switzerland
| | - Baron Murray
- Rheumatology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Otylia Kowal-Bielecka
- Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Dinesh Khanna
- Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Yannick Allanore
- Rheumatology A Department, Universite Paris Descartes, Paris, France
- INSERM U1016, Immunology, Cochin Institute, Paris, France
| | | |
Collapse
|
26
|
Abstract
Systemic sclerosis (SSc) is a multisystem connective tissue disease, characterized by chronic inflammation and vascular changes that result in esophageal smooth muscle atrophy and fibrosis. Subsequent progressive loss of peristalsis in the distal esophagus and loss of lower esophageal sphincter function lead to problems with the protective barrier and exposure of sensitive tissues to the gastroduodenal contents, a disorder called reflux disease. Areas covered: Depending on the range, nature and symptoms of the disease, the term 'reflux disease' may refer to gastroesophageal reflux, laryngopharyngeal reflux, microaspiration into the airways and silent reflux. Despite the links between these visceral complications, this connection remains controversial. This is due to a lack of complete understanding, the asymptomatic nature of the disease and the limited diagnostic accuracy of tests, which can delay diagnosis. Such delays are problematic, given that the early detection of GERD in SSc patients, the timing of assessment, the treatment of the organs involved are critical aspects of patient prognosis and disease outcome. Expert commentary: This review summarizes the most recent knowledge about the pathophysiology, diagnosis and prospective treatment of GERD in SSc patients and highlights how innovative technologies applied through an integrative, interdisciplinary approach may soon lead to effective treatment strategies.
Collapse
Affiliation(s)
- Adam Chwiesko
- a Department of Gastroenterology and Internal Medicine , Medical University of Bialystok , Bialystok , Poland
| | - Otylia Kowal-Bielecka
- b Department of Rheumatology and Internal Medicine , Medical University of Bialystok , Bialystok , Poland
| | - Stanislaw Sierakowski
- b Department of Rheumatology and Internal Medicine , Medical University of Bialystok , Bialystok , Poland
| |
Collapse
|
27
|
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
| |
Collapse
|
28
|
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.
Collapse
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
| | | |
Collapse
|
29
|
Kowal-Bielecka O, Chwiesko-Minarowska S, Bernatowicz PL, Allanore Y, Radstake T, Matucci-Cerinic M, Broen J, Hesselstrand R, Krasowska D, Riemekasten G, Vonk M, Kowalczuk O, Bielecki M, Milewski R, Chyczewski L, Niklinski J, Kowal K. The arachidonate 5-lipoxygenase activating protein gene polymorphism is associated with the risk of scleroderma-related interstitial lung disease: a multicentre European Scleroderma Trials and Research group (EUSTAR) study. Rheumatology (Oxford) 2017; 56:844-852. [DOI: 10.1093/rheumatology/kew499] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Indexed: 01/02/2023] Open
|
30
|
Kowal-Bielecka O, Fransen J, Avouac J, Becker M, Kulak A, Allanore Y, Distler O, Clements P, Cutolo M, Czirjak L, Damjanov N, Del Galdo F, Denton CP, Distler JHW, Foeldvari I, Figelstone K, Frerix M, Furst DE, Guiducci S, Hunzelmann N, Khanna D, Matucci-Cerinic M, Herrick AL, van den Hoogen F, van Laar JM, Riemekasten G, Silver R, Smith V, Sulli A, Tarner I, Tyndall A, Welling J, Wigley F, Valentini G, Walker UA, Zulian F, Müller-Ladner U. Update of EULAR recommendations for the treatment of systemic sclerosis. Ann Rheum Dis 2016; 76:1327-1339. [PMID: 27941129 DOI: 10.1136/annrheumdis-2016-209909] [Citation(s) in RCA: 636] [Impact Index Per Article: 79.5] [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: 05/18/2016] [Revised: 08/22/2016] [Accepted: 10/09/2016] [Indexed: 12/16/2022]
Abstract
