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Lillpers K, Andréasson K, Mcguigan F, Åkesson K, Hesselstrand R. AB0714 Low bone mineral density and increased frequency of osteoporosis in patients with systemic sclerosis – A case-control study. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3947] [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
BackgroundSystemic sclerosis is an autoimmune disease characterized by fibrosis and vascular involvement. Osteoporosis, as a comorbidity among patients with systemic sclerosis is poorly described.ObjectivesThe aim of this cross sectional case-control study was to investigate bone mineral density and prevalence of osteoporosis in patients with systemic sclerosis compared to controls.MethodsWe included 211 patients, 182 females and 29 males, with systemic sclerosis and 506 controls, individually matched for age and sex and from the same catchment area in the very south of Sweden. All participants underwent dual-energy X-ray absorptiometry (DXA). Bone mineral density (BMD, g/cm2) and T-score were measured in lumbar spine L1-L4 and total hip. For patients, disease characteristics were obtained. Students T-test, one-way ANOVA or Chi-square test were used to compare groups and Pearson´s test for correlations. Osteoporosis (T-score ≤ -2.5) and osteopenia (T-score -1.0‒ -2.5) were defined using WHOs definitions.ResultsSystemic sclerosis patients had a mean (SD) age of 61.5 (13.5) and a mean (SD) disease duration from diagnosis of 9.2 (8.0) years. BMD (g/cm2) was significantly lower in patients compared to controls: Total hip (SD) 0.874 (0.147) vs 0.941 (0.145) (p=<0.0001); lumbar spine 1.089 (0.170) vs 1.126 (0.195) (p=0.015). Total hip mean T-score difference between groups was -0.52 (95 % CI -0.67‒ -0.34). The frequency of osteoporosis was 14.7% vs 9.7% and of osteopenia 51.2% vs 41.2% in patients compared with controls (p=0.001). Only one (3.4%) of the male patients had osteoporosis but nearly half of them had osteopenia. In patients, we evaluated vascular features. Those with telangiectasias had lower total hip BMD than those without (p=0.026). Among patients with early disease (<2 years), a higher total hip BMD was observed compared to patients with longer disease duration (p=0.001). The difference was not seen in spine BMD. Features of fibrosis were not associated with BMD, ie there were no difference in BMD between patients with diffuse or limited disease or antibody status.ConclusionPatients with systemic sclerosis have lower BMD and osteoporosis is more frequent than among controls matched for age and sex.Disclosure of InterestsNone declared
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Lindholm A, Kjellstrom B, Seemann F, Carlsson M, Hesselstrand R, Radegran G, Arheden H, Ostenfeld E. Atrioventricular plane displacement and regional contribution to stroke volume to predict outcome in pulmonary arterial hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Patients with pulmonary arterial hypertension (PAH) exhibit high mortality, partially related to right heart failure. Right ventricular (RV) volumes and ejection fraction (EF) can be measured accurately with cardiac magnetic resonance (CMR), but EF is a crude measure of cardiac function. Additional methods for risk assessment and prognosis are of value. Stroke volume (SV) is generated by longitudinal, lateral and septal myocardial contraction. Longitudinal contribution to SV (SVlong%) generated from the atrioventricular displacement (AVPD) is the major contributor to SV in both the left ventricle (LV) and RV. AVPD in both sides and LVSVlong% are lower in patients with PAH compared to controls. However, it is unknown if altered AVPD or regional contributions to SV are prognostic in patients with PAH. The aim of this study was therefore to evaluate if AVPD, longitudinal, lateral or septal contribution to LVSV and RVSV are associated with death or lung transplantation in patients with PAH.
Purpose
To evaluate if biventricular AVPD, and regional contributions to SV are associated with outcome in patients with PAH.
Methods
Seventy-one patients with PAH and 20 sex and age-matched healthy controls underwent CMR. Endocardial and epicardial borders and RV insertion points were defined in end diastole and end systole in cine short-axis stacks to compute biventricular volumes, SVlat% and SVsept%. Eight atrioventricular points were defined in end diastole and end systole in 2-, 3- and 4-chamber cine long-axis views, for computation of AVPD and SVlong%. Cut-off values for survival analysis were defined as above or below mean ± 2 standard deviations from the healthy controls. Outcome was defined as death or lung-transplantation.
Results
Median follow-up time was 3.6 [IQR 3.7] years. AVPD, SVlong%, SVlat% in both ventricles and SVsept% were altered in PAH compared to controls. Transplantation-free survival was lower with values below cut-off for LV-AVPD (hazard ratio (HR)=2.1, 95% CI: 1.2–3.9, p=0.02) and RV-AVPD (HR=9.8, 95% CI: 4.6–21.1, p=0.005) (fig 1). In cox regression analysis, decreased LV-AVPD and RV-AVPD inferred lower transplantation-free survival (LV: HR=1.16 per mm decrease, p=0.007; RV: HR=1.11 per mm decrease, p=0.01) (table 1). LVEF, RVEF, LV-SVlong%, RV-SVlong%, LV-SVlat%, RV-SVlat% or SVsept% did not affect outcome (table 1).
Conclusions
Decreased left and right AVDP were associated with decreased transplantation-free survival in patients with PAH. There were no associations between ejection fraction, longitudinal, lateral or septal contribution to stroke volume.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Skåne University Hospital, Region of Skåne Southern Healthcare Region of Sweden
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Affiliation(s)
| | | | - F Seemann
- Skane University Hospital, Lund, Sweden
| | | | | | | | - H Arheden
- Skane University Hospital, Lund, Sweden
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Mattsson M, Sandqvist G, Hesselstrand R, Olsson D, Kwakkenbos L, Nordin A, Boström C. Validity and reliability of the Swedish version of the Self-Efficacy for Managing Chronic Disease scale for individuals with systemic sclerosis. Scand J Rheumatol 2021; 51:110-119. [PMID: 34251963 DOI: 10.1080/03009742.2021.1917142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ObjectiveTo investigate aspects of validity and reliability of the Swedish version of the Self-Efficacy for Managing Chronic Disease (SEMCD-Swe) scale in systemic sclerosis (SSc).Method: A forward-backward translation procedure was used. Content validity was assessed through interviews with 11 people with SSc and 10 healthcare professionals. Construct validity, internal consistency, test-retest reliability, and floor and ceiling effects were evaluated in 104 SSc patients.Results: The content validity of the SEMCD-Swe was interpreted as satisfactory, but some adjustments were made to increase the understanding. Confirmatory factor analysis supported a single-factor structure. Moderate to strong correlations between the SEMCD-Swe and Scleroderma Health Assessment Questionnaire; Multidimensional Assessment of Fatigue; Patient Health Questionnaire-8 (rs = -0.4 to -0.7), and RAND-36 subscales (rs = 0.5 to 0.7) were found. Weak correlations were found between SEMCD-Swe and modified Rodnan skin score; and disease severity of peripheral vascular and lung (rs = -0.1 to -0.2) and kidney (rs = 0.1) systems (Medsger severity scale). Cronbach's alpha was sufficient (0.85) and corrected item-to-total correlations were good (≥ 0.50). The intraclass correlation coefficient for the total score was sufficient (0.82). No floor or ceiling effects were found.Conclusion: Support for construct validity was indicated, as the SEMCD-Swe in SSc show a single-factor structure and is more strongly associated with pain, fatigue, depressive symptoms, interferences with daily activities, disability, and quality of life than with disease severity. Our results also indicate support for content validity and reliability. However, the responsiveness of the SEMCD-Swe needs to be tested.
