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Hennaert S, Decuman S, Désiron H, Braeckman L, De Baets S, Van de Velde D. IMBA-ICF linking by integrating consensus methods: How group consensus of experts can contribute to in-depth linking of instruments to the ICF. Work 2023; 75:479-493. [PMID: 35912763 DOI: 10.3233/wor-210256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
BACKGROUND A frame of reference is needed to increase the comparability of vocational rehabilitation assessment instruments and the interpretation of their results. The International Classification of Functioning, Disability and Health (ICF) is a relevant framework, and when linking rules are used, items from existing assessment instruments can be linked to the appropriate categories as described in the ICF. OBJECTIVE To develop an adapted linking methodology in which experts are involved by means of the application of consensus methods and to transfer this result in a step-by-step set of guidelines, supporting researchers and professionals, linking complex instruments to the ICF. METHODS The main researcher developed the initial linking of the Integration von Menschen mit Behinderungen in die Arbeitswelt (IMBA) to the ICF by rigorously applying the refined ICF linking rules. To validate this linking, the Delphi and nominal group technique was integrated through different steps, and experts were involved in the process. The method section describes the linking process chronologically with focuses on the used approach, the involvement of experts, and the processing of the output. RESULTS The results are presented in a 7-step set of guidelines describing the chronological process from the initial to the validated linking. These guidelines describe the core elements in the application of the linking rules and consensus methods in a manual for researchers who are interested in linking complex instruments to the ICF by involving experts. CONCLUSIONS The Delphi and nominal group technique can be successfully integrated in the linking process, making it possible to involve experts in linking complex instruments to the ICF. A homogeneous composition of the expert panel in terms of knowledge, a heterogeneous composition in terms of setting, a rigorous and repeated application of the linking rules, and structured processing of the output are essential to achieve a valid linking.
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Affiliation(s)
- Stien Hennaert
- Vocational Rehabilitation Service, Flanders (GTB), Belgium
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Saskia Decuman
- Department of Internal Health and Pediatrics, Faculty of Medicine and Health, Ghent University, Ghent, Belgium
- Disability Benefits Department, National Institute of Health and Disability Insurance, Brussels, Belgium
| | - Huget Désiron
- Faculty Biomedical Sciences - Environment and Health, KU Leuven, Leuven, Belgium
- Scientific collaborator: PXL University College, Hasselt, Belgium
- ACT Désiron, Hasselt, Belgium
| | - Lutgart Braeckman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Stijn De Baets
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Occupational Therapy Program, Ghent University, Ghent, Belgium
| | - Dominique Van de Velde
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Occupational Therapy Program, Ghent University, Ghent, Belgium
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Otte T, Decuman S, Gelade W, Duyver C. Perceptions of medical advisers on ICF core-sets’ use for evaluating work incapacity related to back pain in French-speaking Belgium. Work 2022; 74:1401-1418. [PMID: 36502361 DOI: 10.3233/wor-210247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND: There is willingness in Europe to implement the use of a biopsychosocial model such as the International Classification of Functioning, Disability and Health (ICF) for assessing work incapacity. OBJECTIVE: A preliminary study was conducted to investigate the perceptions of medical advisers on the value of structuring clients’ biopsychosocial information in an ICF-based report. METHOD: A sample (n = 101) received a perception questionnaire after watching two comparative videos based on a clinical case. Questions relating to work incapacity were also asked. The data was analysed using quantitative methods. Comments were also collected. RESULTS: Before knowing the ICF-based report, 61.96% of the respondents believed a return to work seems possible by providing adapted work or a different job. There is an increase of 8.69 pp (p-value: 0.077) after reading the report. Opening up the initial sample to more insurance physicians (n = 119), the difference is more significant (p-value: 0.012). Also, 71.9% of respondents believe they have a better view of the client’s biopsychosocial situation after reading the report. Respondents recognise the clinical and diagnostic relevance of ICF but say it cannot be used at the moment for various reasons, such as the time required or the need for a multidisciplinary team and effective coordination. Older respondents are less enthusiastic about the appropriateness of using ICF. CONCLUSION: The respondents identify an added value in having a biopsychosocial based-report. After learning about the report, more physicians see opportunities for professional re-integration than before. The medical advisers and their team must be strengthened and receive a clear role in order to empower them.