The aim was to update the 2009 European League against Rheumatism (EULAR) recommendations for the treatment of systemic sclerosis (SSc), with attention to new therapeutic questions. Update of the previous treatment recommendations was performed according to EULAR standard operating procedures. The task force consisted of 32 SSc clinical experts from Europe and the USA, 2 patients nominated by the pan-European patient association for SSc (Federation of European Scleroderma Associations (FESCA)), a clinical epidemiologist and 2 research fellows. All centres from the EULAR Scleroderma Trials and Research group were invited to submit and select clinical questions concerning SSc treatment using a Delphi approach. Accordingly, 46 clinical questions addressing 26 different interventions were selected for systematic literature review. The new recommendations were based on the available evidence and developed in a consensus meeting with clinical experts and patients. The procedure resulted in 16 recommendations being developed (instead of 14 in 2009) that address treatment of several SSc-related organ complications: Raynaud's phenomenon (RP), digital ulcers (DUs), pulmonary arterial hypertension (PAH), skin and lung disease, scleroderma renal crisis and gastrointestinal involvement. Compared with the 2009 recommendations, the 2016 recommendations include phosphodiesterase type 5 (PDE-5) inhibitors for the treatment of SSc-related RP and DUs, riociguat, new aspects for endothelin receptor antagonists, prostacyclin analogues and PDE-5 inhibitors for SSc-related PAH. New recommendations regarding the use of fluoxetine for SSc-related RP and haematopoietic stem cell transplantation for selected patients with rapidly progressive SSc were also added. In addition, several comments regarding other treatments addressed in clinical questions and suggestions for the SSc research agenda were formulated. These updated data-derived and consensus-derived recommendations will help rheumatologists to manage patients with SSc in an evidence-based way. These recommendations also give directions for future clinical research in SSc.
Collapse
Affiliation(s)
- Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Jaap Fransen
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jerome Avouac
- Rheumatology A Department, Cochin Hospital, Paris Descartes University, Paris, France
| | - Mike Becker
- University Hospital Charité, Berlin, Germany.,University Hospital Zurich, Zurich, Switzerland
| | - Agnieszka Kulak
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Yannick Allanore
- Rheumatology A Department, Cochin Hospital, Paris Descartes University, Paris, France
| | | | - Philip Clements
- University of California at Los Angeles, Los Angeles, California, USA
| | - Maurizio Cutolo
- Research Laboratories and Clinical Division of Rheumatology, Department of Internal Medicine, University of Genova, IRCCS AOU San Martino, Genova, Italy
| | - Laszlo Czirjak
- Department of Rheumatology and Immunology, Medical Center, University of Pecs, Pecs, Hungary
| | | | | | | | | | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescence Rheumatology, Hamburg, Germany
| | | | | | - Daniel E Furst
- University of California at Los Angeles, Los Angeles, California, USA
| | | | | | - Dinesh Khanna
- University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | | | - Ariane L Herrick
- University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester, UK
| | | | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Richard Silver
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vanessa Smith
- Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Alberto Sulli
- Research Laboratories and Clinical Division of Rheumatology, Department of Internal Medicine, University of Genova, IRCCS AOU San Martino, Genova, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Valentini G, Iudici M, Walker UA, Jaeger VK, Baron M, Carreira P, Czirják L, Denton CP, Distler O, Hachulla E, Herrick AL, Kowal-Bielecka O, Pope J, Müller-Ladner U, Riemekasten G, Avouac J, Frerix M, Jordan S, Minier T, Siegert E, Ong VH, Vettori S, Allanore Y. The European Scleroderma Trials and Research group (EUSTAR) task force for the development of revised activity criteria for systemic sclerosis: derivation and validation of a preliminarily revised EUSTAR activity index. Ann Rheum Dis 2016; 76:270-276. [PMID: 27621285 DOI: 10.1136/annrheumdis-2016-209768] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [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: 04/22/2016] [Revised: 07/13/2016] [Accepted: 08/21/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND Validity of European Scleroderma Study Group (EScSG) activity indexes currently used to assess disease activity in systemic sclerosis (SSc) has been criticised. METHODS Three investigators assigned an activity score on a 0-10 scale for 97 clinical charts. The median score served as gold standard. Two other investigators labelled the disease as inactive/moderately active or active/very active. Univariate-multivariate linear regression analyses were used to define variables predicting the 'gold standard', their weight and derive an