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Affiliation(s)
- M Mattsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Department of Physiotherapy, Sunderby Hospital, Luleå, Sweden
| | - G Sandqvist
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - R Hesselstrand
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Rheumatology, Skåne University Hospital, Lund, Sweden
| | - D Olsson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - L Kwakkenbos
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - A Nordin
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Unit of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - C Boström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Women's Health and Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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Hoffmann-Vold AM, Andréasson K, Hyll Hansen S, Midtvedt S, Fretheim H, Didriksen H, Garen T, Bækkevold E, Midtvedt Ø, Hesselstrand R, Chung BK, Molberg Ø. THU0348 ALTERED IMMUNE RECOGNITION OF SPECIFIC GUT BACTERIA BY IMMUNOGLOBULINS IN EARLY SYSTEMIC SCLEROSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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:Gastrointestinal tract (GIT) involvement is highly prevalent in systemic sclerosis (SSc) and associates with GIT symptoms that are present early and progress over time. Changes in gut microbiota are often reported in inflammatory disease settings but whether GIT symptoms associate with altered immune recognition of specific gut bacteria in early SSc is unknown.Objectives:Here, we profiled Ig coating patterns of gut bacteria in early disease from two well-characterized SSc cohorts to determine if the pattern and extent of bacterial immunoglobulin (Ig) coating differs in early SSc.Methods:We collected fecal material from early SSc patients (<36 months from time of diagnosis) at Oslo and Lund University Hospitals and from healthy age and gender matched controls (HC). To assess whether adaptive immunity was triggered against gut microbiota in early disease, we sorted and sequenced IgA, IgM and IgG coated bacteria from fecal samples by flow cytometry and performed 16s rRNA sequencing to compare the relative Ig coating of early SSc patients to HC. Data was resolved to the family level, rarefied to 5101 reads and converted to relative abundance. Taxonomic profiles, relative abundance, IgA, IgM and IgG coating patterns and extent of Ig coating were assessed. Unadjusted p-values <0.05 were defined as significant.Results:We included 50 SSc patients (26 from Oslo, 24 from Lund) with early SSc and 9 gender and age matched HC. Mean age of SSc patients at time of inclusion was 53 years, mean time since diagnosis was 13 months; 82% were female, 61% had limited cutaneous SSc and 43% were anti-centromere antibody positive. In all, 82% were treatment naïve while 18% had received either cyclophosphomide or mycophenolate mofetil immunosuppressants. We found increased relative abundance of IgA coated Desulfovibrionaceae in both SSc cohorts compared to HC and increased IgM and IgG coating of Veillonellaceae and Streptococcaceae (Figure 1). All of these bacteria have previously been associated with other autoimmune diseases or pro-inflammatory status; Desulfovibrionaceae to immune activation in the gut, and Veillonellaceae and Streptococcaceae to other chronic inflammatory and fibrotic conditions. While abundance of IgA coated Desulfovibrionaceae was higher in cyclophosphomide or mycophenolate mofetil-treated SSc patients than untreated patients, Veillonellaceae and Streptococcaceae were not affected by treatment. A lower abundance of IgA and IgM coated Akkermansiaceae; and IgM and IgG coated Bifidobacteriaceae was detected in treated compared to treatment naïve early SSc patients (Figure 2).Conclusion:We find the pattern and extent of Ig coating to inflammatory-associated gut bacteria differs between treatment-naïve, early SSc patients treated with cyclophosphomide or mycophenolate mofetil and HC which suggests immunosuppressive treatments may modify gut microbiota in SSc. Overall these findings support the involvement of altered immune recognition of specific gut bacteria in early SSc.Disclosure of Interests:Anna-Maria Hoffmann-Vold Grant/research support from: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Actelion, Bayer, GlaxoSmithKline, Speakers bureau: Boehringer Ingelheim, Actelion, Roche, Kristofer Andréasson: None declared, Simen Hyll Hansen: None declared, Simon Midtvedt: None declared, Håvard Fretheim: None declared, Henriette Didriksen Consultant of: Actelion, Torhild Garen: None declared, Espen Bækkevold: None declared, Øyvind Midtvedt: None declared, Roger Hesselstrand: None declared, Brian K Chung: None declared, Øyvind Molberg: None declared
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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
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Moinzadeh P, Frommolt P, Franitza M, Toliat MR, Becker K, Nürnberg P, Nihtyanova SI, Ahrazoglu M, Belz D, Hunzelmann N, Abraham D, Ong VH, Mouthon L, Hesselstrand R, Denton CP, Krieg T. Whole blood gene expression profiling distinguishes systemic sclerosis-overlap syndromes from other subsets. J Eur Acad Dermatol Venereol 2020; 34:e236-e238. [PMID: 31945216 DOI: 10.1111/jdv.16198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- P Moinzadeh
- Department of Dermatology and Venerology, University of Cologne, Cologne, Germany
| | - P Frommolt
- CECAD University of Cologne, Cologne, Germany
| | - M Franitza
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - M R Toliat
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - K Becker
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - P Nürnberg
- CECAD University of Cologne, Cologne, Germany
- Cologne Center for Genomics, University of Cologne, Cologne, Germany
| | - S I Nihtyanova
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School, Royal Free Hospital, London, UK
| | - M Ahrazoglu
- Department of Dermatology and Venerology, University of Cologne, Cologne, Germany
| | - D Belz
- Department of Dermatology and Venerology, University of Cologne, Cologne, Germany
| | - N Hunzelmann
- Department of Dermatology and Venerology, University of Cologne, Cologne, Germany
| | - D Abraham
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School, Royal Free Hospital, London, UK
| | - V H Ong
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School, Royal Free Hospital, London, UK
| | - L Mouthon
- National Reference Centre for Scleroderma and Systemic Vasculitis (LM, LG), Université Paris Descartes, Cochin Hospital, Paris, France
| | - R Hesselstrand
- Department of Rheumatology, Lund University, Lund, Sweden
| | - C P Denton
- Centre for Rheumatology and Connective Tissue Diseases, UCL Medical School, Royal Free Hospital, London, UK
| | - T Krieg
- Department of Dermatology and Venerology, University of Cologne, Cologne, Germany
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Hjalmarsson C, Radegran G, Kjellstrom B, Kylhammar D, Soderberg S, Bartfay SE, Hesselstrand R. P3680Baseline hemodynamics and its effect on survival in patients with idiopathic versus CTD-associated pulmonary arterial hypertension: data from the Swedish Pulmonary Arterial Hypertension Register. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients with CTD-APAH have a worse prognosis than those with IPAH, despite having lower pulmonary vascular resistance at diagnosis.
Purpose
To compare the effect of baseline hemodynamics on one-year survival in incident CTD-APAH patients and IPAH patients.
Methods
Patients with IPAH and CTD-APAH reported to the SPAHR between January 2008 and December 2018 were analyzed. Clinical data, hemodynamic parameters, lung transplantation, and survival were extracted from SPAHR. The relation between baseline hemodynamics and one-year survival was assessed by Cox proportional regression.
Results
There was no difference in age, WHO-FC, and 6MWD. IPAH patients had more often hypertension and diabetes; CTD-APAH patients had worse DLCO. No difference was found regarding kidney function, atrial fibrillation, stroke, and thyroid dysfunction. For details regarding hemodynamics, see Table 1.
One-year survival was similar in IPAH (84%) and CTD-APAH (82%, n.s.). After adjustment for age and gender, the only hemodynamic parameters that independently predicted survival were mRAP (CTD-APAH 1.06; 1.01–1.13, p=0.046 vs. IPAH 1.08; 1.01–1.15, p=0.048) and trans-pulmonary gradient, TPG (CTD-APAH 1.04; 1.01–1.07, p=0.008 vs. IPAH 1.02; 1.01–1.04, p=0.026).
Patient characteristics at diagnosis IPAH (n=311) CTD-APAH (n=204) p-value Age (years) 63±16 65±13 NS Female gender (%) 57 79 <0.001 WHO-FC III (%) 73 67 NS Hypertension (%) 50 38 0.014 Diabetes (%) 27 11 <0.001 6MWD (m) 288 (180–382) 260 (180–393) 0.474 DLCO (%) 45 (31–62) 38 (31–49) 0.002 Hemoglobin (g/L) 147 (134–158) 131 (121–144) <0.001 NTproBNP (ng/L) 1750 (758–4124) 1250 (351–3449) 0.003 mPAP (mmHg) 48 (41–55) 38 (31–45) <0.001 mRAP (mmHg) 8 (5–11) 6 (3–10) <0.001 PVR (WU) 9.4 (7.0–12.3) 6.8 (4.5–10.3) <0.001 CI (L/min/m2) 2.2 (1.8–2.6) 2.5 (2.0–3.0) <0.001 SvO2 (%) 60 (54–66) 64 (57–71) <0.001
Conclusion
Despite having better hemodynamic profile at baseline, CTD-APAH patients had similar one-year survival to IPAH patients; mRAP and TPG were independent predictors of survival in both groups.