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Affiliation(s)
- Thomas Otte
- Department of Disability Benefits, Belgian National Institute for Health and Disability Insurance, Brussels, Belgium
| | - Saskia Decuman
- Department of Disability Benefits, Belgian National Institute for Health and Disability Insurance, Brussels, Belgium
| | - Wouter Gelade
- Center for Research in the Economics of Development, University of Namur, Namur, Belgium
| | - Corentin Duyver
- Centre Académique de Médecine Générale, Université catholique de Louvain, Brussels, Belgium
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De Craemer AS, Deroo L, Renson T, Desimpele I, Delmez L, Decuman S, Janssens X, Boonen A, Elewaut D, Carron P, Van den Bosch F. Work participation is unaffected in Belgian spondyloarthritis patients: data from the BelGian Inflammatory Arthritis and SpoNdylitis cohorT. Rheumatology (Oxford) 2022; 62:1841-1850. [PMID: 36099046 DOI: 10.1093/rheumatology/keac529] [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: 05/29/2022] [Revised: 08/18/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to (1) investigate actual work participation in Belgian spondyloarthritis (SpA) patients compared to the general population, and (2) identify determinants of work-related outcomes. METHODS Adult SpA patients from the Ghent University hospital based Be-GIANT cohort (fulfilling ASAS classification criteria) were cross-sectionally questioned on their socio-economic status and completed a Work Productivity and Activity Impairment questionnaire (May 2018 - May 2019). Results were compared to national and regional data on the general population using indirect standardization. Associations between clinical and job characteristics and work-related outcomes were analyzed with logistic regression (having a paid job) and negative binomial hurdle models (sick leave and presenteeism, i.e. restrictions while at work). RESULTS 215/262 (82%) patients of working-age (<65 y/o) had a paid job, corresponding to an age- and sex-adjusted employment ratio of 1.00 (95%CI 0.88;1.14). Patients worked 39.6±10.5h/week, and 49% (95%CI 42;56%) reported sick leave in the previous year, similar to the general population (39.7h/week, 42%). 56% reported presenteeism of median (IQR) 10% (0-20%). In multivariate analysis, functional impairment (BASFI) and health-related quality of life (HRQoL, EuroQoL-VAS) were associated with each work-related outcome, while contextual factors (education, physically demanding job) were positively associated with respectively having a paid job and presenteeism. Clinical characteristics showed no independent association with any of these outcomes. CONCLUSION Evidence from this academic cohort study does not support a work participation gap between SpA patients and the general population, but confirms the role of physical function, overall HRQoL, and education or job type as risk factors for adverse work outcomes.