activity index. The cut-off point of the index best separating active/very active from inactive/moderately active disease was identified by a receiver-operating curve analysis. The index was validated on a second set of 60 charts assessed by three different investigators on a 0-10 scale and defined as inactive/moderately active or active/very active by other two investigators. One hundred and twenty-three were investigated for changes over time in the index and their relationships with those in the summed Medsger severity score (MSS). RESULTS A weighted 10-point activity index was identified and validated: Δ-skin=1.5 (Δ=patient assessed worsening during the previous month), modified Rodnan skin score (mRss) >18=1.5, digital ulcers=1.5, tendon friction rubs=2.25, C-reactive protein >1 mg/dL=2.25 and diffusing capacity of the lung for CO (DLCO) % predicted <70%=1.0. A cut-off ≥2.5 was found to identify patients with active disease. Changes in the index paralleled those of MSS (p=0.0001). CONCLUSIONS A preliminarily revised SSc activity index has been developed and validated, providing a valuable tool for clinical practice and observational studies.
Collapse
Affiliation(s)
- Gabriele Valentini
- Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Michele Iudici
- Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Ulrich A Walker
- Department of Rheumatology, Basel University, Basel, Switzerland
| | | | - Murray Baron
- Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Patricia Carreira
- Department of Rheumatology, 12 de Octubre University Hospital, Madrid, Spain
| | - László Czirják
- Department of Rheumatology and Immunology, University of Pécs, Medical Centre, Pécs, Hungary
| | - Christopher P Denton
- Division of Medicine, Centre for Rheumatology and Connective Tissue Disease, Royal Free Campus, University College London, London, UK
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Eric Hachulla
- Internal Medicine Department, Claude Huriez Hospital, Lille University, Lille, France
| | - Ariane L Herrick
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Janet Pope
- Department of Medicine, St. Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Bad Neuheim, Germany
| | | | - Jerome Avouac
- Department of Rheumatology and Clinical Immunology, University Hospital Charité, Berlin, Germany
| | - Marc Frerix
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Bad Neuheim, Germany
| | - Suzana Jordan
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Tünde Minier
- Department of Rheumatology and Immunology, University of Pécs, Medical Centre, Pécs, Hungary
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, University Hospital Charité, Berlin, Germany
| | - Voon H Ong
- Division of Medicine, Centre for Rheumatology and Connective Tissue Disease, Royal Free Campus, University College London, London, UK
| | - Serena Vettori
- Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Yannick Allanore
- Rheumatology A Department, INSERM U1016 UMR8104, Cochin Hospital, Paris Descartes University, Paris, France
| |
Collapse
|
32
|
Dobrota R, Becker M, Fligelstone K, Fransen J, Kennedy A, Allanore Y, Carreira P, Czirijak L, Denton C, Hesselstrand R, Sandqvist G, Kowal-Bielecka O, Matucci-Cerinic M, Mihai C, Gheorghiu A, Müller-Ladner U, Frerix M, Heiberg T, Distler O. SAT0204 The Eular Systemic Sclerosis Impact of Disease (ScleroID) Score – A New Patient-Reported Outcome Measure for Patients with Systemic Sclerosis under Development. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
33
|
Dobrota R, Maurer B, Graf N, Kowal-Bielecka O, Matucci-Cerinic M, Airò P, Caramaschi P, Carreira P, Riemekasten G, Rosato E, Allanore Y, Distler O. SAT0244 Active Skin Disease at Baseline Does Not Predict Progression of Skin Fibrosis at One Year Follow Up – A Eustar Analysis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
34
|
Jeziernicka E, Bielecki P, Sacharzewska E, Niklinski J, Kowal K, Kowal-Bielecka O. SAT0003 The Role of 12/15-Lipoxygenase in The Pathogenesis of Osteoporosis in Mice. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
35
|
Dobrota R, Maurer B, Graf N, Jordan S, Mihai C, Kowal-Bielecka O, Allanore Y, Distler O. Prediction of improvement in skin fibrosis in diffuse cutaneous systemic sclerosis: a EUSTAR analysis. Ann Rheum Dis 2016; 75:1743-8. [PMID: 27016052 PMCID: PMC5036205 DOI: 10.1136/annrheumdis-2015-208024] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [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: 06/03/2015] [Accepted: 03/03/2016] [Indexed: 12/03/2022]
Abstract