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Affiliation(s)
- C Hjalmarsson
- Sahlgrenska Academy, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - G Radegran
- Skane University Hospital, Department of Clinical Sciences Lund, Cardiology, Lund, Sweden
| | - B Kjellstrom
- Karolinska Institute, Cardiology Unit, Department of Medicine, Stockholm, Sweden
| | - D Kylhammar
- Linkoping University, Clinical Physiology and Department of Medicine and Health Sciences, Linkoping, Sweden
| | - S Soderberg
- Umeå University, Epidemiology and Clinical Medicine, Medicine, Umeå, Sweden
| | - S E Bartfay
- Sahlgrenska Academy, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
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Nilsson AM, Tufvesson E, Hesselstrand R, Olsson P, Wollmer P, Mandl T. Increased B-cell activating factor, interleukin-6, and interleukin-8 in induced sputum from primary Sjögren's syndrome patients. Scand J Rheumatol 2018; 48:149-156. [PMID: 30270699 DOI: 10.1080/03009742.2018.1473488] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Small airway disease and chronic obstructive pulmonary disease are common in primary Sjögren's syndrome (pSS). However, the underlying inflammatory mechanisms behind pSS-associated airway disease have not been studied in detail. We therefore wanted to study cytokine and leucocyte levels in induced sputum in never-smoking patients with pSS. METHOD Induced sputum cytokines and leucocytes were assessed in 20 never-smoking patients with pSS and 19 age- and gender-matched population-based controls. In addition, pulmonary function, disease activity, respiratory symptoms, and inflammatory and serological features of pSS were assessed. RESULTS B-cell activating factor (BAFF), interleukin-6 (IL-6) and IL-8 were significantly increased in induced sputum in pSS patients compared to population-based controls, while IL-1β, interferon-α, and tumour necrosis factor-α levels and leucocytes were not. The proportion of lymphocytes and BAFF levels in induced sputum correlated significantly in pSS patients. However, cytokine levels in induced sputum were not associated with pulmonary function tests, disease activity, respiratory symptoms, or serological features of pSS. CONCLUSION The increase in BAFF, IL-6, and IL-8 in induced sputum suggests a specific ongoing inflammatory disease process in the airways in pSS patients. Its association with pSS-associated airway disease needs to be further examined in future larger studies.
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Affiliation(s)
- A M Nilsson
- a Department of Clinical Sciences Malmö, Section of Rheumatology , Lund University , Malmö , Sweden.,b Department of Rheumatology , Linköping University Hospital , Linköping , Sweden
| | - E Tufvesson
- c Department of Clinical Sciences, Section of Respiratory Medicine and Allergology , Lund University , Lund , Sweden
| | - R Hesselstrand
- d Department of Clinical Sciences, Section of Rheumatology , Lund University , Lund , Sweden
| | - P Olsson
- a Department of Clinical Sciences Malmö, Section of Rheumatology , Lund University , Malmö , Sweden
| | - P Wollmer
- e Department of Translational Medicine , Lund University , Malmö , Sweden
| | - T Mandl
- a Department of Clinical Sciences Malmö, Section of Rheumatology , Lund University , Malmö , Sweden
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Hjalmarsson C, Hesselstrand R, Rundqvist B, Radegran G, Kjellstrom B. 3015Impact of comorbidity on outcome in CTD-associated pulmonary arterial hypertension: data from the Swedish Pulmonary Arterial Hypertension Registry. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Hjalmarsson
- Sahlgrenska University Hospital, Department of Internal Medicine, Gothenburg, Sweden
| | | | - B Rundqvist
- Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden
| | - G Radegran
- Skane University Hospital, Cardiology, Lund, Sweden
| | - B Kjellstrom
- Karolinska Institute, Cardiology, Stockholm, Sweden
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Carreira PE, Carmona L, Joven BE, Loza E, Andréu JL, Riemekasten G, Vettori S, Balbir-Gurman A, Airò P, Walker U, Damjanov N, Matucci-Cerinic M, Ananieva LP, Rednic S, Czirják L, Distler O, Farge D, Hesselstrand R, Corrado A, Caramaschi P, Tikly M, Allanore Y. Differences associated with age at onset in early systemic sclerosis patients: a report from the EULAR Scleroderma Trials and Research Group (EUSTAR) database. Scand J Rheumatol 2018; 48:42-51. [DOI: 10.1080/03009742.2018.1459830] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- PE Carreira
- Rheumatology Department, University Hospital 12 de Octubre, Madrid, Spain
| | - L Carmona
- Musculoskeletal Health Institute, Madrid, Spain
| | - BE Joven
- Rheumatology Department, University Hospital 12 de Octubre, Madrid, Spain
| | - E Loza
- Musculoskeletal Health Institute, Madrid, Spain
| | - JL Andréu
- Rheumatology Department, University Hospital Puerta de Hierro, Madrid, Spain
| | - G Riemekasten
- Department of Rheumatology, University of Lübeck, Lübeck, Germany
| | - S Vettori
- Rheumatology Unit, Department of Internal Medicine Clinical and Experimental ‘F Magrassi-A-Lanzara’, Second University of Naples, Naples, Italy
| | - A Balbir-Gurman
- B Shine Rheumatology Unit, Rambam Health Care Campus and Rappaport Faculty of Medicine-Technion, Haifa, Israel
| | - P Airò
- Rheumatology and Clinical Immunology Unit, Civil Hospitali, Brescia, Italy
| | - U Walker
- Rheumatology Department, Felix Platter Hospital, Basel, Switzerland
| | - N Damjanov
- University of Belgrade School of Medicine, Belgrade, Serbia
| | - M Matucci-Cerinic
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - LP Ananieva
- Institute of Rheumatology, Russian Academy of Medical Science, Moscow, Russia
| | - S Rednic
- Rheumatology Clinic, University of Medicine and Pharmacy ‘Iuliu Hatieganu’ Cluj, Cluj-Napoca, Romania
| | - L Czirják
- Department of Immunology and Rheumatology, Faculty of Medicine, University of Pécs, Pécs, Hungary
| | - O Distler
- Division of Rheumatology, University Hospital Zürich, Zürich, Switzerland
| | - D Farge
- Department of Internal Medicine, Saint-Louis Hospital, Paris, France
| | - R Hesselstrand
- Department of Rheumatology, Lund University Hospital, Lund, Sweden
| | - A Corrado
- Rheumatology Unit, University of Foggia, ‘Col. D’Avanzo’ Hospital, Foggia, Italy
| | | | - M Tikly
- Rheumatology Unit, Department of Medicine, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Y Allanore
- Rheumatology A Department, Cochin Hospital, APHP, Paris Descartes University, Paris, France
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Kylhammar D, Hesselstrand R, Nielsen S, Scheele C, Rådegran G. Angiogenic and inflammatory biomarkers for screening and follow-up in patients with pulmonary arterial hypertension. Scand J Rheumatol 2018. [DOI: 10.1080/03009742.2017.1378714] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- D Kylhammar
- Department of Clinical Sciences Lund, Cardiology, Faculty of Medicine, Lund University, Lund, Sweden
- Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skåne University Hospital, Lund, Sweden
| | - R Hesselstrand
- Department of Clinical Sciences Lund, Rheumatology, Faculty of Medicine, Lund University, Lund, Sweden
- Section for Rheumatology, VO Gastroenterology, Nephrology and Rheumatology, Skåne University Hospital, Lund, Sweden
| | - S Nielsen
- Centre for Inflammation and Metabolism, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - C Scheele
- Centre for Inflammation and Metabolism, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - G Rådegran
- Department of Clinical Sciences Lund, Cardiology, Faculty of Medicine, Lund University, Lund, Sweden
- Section for Heart Failure and Valvular Disease, VO Heart and Lung Medicine, Skåne University Hospital, Lund, Sweden
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12
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Sandqvist G, Wollmer P, Scheja A, Wildt M, Hesselstrand R. Raynaud's phenomenon and its impact on activities in daily life during one year of follow-up in early systemic sclerosis. Scand J Rheumatol 2017; 47:206-209. [PMID: 28803485 DOI: 10.1080/03009742.2017.1350745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate Raynaud's phenomenon (RP) and its impact on daily life activities during 1 year of follow-up in early systemic sclerosis (SSc). METHOD Fourteen SSc patients with a median disease duration of 2 years were enrolled in the study. Every 7 weeks the patients completed a 7 day diary documenting the frequency and duration of RP attacks, the activity causing the attack, and how they handled the attack. The patients also recorded in the diary daily self-assessments of the difficulties with RP, using a 0-10 ordinal scale according to the Raynaud's Condition Score. RESULTS Ninety-eight RP weekly diaries were analysed. The median number of RP attacks varied between six and nine per week, and the median score reflecting the difficulty associated with the attacks varied between 2.0 and 2.9. No difference was found in the number of attacks or the difficulties associated with them between winter, spring, and autumn. Fewer attacks and less difficulty were reported in August than in any of the other documented weeks (p < 0.05). In all diaries, all patients reported RP attacks associated with domestic activities. The use of heating devices varied during the follow-up. In February, all patients except one used such devices, while about half of the group used devices during the rest of the year. CONCLUSIONS Difficulties resulting from RP are present and disabling all year round, which underscore the importance of intense vasoactive therapy and non-pharmacological strategies throughout the year.