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Affiliation(s)
- Ann-Sophie De Craemer
- Department of Rheumatology, University Hospital Ghent, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Center for Inflammation Research, VIB-UGent, Zwijnaarde, Belgium
| | - Liselotte Deroo
- Department of Rheumatology, University Hospital Ghent, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Center for Inflammation Research, VIB-UGent, Zwijnaarde, Belgium
| | - Thomas Renson
- Department of Rheumatology, University Hospital Ghent, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Center for Inflammation Research, VIB-UGent, Zwijnaarde, Belgium
| | - Ine Desimpele
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Lauren Delmez
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Saskia Decuman
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Service for benefits, National Institute for Health and Disability Insurance, Brussels, Belgium
| | - Xavier Janssens
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dirk Elewaut
- Department of Rheumatology, University Hospital Ghent, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Center for Inflammation Research, VIB-UGent, Zwijnaarde, Belgium
| | - Philippe Carron
- Department of Rheumatology, University Hospital Ghent, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Center for Inflammation Research, VIB-UGent, Zwijnaarde, Belgium
| | - Filip Van den Bosch
- Department of Rheumatology, University Hospital Ghent, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Center for Inflammation Research, VIB-UGent, Zwijnaarde, Belgium
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Hennaert S, Decuman S, Désiron H, Alles T, Bühne D, Braeckman L, De Baets S, Van de Velde D. Linking of the ‘Integration von Menschen mit Behinderungen in die Arbeitswelt’ (IMBA) to the ‘International Classification of Functioning, Disability and Health’ (ICF). Work 2022; 72:1359-1380. [DOI: 10.3233/wor-210257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: The assessment of work capacity, workable work and the need for a common language is challenging in labour market policy. Being a specific instrument to facilitate Return To Work (RTW), the Integration von Menschen mit Behinderungen in die Arbeitswelt (IMBA) might facilitate the documentation of the individual’s work capacity, the job-related workload and the match between these two elements. Since the International Classification of Functioning, Disability and Health (ICF) is worldwide recognized as frame of reference in RTW, this paper presents the linking of IMBA to the ICF, since this is assumed to be beneficial to support RTW. OBJECTIVE: The establishment of the IMBA-ICF linking in order to study 1) the relationship between IMBA and ICF; 2) the content comparison of IMBA with work-related ICF core sets; and 3) the extent to which the linking addresses the challenges in RTW policy. METHODS: A content comparison of IMBA and ICF was conducted, using a 7- step linking methodology in which the Delphi and Nominal Group Technique are integrated in the implementation of the ICF linking rules. An explorative conversion of the scoring systems of IMBA and ICF was established based on expert opinions. RESULTS: In the main 70 IMBA items, 107 concepts have been identified of which 94 were linked to 87 different ICF categories. Body functions and activities and participation are the most presented ICF components in contrast to the environmental factors. IMBA items regarding occupational safety and work organization are respectively ‘not covered’ and ‘not defined’ in ICF. CONCLUSIONS: An integration of IMBA and ICF addresses the challenges in RTW policy in the assessment of work capacity, workable work and the need for a common language. In order to do so, extension of ICF terminology regarding ‘occupational safety’ and ‘work organization’ is priority. In depth quantitative research is necessary to support the conversion of both scoring systems.
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Affiliation(s)
- S. Hennaert
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - S. Decuman
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health, Ghent University, Ghent, Belgium
- Department of Research and Quality, National Institute of Health and Disability Insurance, Brussels, Belgium
| | - H. Désiron
- Faculty Biomedical Sciences, University Leuven (KU Leuven), Leuven, Belgium
- Scientific collaborator at Hogeschool PXL, Hasselt, Belgium
- CEO, ACT Désiron, Hasselt, Belgium
| | - T. Alles
- Institute for Quality Assurance in Prevention and Rehabilitation, German Sport University Cologne, Cologne, Germany
| | - D. Bühne
- Institute for Quality Assurance in Prevention and Rehabilitation, German Sport University Cologne, Cologne, Germany
| | - L. Braeckman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - S. De Baets
- Occupational Therapy Program, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - D. Van de Velde
- Occupational Therapy Program, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Brunois T, Decuman S, Perl F. [Health literacy and health crisis: the example of COVID-19]. Sante Publique 2022; Vol. 33:843-846. [PMID: 35485015 DOI: 10.3917/spub.216.0843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Implementation and enforcement of COVID-19 control measures are essential to limit the spread of the virus. Unfortunately, these actions are very difficult, if not impossible, for part of the population, mainly present in the socio-economically disadvantaged categories. This difficulty is linked, on the one hand, to the lack of health literacy, which is found to be insufficient among almost a third of the European population, and on the other hand, to their increased exposure to the virus. Difficulty in reading and acquiring health measures therefore leads to a challenge for institutions, a socio-economic gap and impacts on future generations. There is therefore no choice than to invest massively in education and health promotion in the long term to minimize the impact of crises and thus limit the increase in inequalities.