Objectives Improvement of skin fibrosis is part of the natural course of diffuse cutaneous systemic sclerosis (dcSSc). Recognising those patients most likely to improve could help tailoring clinical management and cohort enrichment for clinical trials. In this study, we aimed to identify predictors for improvement of skin fibrosis in patients with dcSSc. Methods We performed a longitudinal analysis of the European Scleroderma Trials And Research (EUSTAR) registry including patients with dcSSc, fulfilling American College of Rheumatology criteria, baseline modified Rodnan skin score (mRSS) ≥7 and follow-up mRSS at 12±2 months. The primary outcome was skin improvement (decrease in mRSS of >5 points and ≥25%) at 1 year follow-up. A respective increase in mRSS was considered progression. Candidate predictors for skin improvement were selected by expert opinion and logistic regression with bootstrap validation was applied. Results From the 919 patients included, 218 (24%) improved and 95 (10%) progressed. Eleven candidate predictors for skin improvement were analysed. The final model identified high baseline mRSS and absence of tendon friction rubs as independent predictors of skin improvement. The baseline mRSS was the strongest predictor of skin improvement, independent of disease duration. An upper threshold between 18 and 25 performed best in enriching for progressors over regressors. Conclusions Patients with advanced skin fibrosis at baseline and absence of tendon friction rubs are more likely to regress in the next year than patients with milder skin fibrosis. These evidence-based data can be implemented in clinical trial design to minimise the inclusion of patients who would regress under standard of care.
Collapse
Affiliation(s)
- Rucsandra Dobrota
- Division of Rheumatology, University Hospital Zurich, Zurich, Switzerland Department of Internal Medicine and Rheumatology, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Britta Maurer
- Division of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Suzana Jordan
- Division of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Carina Mihai
- Department of Internal Medicine and Rheumatology, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Otylia Kowal-Bielecka
- Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Yannick Allanore
- Department of Rheumatology, University Paris Descartes and Cochin Hospital, Paris, France
| | - Oliver Distler
- Division of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | | |
Collapse
|
36
|
Sacharzewska E, Bielecki P, Bernatowicz P, Niklinski J, Kowal-Bielecka O, Kowal K. The role of 12/15-lipoxygenase in production of selected eicosanoids in allergic airway inflammation. Adv Med Sci 2016; 61:141-6. [PMID: 26686860 DOI: 10.1016/j.advms.2015.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the role of 12/15-lipoxygenase (LOX) in regulation of synthesis of selected eicosanoids in mice sensitized and challenged with Dermatophagoides pteronyssinus (Dp) allergen extract. MATERIALS AND METHODS Both C57Bl and 12/15-LOX knockout mice were sensitized by 2 intraperitoneal injections and subsequently challenged by inhalation with Dp allergen extract. Sham sensitized and challenged mice were used as controls. Samples of bronchoalveolar lavage (BAL) were used for assessment of prostaglandin E2 (PGE2), cysteinyl leukotreienes (cysLT), lipoxin A4 (LXA4) and 15-hydroxyeicosatetraenoic acid (15-HETE) concentration using ELISA method. Whole lung samples were used for isolation of RNA and evaluation of selected genes involved in eicosanoid metabolism, including cyclooxygenase-2 (COX-2), 12/15-LOX, 5-LOX and 5-LOX activated protein (FLAP). RESULTS Allergen-induced airway inflammation was associated with significant (9-fold, 95% CI 8.068-9.932-fold; p<0.05) up-regulation of 12/15-LOX in wild type but not in the 12/15-LOX knockout mice in which 12/15-LOX mRNA remained undetectable. Lack of 12/15-LOX was associated with significant attenuation of production of 15-HETE in response to allergen challenge. On the contrary, the greatest up-regulation of COX-2 after allergen exposure was demonstrated in the 12/15-LOX knockout mice (4.3-fold vs sham group) and was significantly greater than in the wild type counterparts (5.185-fold, 95% CI 4.723-6.309-fold; p<0.05 vs wild type mice). Also, allergen challenged 12/15-LOX knockout mice were characterized by greater production of PGE2 and cysLT. CONCLUSION The 12/15-LOX plays an important role in the metabolism of eicosanoids in response to allergen-induced airway inflammation.