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Affiliation(s)
- G Sandqvist
- a Department of Clinical Sciences Lund, Section of Rheumatology , Lund University, Skåne University Hospital , Lund , Sweden
| | - P Wollmer
- b Department of Translational Medicine , Lund University , Lund , Sweden
| | - A Scheja
- a Department of Clinical Sciences Lund, Section of Rheumatology , Lund University, Skåne University Hospital , Lund , Sweden
| | - M Wildt
- a Department of Clinical Sciences Lund, Section of Rheumatology , Lund University, Skåne University Hospital , Lund , Sweden
| | - R Hesselstrand
- a Department of Clinical Sciences Lund, Section of Rheumatology , Lund University, Skåne University Hospital , Lund , Sweden
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13
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Sjogren H, Lundqvist K, Gyllenhammar T, Steding-Ehrenborg K, Hesselstrand R, Radegran G, Arheden H, Ostenfeld E. P3528Left ventricular global longitudinal strain and filling is decreased with cardiac magnetic resonance in patients with pulmonary arterial hypertension. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H. Sjogren
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Lund, Sweden
| | - K. Lundqvist
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Lund, Sweden
| | - T. Gyllenhammar
- Lund University, Dept of Clinical Sciences Lund, Clinical Physiology, and Skane University Hospital, Lund, Sweden
| | - K. Steding-Ehrenborg
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, Lund, Sweden
| | - R. Hesselstrand
- Lund University, Dept of Clinical Sciences Lund, Rheumatolgy, and Skane University Hospital, Lund, Sweden
| | - G. Radegran
- Lund University, Dept of Clinical Sciences Lund, Cardiology, and Section for Heart Failure and Valvular Disease, Lund, Sweden
| | - H. Arheden
- Lund University, Dept of Clinical Sciences Lund, Clinical Physiology, and Skane University Hospital, Lund, Sweden
| | - E. Ostenfeld
- Lund University, Dept of Clinical Sciences Lund, Clinical Physiology, and Skane University Hospital, Lund, Sweden
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14
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Lindholm A, Seemann F, Hesselstrand R, Radegran G, Steding-Ehrenborg K, Arheden H, Heiberg E, Ostenfeld E. P3526Low right and left atrioventricular plane displacement is a predictor of worse survival in precapillary pulmonary hypertension. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- A. Lindholm
- Lund University, Dept of Clinical Sciences Lund, Clinical Physiology, Lund, Sweden
| | - F. Seemann
- Lund University, Dept of Clinical Sciences Lund, Clinical Physiology, Lund, Sweden
| | - R. Hesselstrand
- Lund University, Department of Clinical Sciences Lund, Rheumatology, and Skane University Hospital, Lund, Sweden
| | - G. Radegran
- Lund University, Dept of Clinical Sciences Lund, Cardiology, and Section for Heart Failure and Valvular Disease, Lund, Sweden
| | - K. Steding-Ehrenborg
- Lund University, Dept of Clinical Sciences Lund, Clinical Physiology, Lund, Sweden
| | - H. Arheden
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, and Skane University Hospital, Lund, Sweden
| | - E. Heiberg
- Lund University, Dept of Clinical Sciences Lund, Clinical Physiology, Lund, Sweden
| | - E. Ostenfeld
- Lund University, Department of Clinical Sciences Lund, Clinical Physiology, and Skane University Hospital, Lund, Sweden
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15
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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]
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16
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Dinsdale G, Moore T, O'Leary N, Manning J, Murray A, Berks M, Tresadern P, Allen J, Anderson M, Cutolo M, Hesselstrand R, Howell K, Pizzorni C, Pyrkotsch P, Smith V, Sulli A, Wildt M, Taylor C, Roberts C, Herrick A. FRI0530 Intra-and Inter-Observer Reliability of Nailfold Videocapillaroscopy – A Possible Outcome Measure for Systemic Sclerosis-Related Microangiopathy?: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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17
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Ndosi M, Alcacer-Pitarch B, Allanore Y, Del Galdo F, Frerix M, García Díaz S, Guidi F, Hesselstrand R, Kendall C, Matucci-Cerinic M, Müller-Ladner U, Sandqvist G, Torrente-Segarra V, Redmond A. OP0060-HPR Cross-Cultural Validation of The Systemic Sclerosis Quality of Life Questionnaire in Six European Countries: A Tool Validation Study: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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18
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Herrick A, Pan X, Peytrignet S, Hesselstrand R, Mouthon L, Brown E, Czirjak L, Distler J, Distler O, Fligelstone K, Gregory W, Ochiel R, Silman A, Vonk M, Lunt M, Denton C. FRI0261 Observational Study of Outcome in Patients with Early Diffuse Cutaneous Systemic Sclerosis Treated with Immunosuppressive Therapies (ESOS Study). Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2261] [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]
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Lazzaroni M, Cavazzana I, Colombo E, Distler O, Dobrota R, Hernandez J, Hesselstrand R, Czirjak L, Varju C, Nagy G, Smith V, Caramaschi P, Riccieri V, Hachulla E, Romanowska-Prochnicka K, Balbir-Gurman A, Chatelus E, Araùjo A, Allanore Y, Airò P. OP0031 Risk Factors for Malignancies Synchronous To The Onset of Systemic Sclerosis in Patients Positive for Anti- RNA Polymerase III Antibodies: A Eustar Multicentre Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rådegran G, Kjellström B, Ekmehag B, Hesselstrand R, Kornhall B, Larsen F, Nissel M, Rundkvist B, Ullman B, Wall K, Wikström G, Willehadson M, Jansson K, Söderberg S. Survival of the PAH and CTEPH Patients in the Swedish Pulmonary Arterial Hypertension Register 2000-2014. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.1040] [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: 10/22/2022] Open
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Wuttge DM, Andreasson A, Tufvesson E, Johansson ÅCM, Scheja A, Hellmark T, Hesselstrand R, Truedsson L. CD81 and CD48 show different expression on blood eosinophils in systemic sclerosis: new markers for disease and pulmonary inflammation? Scand J Rheumatol 2015; 45:107-13. [PMID: 26926492 DOI: 10.3109/03009742.2015.1054877] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES In systemic sclerosis (SSc)-related interstitial lung disease (ILD), elevated eosinophil counts in bronchoalveolar lavage are associated with a worse outcome. We hypothesized that eosinophils may be activated in the peripheral circulation, thereby increasing their recruitment to affected tissues and contributing to inflammation and fibrosis. The aim of this study was to characterize the blood eosinophils in SSc patients. METHOD Expression levels of surface markers CD11b, CD44, CD48, CD54, CD69, CD81, and HLA-DR on CD16(low)CD9(high)-expressing eosinophils were measured by flow cytometry in whole blood from SSc patients (n = 32) and controls (n = 11). RESULTS Expression levels of CD54, CD69, and HLA-DR were undetectable in all groups. CD44 and CD11b expression levels were similar between groups. CD81 expression was lower in patients compared to controls independent of disease duration (p = 0.001). CD48 expression was increased in patients with a short disease duration (< 2 years) compared to both controls (p = 0.042) and patients with longer disease duration (≥ 2 years; p = 0.027). In patients with short disease duration, increased CD48 expression was associated with alveolar inflammation as measured by an increased concentration of alveolar nitric oxide (r = 0.76, p = 0.003). CONCLUSIONS Blood eosinophils change phenotype during disease evolution in SSc, and CD48 expression may be used as a biomarker for pulmonary inflammation.