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Goorts K, Boets I, Decuman S, Du Bois M, Rusu D, Godderis L. Psychosocial determinants predicting long-term sickness absence: a register-based cohort study. J Epidemiol Community Health 2020; 74:913-918. [PMID: 32661133 PMCID: PMC7576578 DOI: 10.1136/jech-2020-214181] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/26/2020] [Accepted: 06/25/2020] [Indexed: 11/05/2022]
Abstract
Background This study assessed the psychosocial determinants as explanatory variables for the length of the work disability period. The aim was to estimate the predictive value of a selected set of psychosocial determinants from the Quickscan questionnaire for the length of the sick leave period. A comparison was also made with the most common biomedical determinant: diagnosis. Methods In a cohort study of 4 981 insured Belgian patients, the length of the sick leave was calculated using Kaplan–Meier. Predictive psychosocial determinants were selected using backward conditional selection in Cox regression and using concordance index values (C-index) we compared the predictive value of the biomedical to the psychosocial model in a sample subset. Results Fourteen psychosocial determinants were significantly (p<0.10) related to the length of the sick leave: health perception of the patient, physical workload, social support management, social support colleagues, work–health interference, psychological distress, fear of colleagues’ expectations, stressful life-events, autonomy, learning and development opportunities, job satisfaction, workload, work expectations and expectation to return to work. The C-index of this biopsychosocial model including gender, age and labour status was 0.80 (CI: 0.78; 0.81) (n=4 981). In the subset of 2 868 respondents with diagnostic information, the C-index for the same model was .73 (CI: 0.71; 0.76) compared with 0.63 (CI: 0.61; 0.65) for the biomedical model. Conclusions A set of 14 psychosocial determinants showed good predictive capacity (C-index: 0.80). Also, in a subset of the sample, the selected determinants performed better compared with diagnostic information to predict long-term sick leave (>6 months).
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Affiliation(s)
| | - Isabelle Boets
- Environment and Health, KU Leuven, Leuven, Belgium
- IDEWE Vzw, Leuven, Belgium
| | - Saskia Decuman
- National Institute for Health and Disability Insurance, Brussels, Belgium
- Health Sciences and Medicine, Ghent University, Gent, Belgium
| | - Marc Du Bois
- Environment and Health, KU Leuven, Leuven, Belgium
| | - Dorina Rusu
- University of Liege, Liege, Belgium
- SPMT-ARISTA, Liège, Belgium
| | - Lode Godderis
- Environment and Health, KU Leuven, Leuven, Belgium
- IDEWE Vzw, Leuven, Belgium
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Goorts K, Vandenbroeck S, Vander Elst T, Rusu D, Du Bois M, Decuman S, Godderis L. Quickscan assesses risk factors of long-term sickness absence: A cross-sectional (factorial) construct validation study. PLoS One 2019; 14:e0210359. [PMID: 30633762 PMCID: PMC6329504 DOI: 10.1371/journal.pone.0210359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/20/2018] [Indexed: 11/30/2022] Open
Abstract
Objectives The number of sick-listed employees has increased dramatically worldwide. Therefore, many countries aim to stimulate early and sustainable return to work opportunities to obtain better health outcomes and lower costs for disability pensions. To effectively orientate resources to patients with a high risk of not resuming work spontaneously, it is necessary to screen patients early in their sickness absence process. In this study, we validate “Quickscan”, a new instrument to assess return-to-work needs and to predict risks of long-term sick leave. Methods As part of the Quickscan validation process, we tested and compared the reliability and construct validity of the questionnaire in two different populations. First, we conducted a cross-sectional study in which the screening instrument was sent to sick-listed individuals in healthcare insurance. In a second cross-sectional study, sick-listed workers who consulted the occupational health physician for return-to-work assessment were asked to fill out the questionnaire. We compared both samples for descriptive statistics: frequencies, means and standard deviations. Reliability of the scales was calculated using Cronbach’s alpha. Confirmatory factor analysis was performed to evaluate the construct (factorial) validity of the studied scales using software package AMOS 24. Results The screening tool was shown to be an instrument with reliable scales (except for the perfectionism and health perception patient scale) in both populations. The construct validity was satisfactory: we found that the hypothesized measurement models with the theoretical factors fitted the data well in both populations. In the first sample, the model improved for scales concerning stressful life events and showed worse fit for person-related factors. Work-related factors and functioning factors both showed similar fit indices across samples. We found small differences in descriptive statistics, which we could explain by the differences in characteristics of both populations. Conclusions We can conclude that the instrument has considerable potential to function as a screening tool for disability management and follow-up of sick-leave, provided that some adaptations and validation tests are executed.