Collapse
|
37
|
Kowal-Bielecka O, Fransen J, Avouac J, Becker M, Kulak A, Allanore Y, Distler O, Czirjak L, Denton C, Fligelstone K, Welling J, Mueller-Ladner U. OP0061 Update of Eular Recommendations for the Treatment of Systemic Sclerosis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4695] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
38
|
Dobrota R, Maurer B, Graf N, Mihai C, Kowal-Bielecka O, Allanore Y, Distler O. SAT0439 Prediction of Improvement in Skin Fibrosis in Diffuse Cutaneous Systemic Sclerosis – a Eustar Analysis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
39
|
Johnson S, Fransen J, Khanna D, van den Hoogen F, Baron M, Matucci-Cerinic M, Denton C, Medsger T, Carreira P, Riemekasten G, Distler J, Gabrielli A, Steen V, Chung L, Silver R, Varga J, Muller-Ladner U, Vonk M, Walker U, Wollheim F, Herrick A, Furst D, Czirjak L, Kowal-Bielecka O, DelGaldo F, Cutolo M, Hunzelmann N, Murray C, Foeldvari I, Mouthon L, Damjanov N, Kahaleh B, Frech T, Assassi S, Saketkoo L, Pope J. AB0727 There is a Need for New Systemic Sclerosis Subset Criteria. A Content Analytic Approach. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
40
|
Lammi MR, Baughman RP, Birring SS, Russell AM, Ryu JH, Scholand M, Distler O, LeSage D, Sarver C, Antoniou K, Highland KB, Kowal-Bielecka O, Lasky JA, Wells AU, Saketkoo LA. Outcome Measures for Clinical Trials in Interstitial Lung Diseases. Curr Respir Med Rev 2015; 11:163-174. [PMID: 27019654 PMCID: PMC4806861 DOI: 10.2174/1573398x11666150619183527] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The chronic fibrosing idiopathic interstitial pneumonias (IIPs) are a group of heterogeneous pulmonary parenchymal disorders described by radiologic and histological patterns termed usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP). These include idiopathic pulmonary fibrosis (IPF) and those related to connective tissue disease (CTD) and are associated with substantial morbidity and mortality. Beyond the importance of establishing an appropriate diagnosis, designing optimal clinical trials for IIPs has been fraught with difficulties in consistency of clinical endpoints making power analyses, and the establishment of efficacy and interpretation of results across trials challenging. Preliminary recommendations, developed by rigorous consensus methods, proposed a minimum set of outcome measures, a 'core set', to be incorporated into future clinical trials (Saketkoo et al, THORAX. 2014.). This paper sets out to examine the candidate instruments for each domain (Dyspnea, Cough, Health Related Quality of Life, Imaging, Lung Physiology and Function, Mortality). Candidate measures that were not selected as well as measures that were not available for examination at the time of the consensus process will also be discussed.