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Affiliation(s)
- D M Wuttge
- a Section of Rheumatology, Department of Clinical Sciences, Lund University and Skåne University Hospital , Lund , Sweden
| | - A Andreasson
- b Section of Microbiology, Immunology and Glycobiology, Department of Laboratory Medicine, Lund University and Skåne University Hospital , Lund , Sweden
| | - E Tufvesson
- c Section of Respiratory Medicine and Allergy, Department of Clinical Sciences, Lund University and Skåne University Hospital , Lund , Sweden
| | - Å C M Johansson
- b Section of Microbiology, Immunology and Glycobiology, Department of Laboratory Medicine, Lund University and Skåne University Hospital , Lund , Sweden
| | - A Scheja
- a Section of Rheumatology, Department of Clinical Sciences, Lund University and Skåne University Hospital , Lund , Sweden
| | - T Hellmark
- d Section of Nephrology, Department of Clinical Sciences, Lund, Lund University and Skåne University Hospital , Lund , Sweden
| | - R Hesselstrand
- a Section of Rheumatology, Department of Clinical Sciences, Lund University and Skåne University Hospital , Lund , Sweden
| | - L Truedsson
- b Section of Microbiology, Immunology and Glycobiology, Department of Laboratory Medicine, Lund University and Skåne University Hospital , Lund , Sweden
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Mattsson M, Boström C, Mihai C, Stöcker J, Geyh S, Stummvoll G, Gard G, Möller B, Hesselstrand R, Sandqvist G, Draghicescu O, Gherghe AM, Voicu M, Distler O, Smolen JS, Stamm TA. Personal factors in systemic sclerosis and their coverage by patient-reported outcome measures. A multicentre European qualitative study and literature review. Eur J Phys Rehabil Med 2015; 51:405-421. [PMID: 25573599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Systemic sclerosis (SSc) is an autoimmune disease where thickening of the skin can lead to reduced body function and limitations in activities. Severe forms can also affect and seriously damage inner organs. Patient-centred rehabilitation emphasises considerations of patients' background, experience and behavior which highlights the need to know if patient-reported outcome measures (PROMs) include such personal factors. AIM To identify and describe personal factors in the experiences of functioning and health of persons with SSc and to examine if and to what extent PROMs in SSc research cover these factors. DESIGN Data from a qualitative study with focus group interviews were analysed. PROMs in SSc research were identified in a literature review between 2008-2013. SETTING Participants were recruited from outpatient clinics at rheumatology department. POPULATION Sixty-three patients with SSc from four European countries participated. METHODS Data from interviews were analysed using a structure of personal factors developed by Geyh et al. Identified PROMs were analysed and linked to main concepts, related to the personal factors, found in the interview data. RESULTS Nineteen main concepts were related to the area "patterns of experience and behaviour" in the personal factor structure, 16 to "thoughts and beliefs", nine to "feelings", one to "motives" and one to "personal history and biography", respectively. Among the 35 PROMs identified, 15 did not cover any of the identified concepts. Concepts within the area "feelings" were mostly covered by the PROMs. Five of the PROMs covered "patterns of experience and behaviour", while "motives" and "personal history and biography" were not covered at all. Four of the identified PROMs covered concepts within the areas "feelings", "thoughts and beliefs" and "patterns of experience and behaviour" in the same instrument. The Illness Cognition Questionnaire and Illness Behaviour Questionnaire were such PROMs. CONCLUSION Patterns of experience and behaviour had the highest number of concepts related to personal factors, but few of the PROMs in SSc research covered these factors. Only a few PROMs covered several personal factors areas in the same instrument. CLINICAL REHABILITATION IMPACT The results would be of value when developing core sets for outcome measurements in SSc.
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Affiliation(s)
- M Mattsson
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden -
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Lazzaroni M, Colombo E, Cavazzana I, Distler O, Hesselstrand R, Smith V, Caramaschi P, Hachulla E, Balbir-Gurman A, Romanowska-Pròchnicka K, Riccieri V, Allanore Y, Airo' P. OP0055 Anti-RNA Polymerase III Antibodies in Patients with Systemic Sclerosis: A Eustar Multicenter Collaborative Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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24
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Sandqvist G, Hesselstrand R, Petersson I, Kristensen LE. FRI0467 Work Disability in Early Systemic Sclerosis: A Longitudinal Population-Based Cohort Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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25
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Hesselstrand R, Distler J, Riemekasten G, Törngren M, Nyhlén H, Stenström M, Andersson F, Eriksson H, Sparre B, Tuvesson H, Distler O. FRI0496 An Open-Label Study to Evaluate Biomarkers and Safety in Systemic Sclerosis (SSC) Patients Treated with Paquinimod (ABR-215757). Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4207] [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]
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26
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Hesselstrand R, Carlestam J, Andréasson K, Wildt M, Sandqvist G. AB0641 High Frequency Ultrasound of Skin Involvement in Systemic Sclerosis – A Follow-Up Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bartosik I, Andréasson K, Starck M, Scheja A, Hesselstrand R. Vascular events are risk factors for anal incontinence in systemic sclerosis: a study of morphology and functional properties measured by anal endosonography and manometry. Scand J Rheumatol 2014; 43:391-7. [PMID: 24720395 DOI: 10.3109/03009742.2014.889210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To study anal sphincter morphology, anal sphincter pressure, and rectoanal inhibitory reflex (RAIR) in patients with systemic sclerosis (SSc) complicated by anal incontinence (AI) and to investigate possible risk factors for AI in SSc. METHOD Nineteen SSc patients with severe AI were investigated using anal endosonography, anal manometry, and rectal manovolumetry. To determine risk factors for AI, disease characteristics of SSc patients with AI were compared with those of 95 SSc patients without AI; there were five matched SSc patients without AI for each SSc patient with AI. RESULTS The mean (SD) internal sphincter thickness was 1.3 (0.46) mm in patients with AI, which was thinner (p < 0.001) than reference data from healthy individuals whose internal sphincter measured 2.2 (0.45) mm, whereas the external sphincter thickness did not differ. The mean (SD) resting pressure in AI patients was lower than the reference data from healthy individuals [60 (22) vs. 94 (29) mmHg, p < 0.002] whereas the squeeze pressure did not differ. Centromeric antibodies and features of vascular disease [i.e. the presence of pulmonary arterial hypertension (PAH), digital ulcers, pitting scars, or the need for iloprost infusions] were associated with AI whereas fibrotic manifestations [i.e. modified Rodnan skin score (mRss), the diffuse cutaneous SSc (dcSSc) subset, or low vital capacity (VC)] were not. CONCLUSIONS SSc patients with AI have a thin internal anal sphincter and a low resting pressure. Risk factors for AI among SSc patients are centromeric antibodies and vascular disease, which supports the hypothesis that gastrointestinal involvement in SSc is in part a vascular manifestation of the disease.
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Affiliation(s)
- I Bartosik
- Department of Clinical Sciences, Section for Rheumatology, Lund University , Lund , Sweden
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Nilsson AM, Theander E, Hesselstrand R, Piitulainen E, Wollmer P, Mandl T. The forced oscillation technique is a sensitive method for detecting obstructive airway disease in patients with primary Sjögren’s syndrome. Scand J Rheumatol 2014; 43:324-8. [DOI: 10.3109/03009742.2013.856466] [Citation(s) in RCA: 7] [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: 11/13/2022]
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29
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Andréasson K, Saxne T, Bergknut C, Hesselstrand R, Englund M. Prevalence and incidence of systemic sclerosis in southern Sweden: population-based data with case ascertainment using the 1980 ARA criteria and the proposed ACR-EULAR classification criteria. Ann Rheum Dis 2013; 73:1788-92. [PMID: 23897770 DOI: 10.1136/annrheumdis-2013-203618] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To estimate the prevalence and incidence of systemic sclerosis (SSc) in southern Sweden. METHODS In Skåne, the southernmost region of Sweden (total population 1.2 million), healthcare provided is registered in the Skåne Healthcare Register. We identified all Skåne residents who had received an International Classification of Diseases 10 diagnosis of SSc (M34) or Raynaud's phenomenon (I73.0) between 1998 and 2010. Every single case was ascertained by review of medical records in reference to the 1980 American Rheumatism Association preliminary classification criteria for SSc and the proposed American College of Rheumatology (ACR)-European League Against Rheumatism (EULAR) classification criteria presented at the ACR/Association of Rheumatology Health Professionals Annual Meeting 2012. We calculated the point prevalence by the end of 2010 by linkage with the population register to exclude deceased persons and we also estimated the mean annual cumulative incidence for 2006-2010. RESULTS Using the 1980 ARA criteria, the adult prevalence and annual incidence of SSc in the Skåne region were 235 and 14 per 1 million inhabitants respectively. Applying the proposed ACR-EULAR criteria, the corresponding figures were 305 and 19 per 1 million inhabitants. A majority (82%) of the prevalent cases had the limited cutaneous SSc subtype. CONCLUSIONS The prevalence and incidence of SSc in southern Sweden, based on the 1980 ARA criteria, are higher than previously reported in northern Europe and do not support the concept of a north-south gradient of SSc occurrence in Europe. Application of the proposed ACR-EULAR classification criteria in this population results in about 30-40% higher estimates of SSc prevalence and incidence compared to the 1980 ARA criteria.