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Affiliation(s)
- Kaat Goorts
- University of Leuven, Centre for Environment and Health, Leuven, Belgium
- * E-mail:
| | - Sofie Vandenbroeck
- University of Leuven, Centre for Environment and Health, Leuven, Belgium
- Idewe, External Service for Prevention and Protection at Work, Leuven, Belgium
| | - Tinne Vander Elst
- Idewe, External Service for Prevention and Protection at Work, Leuven, Belgium
- University of Leuven, Faculty of Psychology and Educational Sciences, Leuven, Belgium
| | - Dorina Rusu
- Université de Liège, Département des Sciences de la Santé publique, Liège, Belgium
- SPMT-ARISTA, External Service for Prevention and Protection at Work, Liège, Belgium
| | - Marc Du Bois
- University of Leuven, Centre for Environment and Health, Leuven, Belgium
| | - Saskia Decuman
- National Institute for Health and Disability Insurance, Department of Benefits, Brussels, Belgium
| | - Lode Godderis
- University of Leuven, Centre for Environment and Health, Leuven, Belgium
- Idewe, External Service for Prevention and Protection at Work, Leuven, Belgium
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Lefever M, Decuman S, Perl F, Braeckman L, Van de Velde D. The efficacy and efficiency of Disability Management in job-retention and job-reintegration. A systematic review. Work 2018; 59:501-534. [PMID: 29733052 DOI: 10.3233/wor-182709] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Disability management (DM) is a systematic method to ensure job-retention and job-reintegration in competitive employment for individuals with a disability. There is evidence that 'returning to work' has a positive impact on the individual, the company and on the society. However, a clear overview of the efficacy and efficiency of the DM programs is scarce. OBJECTIVE To systematically review the efficacy and efficiency of the disability management programs. Cochrane, PubMed, Google Scholar, and Web of Science were searched from 1994 to 2015. METHODS Two reviewers independently evaluated the articles on title, abstract, and full text. The data extraction and results are documented according to the study designs. RESULTS Twenty-eight articles were included in the review. These 28 articles consisted of 7 systematic reviews, 3 randomized controlled trials, 9 clinical trials, 4 mixed-method studies and 5 qualitative studies. CONCLUSIONS The DM program has shown to be effective and efficient. A consensus about the DM components is still not reached. Nevertheless, some components are emphasized more than others; job accommodation, facilitation of transitional duty, communication between all stakeholders, health care provider advice, early intervention, and acceptance, goodwill and trust in the stakeholders, in the organization, and in the disability management process.