Collapse
Affiliation(s)
- Matthew R. Lammi
- Louisiana State University Health Sciences Center, New Orleans,
New Orleans, LA, USA
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research
Center; New Orleans, LA, USA
| | | | | | - Anne-Marie Russell
- Royal Brompton Hospital and National Heart and Lung Institute;
London, UK
| | - Jay H. Ryu
- Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Oliver Distler
- Division of Rheumatology, University Hospital Zurich,
Switzerland
| | - Daphne LeSage
- Patient Research Partner, Office of Public Health, New Orleans,
LA, USA
| | | | | | | | | | - Joseph A. Lasky
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research
Center; New Orleans, LA, USA
- Tulane University Lung Center; New Orleans, LA, USA
| | - Athol U. Wells
- Royal Brompton Hospital and National Heart and Lung Institute;
London, UK
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research
Center; New Orleans, LA, USA
- Tulane University Lung Center; New Orleans, LA, USA
| |
Collapse
|
41
|
Kowal-Bielecka O, Bielecki M, Guiducci S, Trzcinska-Butkiewicz B, Michalska-Jakubus M, Matucci-Cerinic M, Brzosko M, Krasowska D, Chyczewski L, Kowal K. High serum sCD163/sTWEAK ratio is associated with lower risk of digital ulcers but more severe skin disease in patients with systemic sclerosis. Arthritis Res Ther 2014; 15:R69. [PMID: 23800379 PMCID: PMC4060194 DOI: 10.1186/ar4246] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 02/21/2013] [Accepted: 06/24/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Systemic sclerosis (SSc) is an autoimmune disease characterized by chronic inflammation, vascular injury and excessive fibrosis. CD163 is a scavenger receptor which affects inflammatory response and may contribute to connective tissue remodelling. It has recently been demonstrated that CD163 can bind and neutralize the TNF-like weak inducer of apoptosis (TWEAK), a multifunctional cytokine which regulates inflammation, angiogenesis and tissue remodelling. We aimed to investigate the relationships between serum levels of soluble CD163 (sCD163) and soluble TWEAK (sTWEAK) in relation to disease manifestations in SSc patients. METHODS This study included 89 patients with SSc who had not received immunosuppressive drugs or steroids for at least 6 months and 48 age- and sex-matched healthy controls (HC) from four European centres. Serum concentrations of sTWEAK and sCD163 were measured using commercially available ELISA kits. RESULTS The mean serum concentrations of sTWEAK were comparable between SSc patients (mean +/- SD: 270 +/- 171 pg/mL) and HC (294 +/- 147pg/mL, P >0.05). Concentration of sCD163 and sCD163/sTWEAK ratio were significantly greater in SSc patients (984 +/- 420 ng/mL and 4837 +/- 3103, respectively) as compared to HC (823 +/- 331 ng/mL and 3115 +/- 1346 respectively, P <0.05 for both). High sCD163 levels and a high sCD163/sTWEAK ratio (defined as > mean +2SD of HC) were both associated with a lower risk of digital ulcers in SSc patients (OR, 95%CI: 0.09; 0.01, 0.71, and 0.17; 0.06, 0.51, respectively). Accordingly, patients without digital ulcers had a significantly higher sCD163 concentration and sCD163/sTWEAK ratio as compared to SSc patients with digital ulcers (P <0.01 for both) and HC (P <0.05 for both). A high sCD163/sTWEAK ratio, but not high sCD163 levels, was associated with greater skin involvement. CONCLUSIONS The results of our study indicate that CD163-TWEAK interactions might play a role in the pathogenesis of SSc and that CD163 may protect against the development of digital ulcers in SSc. Further studies are required to reveal whether targeting of the CD163-TWEAK pathway might be a potential strategy for treating vascular disease and/or skin fibrosis in SSc.