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Affiliation(s)
- K Andréasson
- Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden
| | - T Saxne
- Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden
| | - C Bergknut
- Epi-centre Skåne, Skåne University Hospital, Lund, Sweden Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - R Hesselstrand
- Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden
| | - M Englund
- Epi-centre Skåne, Skåne University Hospital, Lund, Sweden Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden Clinical Epidemiology Research and Training Unit, Boston University, Boston, Massachusetts, USA
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Ghrenassia E, Avouac J, Derk C, Airo P, Khanna D, Berezne A, Tiev K, Ingegnoli F, Rosato E, Caramaschi P, Hesselstrand R, Riccieri V, Bae S, Steen V, Allanore Y. FRI0242 Watermelon stomach in systemic sclerosis: A EUSTAR case-control study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hesselstrand R, Nilsson JÅ, Sandqvist G. Psychometric properties of the Swedish version of the Scleroderma Health Assessment Questionnaire and the Cochin Hand Function Scale in patients with systemic sclerosis. Scand J Rheumatol 2013; 42:317-24. [DOI: 10.3109/03009742.2012.756928] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wuttge DM, Lood C, Tufvesson E, Scheja A, Truedsson L, Bengtsson AA, Hesselstrand R. Increased serum type I interferon activity in early systemic sclerosis patients is associated with antibodies against Sjögren's syndrome antigens and nuclear ribonucleoprotein antigens. Scand J Rheumatol 2013; 42:235-40. [PMID: 23379597 DOI: 10.3109/03009742.2012.736532] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To study serum type I interferon (IFN) activity in patients with early systemic sclerosis (SSc). METHOD Serum type I IFN activity was measured in 33 consecutive patients with SSc and a disease duration of < 2 years and in 13 healthy individuals by calculating a type I IFN score according to the induction of six IFN-α regulated genes in a reporter cell line. RESULTS Twenty-seven per cent of the SSc patients had an increased type I IFN score compared to none of the healthy individuals (p < 0.05). The clinical SSc phenotype associated with high serum type I IFN activity did not differ from patients with low serum type I IFN activity regarding the presence of skin or lung fibrosis, pulmonary hypertension, or digital complications. Patients with high serum type I IFN activity were younger (p < 0.01) and had a lower frequency of cardiac involvement (p = 0.053), lower leucocyte count (p < 0.001), higher immunoglobulin (Ig)G levels (p < 0.05), and a higher amount of antibodies against extractable nuclear antigens (p < 0.01) than patients with low serum type I IFN activity. The presence of antibodies against topoisomerase I, Sjögren's syndrome antigen, and nuclear ribonucleoprotein antigens was associated with higher type I IFN activity (p < 0.05 for all comparisons). CONCLUSIONS Our study indicates that increased serum type I IFN activity in early SSc patients is associated with an antibody and laboratory profile that may reflect a subclinical overlap of SSc with other type I IFN-driven connective tissue diseases (CTDs).
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Affiliation(s)
- D M Wuttge
- Section of Rheumatology, Department of Clinical Sciences, Lund University/Skåne University Hospital, Lund, Sweden.
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Hofstee HMA, Serne EH, Roberts C, Hesselstrand R, Scheja A, Moore TL, Wildt M, Manning JB, Vonk Noordegraaf A, Voskuyl AE, Herrick AL. Comment on: A multicentre study on the reliability of qualitative and quantitative nailfold videocapillaroscopy assessment: reply. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes197] [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: 11/12/2022] Open
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McKinney C, Broen JCA, Vonk MC, Beretta L, Hesselstrand R, Hunzelmann N, Riemekasten G, Scorza R, Simeon CP, Fonollosa V, Carreira PE, Ortego-Centeno N, Gonzalez-Gay MA, Airo P, Coenen M, Martin J, Radstake TRDJ, Merriman TR. Evidence that deletion at FCGR3B is a risk factor for systemic sclerosis. Genes Immun 2012; 13:458-60. [PMID: 22551723 DOI: 10.1038/gene.2012.15] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
There is increasing evidence that gene copy number (CN) variation influences clinical phenotype. The low-affinity Fc receptor 3B (FCGR3B) located in the FCGR gene cluster is a CN polymorphic gene involved in the recruitment of polymorphonuclear neutrophils to sites of inflammation and their activation. Given the genetic overlap between systemic lupus erythematosus and systemic sclerosis (SSc) and the strong evidence for FCGR3B CN in the pathology of SLE, we hypothesised that FCGR3B gene dosage influences susceptibility to SSc. We obtained FCGR3B deletion status in 777 European Caucasian cases and 1000 controls. There was an inverse relationship between FCGR3B CN and disease susceptibility. CN of ≤ 1 was a significant risk factor for SSc (OR=1.55 (1.13-2.14), P=0.007) relative to CN ≥ 2. Although requiring replication, these results suggest that impaired immune complex clearance arising from FCGR3B deficiency contributes to the pathology of SSc, and FCGR3B CN variation is a common risk factor for systemic autoimmunity.
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Affiliation(s)
- C McKinney
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
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Broen JCA, Bossini-Castillo L, van Bon L, Vonk MC, Knaapen H, Beretta L, Rueda B, Hesselstrand R, Herrick A, Worthington J, Hunzelman N, Denton CP, Fonseca C, Riemekasten G, Kiener HP, Scorza R, Simeón CP, Ortego-Centeno N, Gonzalez-Gay MA, Airò P, Coenen MJH, Martín J, Radstake TRDJ. A rare polymorphism in the gene for Toll-like receptor 2 is associated with systemic sclerosis phenotype and increases the production of inflammatory mediators. ACTA ACUST UNITED AC 2012; 64:264-71. [PMID: 21905008 DOI: 10.1002/art.33325] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To investigate whether polymorphisms in Toll-like receptor (TLR) genes, previously reported to be associated with immune-mediated diseases, are involved in systemic sclerosis (SSc). METHODS We genotyped 14 polymorphisms in the genes for TLRs 2, 4, 7, 8, and 9 in a discovery cohort comprising 452 SSc patients and 537 controls and a replication cohort consisting of 1,170 SSc patients and 925 controls. In addition, we analyzed 15-year followup data on 964 patients to assess the potential association of TLR variants with the development of disease complications. We analyzed the functional impact of the associated polymorphism on monocyte-derived dendritic cells. RESULTS In the discovery cohort, we observed that a rare functional polymorphism in TLR2 (Pro631His) was associated with antitopoisomerase (antitopo) positivity (odds ratio 2.24 [95% confidence interval 1.24-4.04], P=0.003). This observation was validated in the replication cohort (odds ratio 2.73 [95% confidence interval 1.85-4.04], P=0.0001). In addition, in the replication cohort the TLR2 variant was associated with the diffuse subtype of the disease (P=0.02) and with the development of pulmonary arterial hypertension (PAH) (Cox proportional hazards ratio 5.61 [95% confidence interval 1.53-20.58], P=0.003 by log rank test). Functional analysis revealed that monocyte-derived dendritic cells carrying the Pro63His variant produced increased levels of inflammatory mediators (tumor necrosis factor α and interleukin-6) upon TLR-2-mediated stimulation (both P<0.0001). CONCLUSION Among patients with SSc, the rare TLR2 Pro631His variant is robustly associated with antitopoisomerase positivity, the diffuse form of the disease, and the development of PAH. In addition, this variant influences TLR-2-mediated cell responses. Further research is needed to elucidate the precise role of TLR-2 in the pathogenesis of SSc.