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Affiliation(s)
- Marlies Lefever
- Department of Rehabilitation Sciences and Physiotherapy, Occupational Therapy Program, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Saskia Decuman
- Department of Benefits, National Institute of Health and Disability Insurance, Brussels, Belgium.,Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - François Perl
- Department of Benefits, National Institute of Health and Disability Insurance, Brussels, Belgium
| | - Lutgart Braeckman
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Dominique Van de Velde
- Department of Rehabilitation Sciences and Physiotherapy, Occupational Therapy Program, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Vandecasteele E, Melsens K, De Keyser F, De Pauw M, Deschepper E, Decuman S, Piette Y, Thevissen K, Brusselle G, Smith V. A prospective, longitudinal study evaluating the baseline six-minute walk test as an individual reference value in systemic sclerosis patients. Clin Exp Rheumatol 2018; 36 Suppl 113:95-101. [PMID: 30183593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/18/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) are the leading causes of death in systemic sclerosis (SSc). Although the six-minute walk test (6MWT) is used for evaluating ILD and PAH, no data are available on the evolution of the six-minute walk distance (6MWD) in SSc patients without ILD and PAH and whether the baseline 6MWD could serve as individual reference value for the management of those who will develop PAH or ILD. METHODS Prospectively collected data of the first 6MWT (at baseline or 6-month follow-up) and the 6MWTs at 18-, 30-, 42-, 54-, and 66-month visit of 165 consecutive SSc patients without ILD and PAH, included in the Ghent University SSc Cohort between May 2006 and December 2016 were analysed. RESULTS 96-100% of the included patients performed a 6MWT during the follow-up visits. The mean 6MWD during the baseline 6MWT of 165 SSc patients without ILD and PAH (35% limited, 56% limited cutaneous, 9% diffuse cutaneous SSc) was 484.20+/-92.65m with no significant difference in the 6MWD at different follow-up visits as compared to baseline. In 46 SSc patients without ILD and PAH who performed a 6MWT at baseline and at 66-month visit, the 6MWD walked at 66-month visit correlated with the baseline 6MWD (r=0.564, p<0.001). CONCLUSIONS In SSc without ILD and PAH, the 6MWT is feasible and the 6MWD is clinically stable over a 66 months period. Hence, the individual 6MWD might be used as individual reference value in management of those who will develop PAH or ILD.
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Affiliation(s)
- Els Vandecasteele
- Department of Cardiology, Ghent University Hospital; and Department of Internal Medicine, Ghent University, Belgium.
| | - Karin Melsens
- Department of Internal Medicine, Ghent University, Belgium
| | - Filip De Keyser
- Department of Internal Medicine, Ghent University, and Department of Rheumatology, Ghent University Hospital, Belgium
| | - Michel De Pauw
- Department of Cardiology, Ghent University Hospital, Belgium
| | - Ellen Deschepper
- Biostatistics Unit, Department of Public Health, Ghent University, Belgium
| | - Saskia Decuman
- Department of Internal Medicine, Ghent University, Belgium
| | - Yves Piette
- Department of Rheumatology, Ghent University Hospital, Belgium
| | | | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Belgium
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, and Department of Rheumatology, Ghent University Hospital, Belgium
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Melsens K, Vandecasteele E, Deschepper E, Badot V, Blockmans D, Brusselle G, De Langhe E, De Pauw M, Debusschere C, Decuman S, Deroo L, Houssiau F, Lenaerts J, Piette Y, Thevissen K, Vanthuyne M, Westhovens R, Wijnant S, De Keyser F, Smith V. Two years follow-up of an open-label pilot study of treatment with rituximab in patients with early diffuse cutaneous systemic sclerosis. Acta Clin Belg 2018; 73:119-125. [PMID: 28891418 DOI: 10.1080/17843286.2017.1372244] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Following results in open-label studies of rituximab in patients with systemic sclerosis, a Belgian three-centre initiative was launched to explore safety and efficacy of rituximab in early, diffuse cutaneous systemic sclerosis (dcSSc). METHODS Open-label study of 17 patients with early dcSSc, treated with two courses of rituximab, at month 0 and 6. Clinical examination, lung function testing, echocardiography, disease activity score (DAS) and functional status were performed at baseline and over 24 months of follow-up. RESULTS Modified Rodnan skin score (MRSS) changed significantly over time, with a mean of 25.5 (standard deviation [SD] 6.0) at baseline to 12.6 (SD 5.1) at month 24 (Mixed Model Analysis [MMA] p < 0.0001), which is a decrease of 51% at month 24 vs. baseline. DAS showed significant decrease over the total study period, with a score of 4.1 (SD 1.7) at baseline to 1.5 (SD 1.8) at month 24 (MMA p < 0.0001). Additionally, this was significant at all time points vs. baseline, both for MRSS and DAS. Internal organ status remained clinically stable throughout the study period. No statistically significant differences compared to baseline were found at the follow-up time points. Seven serious adverse events took place, all except for one, considered unrelated to study medication. CONCLUSIONS This is the first multicentre Belgian collaboration investigating potential efficacy of rituximab in early dcSSc. Rituximab appears to be safe and tolerable and it may have beneficial effects on skin involvement, on overall disease activity and on stabilization of internal organ status in early dcSSc.