Collapse
|
42
|
Kowal-Bielecka O, Bielecki M, Trzcinska-Butkiewicz B, Michalska-Jakubus M, Brzosko M, Krasowska D, Kowal K. OP0090 Serum CD163/Tweak Ratio Predicts Clinical Course of Digital Ulcers in Patients with Systemic Sclerosis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
43
|
Jasiewicz M, Kowal K, Kowal-Bielecka O, Knapp M, Skiepko R, Bodzenta-Lukaszyk A, Sobkowicz B, Musial WJ, Kaminski KA. Serum levels of CD163 and TWEAK in patients with pulmonary arterial hypertension. Cytokine 2014; 66:40-5. [DOI: 10.1016/j.cyto.2013.12.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/12/2013] [Accepted: 12/24/2013] [Indexed: 01/27/2023]
|
44
|
van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Ellen Csuka M, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE. 2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative. Ann Rheum Dis 2013; 72:1747-55. [PMID: 24092682 DOI: 10.1136/annrheumdis-2013-204424] [Citation(s) in RCA: 1405] [Impact Index Per Article: 127.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The 1980 American College of Rheumatology (ACR) classification criteria for systemic sclerosis (SSc) lack sensitivity for early SSc and limited cutaneous SSc. The present work, by a joint committee of the ACR and the European League Against Rheumatism (EULAR), was undertaken for the purpose of developing new classification criteria for SSc. METHODS Using consensus methods, 23 candidate items were arranged in a multicriteria additive point system with a threshold to classify cases as SSc. The classification system was reduced by clustering items and simplifying weights. The system was tested by (1) determining specificity and sensitivity in SSc cases and controls with scleroderma-like disorders, and (2) validating against the combined view of a group of experts on a set of cases with or without SSc. RESULTS It was determined that skin thickening of the fingers extending proximal to the metacarpophalangeal joints is sufficient for the patient to be classified as having SSc; if that is not present, seven additive items apply, with varying weights for each: skin thickening of the fingers, fingertip lesions, telangiectasia, abnormal nailfold capillaries, interstitial lung disease or pulmonary arterial hypertension, Raynaud's phenomenon, and SSc-related autoantibodies. Sensitivity and specificity in the validation sample were, respectively, 0.91 and 0.92 for the new classification criteria and 0.75 and 0.72 for the 1980 ACR classification criteria. All selected cases were classified in accordance with consensus-based expert opinion. All cases classified as SSc according to the 1980 ACR criteria were classified as SSc with the new criteria, and several additional cases were now considered to be SSc. CONCLUSIONS The ACR/EULAR classification criteria for SSc performed better than the 1980 ACR criteria for SSc and should allow for more patients to be classified correctly as having the disease.
Collapse
Affiliation(s)
- Frank van den Hoogen
- St. Maartenskliniek and Radboud University Nijmegen Medical Centre, , Nijmegen, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Csuka ME, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. ACTA ACUST UNITED AC 2013; 65:2737-47. [PMID: 24122180 DOI: 10.1002/art.38098] [Citation(s) in RCA: 2001] [Impact Index Per Article: 181.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 07/16/2013] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The 1980 American College of Rheumatology (ACR) classification criteria for systemic sclerosis (SSc) lack sensitivity for early SSc and limited cutaneous SSc. The present work, by a joint committee of the ACR and the European League Against Rheumatism (EULAR), was undertaken for the purpose of developing new classification criteria for SSc. METHODS Using consensus methods, 23 candidate items were arranged in a multicriteria additive point system with a threshold to classify cases as SSc. The classification system was reduced by clustering items and simplifying weights. The system was tested by 1) determining specificity and sensitivity in SSc cases and controls with scleroderma-like disorders, and 2) validating against the combined view of a group of experts on a set of cases with or without SSc. RESULTS It was determined that skin thickening of the fingers extending proximal to the metacarpophalangeal joints is sufficient for the patient to be classified as having SSc; if that is not present, 7 additive items apply, with varying weights for each: skin thickening of the fingers, fingertip lesions, telangiectasia, abnormal nailfold capillaries, interstitial lung disease or pulmonary arterial hypertension, Raynaud's phenomenon, and SSc-related autoantibodies. Sensitivity and specificity in the validation sample were, respectively, 0.91 and 0.92 for the new classification criteria and 0.75 and 0.72 for the 1980 ACR classification criteria. All selected cases were classified in accordance with consensus-based expert opinion. All cases classified as SSc according to the 1980 ACR criteria were classified as SSc with the new criteria, and several additional cases were now considered to be SSc. CONCLUSION The ACR/EULAR classification criteria for SSc performed better than the 1980 ACR criteria for SSc and should allow for more patients to be classified correctly as having the disease.