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Affiliation(s)
- J C A Broen
- Department of Rheumatology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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Hesselstrand R, Andreasson K, Wuttge DM, Bozovic G, Scheja A, Saxne T. Increased serum COMP predicts mortality in SSc: results from a longitudinal study of interstitial lung disease. Rheumatology (Oxford) 2012; 51:915-20. [DOI: 10.1093/rheumatology/ker442] [Citation(s) in RCA: 23] [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] [Indexed: 11/13/2022] Open
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Hofstee HMA, Serne EH, Roberts C, Hesselstrand R, Scheja A, Moore TL, Wildt M, Manning JB, Vonk Noordegraaf A, Voskuyl AE, Herrick AL. A multicentre study on the reliability of qualitative and quantitative nail-fold videocapillaroscopy assessment. Rheumatology (Oxford) 2011; 51:749-55. [DOI: 10.1093/rheumatology/ker403] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hesselstrand R, Scheja A, Wuttge DM. Scleroderma renal crisis in a Swedish systemic sclerosis cohort: survival, renal outcome, and RNA polymerase III antibodies as a risk factor. Scand J Rheumatol 2011; 41:39-43. [PMID: 22044051 DOI: 10.3109/03009742.2011.610032] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To study survival, renal outcome, and RNA polymerase III antibodies (RNAP Abs) as a risk factor for scleroderma renal crisis (SRC) in a Swedish cohort of systemic sclerosis (SSc) patients. METHODS SRC was diagnosed in 16 SSc patients during the period from 1982 to 2010. For comparison, 112 (seven for each SRC patient) SSc patients without SRC were included. RNAP Abs were detected by a fully automated fluoroenzyme immunoassay (EliA). Values greater than 15 μg/L were considered positive. Frozen serum samples from the time of diagnosis of SSc were used. RESULTS The 5- and 10-year survival rates were, respectively, 58% and 40% for SRC patients and 90% and 76% for patients without SRC (p < 0.001). The odds ratio (OR) for mortality was 4.39 [95% confidence interval (CI) 2.10-9.16, p < 0.001] in patients with SRC compared to those without SRC. Renal outcome was good in three patients. Haemodialysis was started in 10 patients and peritoneal dialysis in three. Renal function improved in three patients and dialysis was terminated. Four patients underwent renal transplantation. Seven SRC patients and nine without SRC were positive for RNAP Abs. Anti-RNAP Abs was a strong predictor of SRC. The sensitivity and specificity for development of SRC were 0.44 and 0.92, respectively. The OR for development of SRC was 8.90 (95% CI 2.68-29.6, p = 0.001) in RNAP-positive patients. CONCLUSIONS RNAP positivity is a strong risk factor for SRC. Renal outcome was variable and survival is still notably decreased.
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Affiliation(s)
- R Hesselstrand
- Department of Clinical Sciences, Section for Rheumatology, Lund University, Lund, Sweden.
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Scheja A, Wildt M, Wuttge DM, Hesselstrand R. Progressive capillary loss over a decade in patients with systemic sclerosis, in particular in patients with early digital ischaemic manifestations. Scand J Rheumatol 2011; 40:457-61. [PMID: 21936615 DOI: 10.3109/03009742.2011.599070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Characteristic capillary abnormalities occur early in systemic sclerosis (SSc). Our aim was to study the longitudinal development of capillary density in SSc patients. METHODS Forty-eight consecutive patients with SSc fulfilling a follow-up of at least 8 years were retrospectively analysed for capillary loss over the observation period. Eleven had diffuse cutaneous SSc (dcSSc) and 37 limited cutaneous SSc (lcSSc). The median disease duration at first assessment was 2.5 years. Capillary density was determined by direct counting of capillaries in the distal row on eight fingers in a stereo-zoom microscope at 20× magnification. RESULTS Capillary density decreased over the observation period in dcSSc (from median 5.1 to 4.4 loops/mm, p < 0.05) and in lcSSc (from 5.1 to 4.2 loops/mm, p < 0.001). No significant difference was found between the two forms at start or at follow-up. Digital ischaemic manifestations had already been found at the first assessment in 19 patients. They did not differ in capillary density from those without ischaemic manifestations at the first assessment (5.0 and 5.3 loops/mm), but did differ at follow-up (3.6 and 4.7 loops/mm, p < 0.001). Capillary loss was more pronounced in patients who already had digital ischaemic manifestations at the first assessment compared to those without (p < 0.02). CONCLUSION In SSc, early digital ischaemic manifestations may precede a subsequent progressive capillary loss. The association between capillary loss and serious internal vascular complications remains to be studied.
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Affiliation(s)
- A Scheja
- Department of Clinical Sciences, Division of Rheumatology, Lund University, Lund, Sweden.
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Sandqvist G, Archenholtz B, Scheja A, Hesselstrand R. The Swedish version of the Multidimensional Assessment of Fatigue (MAF) in systemic sclerosis: reproducibility and correlations to other fatigue instruments. Scand J Rheumatol 2011; 40:493-4. [DOI: 10.3109/03009742.2011.605395] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Fransen J, Popa-Diaconu D, Hesselstrand R, Carreira P, Valentini G, Beretta L, Airo P, Inanc M, Ullman S, Balbir-Gurman A, Sierakowski S, Allanore Y, Czirjak L, Riccieri V, Giacomelli R, Gabrielli A, Riemekasten G, Matucci-Cerinic M, Farge D, Hunzelmann N, Van den Hoogen FHJ, Vonk MC. Clinical prediction of 5-year survival in systemic sclerosis: validation of a simple prognostic model in EUSTAR centres. Ann Rheum Dis 2011; 70:1788-92. [PMID: 21784727 DOI: 10.1136/ard.2010.144360] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is associated with a significant reduction in life expectancy. A simple prognostic model to predict 5-year survival in SSc was developed in 1999 in 280 patients, but it has not been validated in other patients. The predictions of a prognostic model are usually less accurate in other patients, especially from other centres or countries. A study was undertaken to validate the prognostic model to predict 5-year survival in SSc in other centres throughout Europe. METHODS A European multicentre cohort of patients with SSc diagnosed before 2002 was established. Patients with SSc according to the preliminary American College of Rheumatology classification criteria were eligible for the study when they were followed for at least 5 years or shorter if they died. The primary outcome was 5-year survival after diagnosis of SSc. The predefined prognostic model uses the following baseline variables: age, gender, presence of urine protein, erythrocyte sedimentation rate (ESR) and carbon monoxide diffusing capacity (DLCO). RESULTS Data were available for 1049 patients, 119 (11%) of whom died within 5 years after diagnosis. Of the patients, 85% were female, the mean (SD) age at diagnosis was 50 (14) years and 30% were classified as having diffuse cutaneous SSc. The prognostic model with age (OR 1.03), male gender (OR 1.93), urine protein (OR 2.29), elevated ESR (1.89) and low DLCO (OR 1.94) had an area under the receiver operating characteristic curve of 0.78. Death occurred in 12 (2.2%) of 509 patients with no risk factors, 45 (13%) of 349 patients with one risk factor, 55 (33%) of 168 patients with two risk factors and 7 (30%) of 23 patients with three risk factors. CONCLUSION A simple prognostic model using three disease factors to predict 5-year survival at diagnosis in SSc showed reasonable performance upon validation in a European multicentre study.
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Affiliation(s)
- J Fransen
- Correspondence to J Fransen, Department of Rheumatology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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Abstract
BACKGROUND Assessment of gastrointestinal (GI) involvement in systemic sclerosis (SSc) is difficult. Measurement of calprotectin in faeces is a valuable tool for the assessment of inflammatory bowel diseases. Calprotectin is an intracellular protein found in leucocytes and is a potent activator of the innate immune system. OBJECTIVE To determine whether faecal calprotectin (F-calprotectin) could serve as a biomarker of GI disease in SSc. DESIGN In a cross-sectional study, F-calprotectin and plasma calprotectin were measured in patients with SSc using an enzyme-linked immunosorbent assay. F-calprotectin concentrations were evaluated in relation to cineradiography, medical records, laboratory measurements and patients' subjective GI symptoms. SETTING The study was conducted at a tertiary referral centre for SSc. SUBJECTS The study comprised 81 consecutive patients with SSc. RESULTS A majority of the patients had pathological levels of F-calprotectin when compared to accepted clinical reference values for healthy adults. F-calprotectin did not correlate with calprotectin levels in plasma. F-calprotectin was associated with the following patient characteristics: pathological cineradiography, history of referral to another clinic because of GI disease, treatment of vitamin or mineral deficiency and use of proton pump inhibitors. We did not find any significant correlation between F-calprotectin and patient-reported GI symptoms. CONCLUSION Faecal calprotectin is increased in a majority of patients with SSc. It correlates with objective and clinically important features of GI disease, and faecal concentrations do not vary with plasma concentrations. We suggest that F-calprotectin is a promising objective non-invasive biomarker of GI involvement in SSc.