Collapse
Affiliation(s)
- Frank van den Hoogen
- St. Maartenskliniek and Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Mihai C, Landewé R, van der Heijde D, Walker U, Constantin PI, Ionescu RM, Rednic S, Gherghe AM, Sfrent-Cornăteanu R, Allanore Y, Avouac J, Czirjak L, Farge-Bancel D, Damjanov N, Kowal-Bielecka O, van den Hoogen F, Tyndall A, Cutolo M, Müller-Ladner U, Matucci Cerinic M. FRI0393 Predictive value of history of digital ulcers in a eustar cohort of patients with systemic sclerosis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
47
|
Kowal-Bielecka O, Bielecki M, Michalska-Jakubus M, Krasowska D. SAT0212 Circulating Endothelial Microparticles Reflect Microvascular Impairment in Patients with Systemic Sclerosis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
48
|
Saketkoo L, Khanna D, Huscher D, Dellaripa P, Flaherty K, Matteson E, Oddis C, Wells A, Denton C, Distler O, Kowal-Bielecka O, Sandorfi N, Christmann R, Phillips K, Pittrow D, Strand V, Brown K, Seibold J. OP0001 Developing a disease activity and therapeutic response index in connective tissue disease - interstitial lung disease (CTD-ILD): Results from a delphi exercise: Consensus on domains. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
49
|
Lapinska A, Bielecki M, Distler O, Domyslawska I, Chyczewski L, Sierakowski S, Gay S, Kowal K, Kowal-Bielecka O. SAT0024 Increased production of leukotrienes by peripheral blood mononuclear cells is associated with more severe disease and worse prognosis in patients with systemic sclerosis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
50
|
Głowińska-Olszewska B, Bossowski A, Dobreńko E, Hryniewicz A, Konstantynowicz J, Milewski R, Łuczyński W, Piotrowska-Jastrzębska J, Kowal-Bielecka O. Subclinical cardiovascular system changes in obese patients with juvenile idiopathic arthritis. Mediators Inflamm 2013; 2013:436702. [PMID: 23554546 PMCID: PMC3608356 DOI: 10.1155/2013/436702] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 02/03/2013] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE We aimed to determine the prevalence of excess body mass in juvenile idiopathic arthritis (JIA) children and to investigate the influence of obesity into the early, subclinical changes in cardiovascular system in these patients. METHODS Fifty-eight JIA patients, aged median 13 years, were compared to 36 healthy controls. Traditional cardiovascular risk factors and inflammatory markers (hsCRP, IL-6, TNF α, adiponectin) were studied together with IMT (intima-media thickness), FMD (flow mediated dilation), and LVMi (left ventricle mass index) as surrogate markers of subclinical atherosclerosis. RESULTS Thirteen JIA children (22%) were obese and had increased systolic blood pressure, cholesterol, triglycerides, insulin, HOMA, hsCRP, and IL-6 compared to nonobese JIA and controls. FMD was decreased compared to nonobese JIA and controls, whereas IMT and LVMi were increased. In multivariate regression analysis, TNF α, SDS-BMI, and systolic blood pressure were independent predictors of early CV changes in JIA. CONCLUSIONS Coincident obesity is common in JIA children and is associated with insulin resistance, dyslipidemia, and increased levels of inflammatory markers leading to early changes in cardiovascular system. Thus, medical care of children with JIA should include strategies preventing cardiovascular disease by maintenance of adequate body weight.
Collapse
Affiliation(s)
- Barbara Głowińska-Olszewska
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Waszyngtona 17 Street, 15-274 Białystok, Poland.
| | | | | | | | | | | | | | | | | |
Collapse
|