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Affiliation(s)
- K Andréasson
- Section for Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
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Carmona FD, Simeon CP, Beretta L, Carreira P, Vonk MC, Rios-Fernandez R, Espinosa G, Navarrete N, Vicente-Rabaneda E, Rodriguez-Rodriguez L, Tolosa C, Garcia-Hernandez FJ, Castellvi I, Egurbide MV, Fonollosa V, Gonzalez-Gay MA, Rodriguez-Carballeira M, Diaz-Gonzalez F, Saez-Comet L, Hesselstrand R, Riemekasten G, Witte T, Voskuyl AE, Schuerwegh AJ, Madhok R, Shiels P, Fonseca C, Denton C, Nordin A, Palm O, Hoffmann-Vold AM, Airo P, Scorza R, Lunardi C, van Laar JM, Hunzelmann N, Kreuter A, Herrick A, Worthington J, Koeleman BPC, Radstake TRDJ, Martin J. Association of a non-synonymous functional variant of the ITGAM gene with systemic sclerosis. Ann Rheum Dis 2011; 70:2050-2. [DOI: 10.1136/ard.2010.148874] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Broen JCA, Gourh P, Vonk MC, Beretta L, Niederer F, Rueda B, Geurts-van Bon L, Brouwer C, Hesselstrand R, Herrick A, Worthington J, Hunzelman N, Fonseca DC, Riemekasten G, Kiener H, Scorza R, Simeon CP, Fonollosa V, Carreira P, Ortego-Centeno N, Gonzalez-Gay MA, Airo' P, Coenen MJH, Mayes M, Kyburz D, Arnett FC, Martin J, Radstake TRDJ. Variants of PBEF predispose to systemic sclerosis and pulmonary arterial hypertension development. Ann Rheum Dis 2011. [DOI: 10.1136/ard.2010.148965.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Andreasson K, Gustafsson R, Ivars F, Roth J, Vogl T, Hesselstrand R, Heinegard D, Saxne T. S100A8/A9 in bleomycin-induced skin fibrosis. Ann Rheum Dis 2011. [DOI: 10.1136/ard.2010.149104.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Diaz-Gallo LM, Gourh P, Broen J, Simeon C, Fonollosa V, Ortego-Centeno N, Agarwal S, Vonk MC, Coenen M, Riemekasten G, Hunzelmann N, Hesselstrand R, Tan FK, Reveille JD, Assassi S, García-Hernandez FJ, Carreira P, Camps MT, Fernandez-Nebro A, de la Peña PG, Nearney T, Hilda D, González-Gay MA, Airo P, Beretta L, Scorza R, Herrick A, Worthington J, Pros A, Gómez-Gracia I, Trapiella L, Espinosa G, Castellvi I, Witte T, de Keyser F, Vanthuyne M, Mayes MD, Radstake TRDJ, Arnett FC, Martin J, Rueda B. Analysis of the influence of PTPN22 gene polymorphisms in systemic sclerosis. Ann Rheum Dis 2010; 70:454-62. [PMID: 21131644 DOI: 10.1136/ard.2010.130138] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Two functional single nucleotide polymorphisms (SNP) in the PTPN22 gene (rs24746601 and rs33996649) have been associated with autoimmunity. The aim of this study was to investigate the role of the R263Q SNP for the first time and to re-evaluate the role of the R620W SNP in the genetic predisposition to systemic sclerosis (SSc) susceptibility and clinical phenotypes. METHODS 3422 SSc patients (2020 with limited cutaneous SSc and 1208 with diffuse cutaneous SSc) and 3638 healthy controls of Caucasian ancestry from an initial case--control set of Spain and seven additional independent replication cohorts were included in our study. Both rs33996649 and rs2476601 PTPN22 polymorphisms were genotyped by TaqMan allelic discrimination assay. A meta-analysis was performed to test the overall effect of these PTPN22 polymorphisms in SSc. RESULTS The meta-analysis revealed evidence of association of the rs2476601 T allele with SSc susceptibility (p(FDRcorrected)=0.03 pooled, OR 1.15, 95% CI 1.03 to 1.28). In addition, the rs2476601 T allele was significantly associated with anticentromere-positive status (p(FDRcorrected)=0.02 pooled, OR 1.22, 95% CI 1.05 to 1.42). Although the rs33996649 A allele was significantly associated with SSc in the Spanish population (p(FDRcorrected)=0.04, OR 0.58, 95% CI 0.36 to 0.92), this association was not confirmed in the meta-analysis (p=0.36 pooled, OR 0.89, 95% CI 0.72 to 1.1). CONCLUSION The study suggests that the PTPN22 R620W polymorphism influences SSc genetic susceptibility but the novel R263Q genetic variant does not. These data strengthen evidence that the R620W mutation is a common risk factor in autoimmune diseases.
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Affiliation(s)
- L M Diaz-Gallo
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan. [corrected]
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Bossini-Castillo L, Broen JCA, Simeon CP, Beretta L, Vonk MC, Ortego-Centeno N, Espinosa G, Carreira P, Camps MT, Navarrete N, González-Escribano MF, Vicente-Rabaneda E, Rodríguez L, Tolosa C, Román-Ivorra JA, Gómez-Gracia I, García-Hernández FJ, Castellví I, Gallego M, Fernández-Nebro A, Egurbide MV, Follonosa V, García de la Peña P, Pros A, González-Gay MA, Hesselstrand R, Riemekasten G, Witte T, Coenen MJH, Koeleman BP, Houssiau F, Smith V, De Keyser F, Westhovens R, De Langhe E, Voskuyl AE, Schuerwegh AJ, Chee MM, Madhok R, Shiels P, Fonseca C, Denton C, Claes K, Padykov L, Nordin A, Palm Ø, Lie BA, Airó P, Scorza R, van Laar JM, Hunzelmann N, Kreuter A, Herrick A, Worthington J, Radstake TRDJ, Martín J, Rueda B. A replication study confirms the association of TNFSF4 (OX40L) polymorphisms with Systemic Sclerosis in a large European cohort. J Transl Med 2010. [PMCID: PMC3007795 DOI: 10.1186/1479-5876-8-s1-p5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Gorlova O, Martin JM, Rueda B, Koeleman BPC, Ying J, Teruel M, Diaz-Gallo LM, Broen JC, Vonk MC, Simeon CP, Alizadeh BZ, Coenen MJH, Voskuyl AE, Schuerwegh AJ, van Riel PLCM, Vanthuyne M, van ‘t Slot R, Italiaander A, Ophoff RA, Hunzelmann N, Fonollosa V, Ortego-Centeno N, González-Gay MA, García-Hernández FJ, González-Escribano MF, Airo P, van Laar J, Worthington J, Hesselstrand R, Smith V, De Keyser F, Houssiau F, Chee MM, Madhok R, Shiels P, Westhovens R, Kreuter A, de Baere E, Witte T, Padyukov L, Nordin A, Scorza R, Lunardi C, Lie BA, Hoffmann-Vold AM, García de la Peña P, Carreira P, Varga J, Hinchcliff M, Lee AT, Gourh P, Amos CI, Riemekasten G, Herrick A, Beretta L, Fonseca C, Denton CP, Gregersen PK, Agarwal S, Assassi S, Tan FK, Arnett FC, Radstake TRDJ, Mayes MD, Martin J. Identification of novel genetic markers associated with the clinical phenotypes of systemic sclerosis through a genome wide association strategy. Lab Invest 2010. [PMCID: PMC3007743 DOI: 10.1186/1479-5876-8-s1-o1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Broen JCA, Gourh P, Vonk MC, Beretta L, Niederer F, Rueda B, Geurts-van Bon L, Brouwer C, Hesselstrand R, Herrick A, Worthington J, Hunzelman N, Denton C, Fonseca C, Riemekasten G, Kiener H, Scorza R, Simeon CP, Fonollosa V, Carreira P, Ortego-Centeno N, Gonzalez-Gay MA, Airò P, Coenen MJH, Mayes M, Kyburz D, Arnett FC, Martin J, Radstake TRDJ. Variants of PBEF predispose to systemic sclerosis and pulmonary arterial hypertension development. Lab Invest 2010. [PMCID: PMC3007791 DOI: 10.1186/1479-5876-8-s1-p46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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