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Affiliation(s)
- Karin Melsens
- Department of Rheumatology, Universitair Ziekenhuis Gent, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Internal Medicine, Universiteit Gent, Ghent, Belgium
| | - Els Vandecasteele
- Department of Cardiology, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Ellen Deschepper
- Department of Public Health, Biostatistics Unit, Universiteit Gent, Ghent, Belgium
| | - Valérie Badot
- Department of Rheumatology, Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Daniel Blockmans
- Department of General Internal Medicine, universitaire ziekenhuizen leuven, Leuven, Belgium
| | - Guy Brusselle
- Department of Respiratory Medicine, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Ellen De Langhe
- Department of Rheumatology, universitaire ziekenhuizen leuven, Leuven, Belgium
| | - Michel De Pauw
- Department of Cardiology, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Claire Debusschere
- Department of Rheumatology, Universitair Ziekenhuis Gent, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Internal Medicine, Universiteit Gent, Ghent, Belgium
| | - Saskia Decuman
- Faculty of Medicine and Health Sciences, Department of Internal Medicine, Universiteit Gent, Ghent, Belgium
| | - Liselotte Deroo
- Faculty of Medicine and Health Sciences, Universiteit Gent, Ghent, Belgium
| | - Frédéric Houssiau
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jan Lenaerts
- Department of Rheumatology, universitaire ziekenhuizen leuven, Leuven, Belgium
| | - Yves Piette
- Department of Rheumatology, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Kristof Thevissen
- Department of Rheumatology, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Marie Vanthuyne
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - René Westhovens
- Department of Rheumatology, universitaire ziekenhuizen leuven, Leuven, Belgium
| | - Sara Wijnant
- Faculty of Medicine and Health Sciences, Universiteit Gent, Ghent, Belgium
| | - Filip De Keyser
- Department of Rheumatology, Universitair Ziekenhuis Gent, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Internal Medicine, Universiteit Gent, Ghent, Belgium
| | - Vanessa Smith
- Department of Rheumatology, Universitair Ziekenhuis Gent, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Internal Medicine, Universiteit Gent, Ghent, Belgium
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11
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Cutolo M, Melsens K, Wijnant S, Ingegnoli F, Thevissen K, De Keyser F, Decuman S, Müller-Ladner U, Piette Y, Riccieri V, Ughi N, Vandecasteele E, Vanhaecke A, Smith V. Nailfold capillaroscopy in systemic lupus erythematosus: A systematic review and critical appraisal. Autoimmun Rev 2018; 17:344-352. [PMID: 29427827 DOI: 10.1016/j.autrev.2017.11.025] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/02/2017] [Indexed: 01/03/2023]
Abstract
Nailfold capillaroscopy is an easy, non-invasive technique to assess microvascular involvement in rheumatic diseases. Multiple studies describe capillaroscopic changes in systemic lupus erythematosus (SLE), including a wide range of non-specific findings. On behalf of the European League Against Rheumatism (EULAR) study group on microcirculation in rheumatic diseases, a systematic review was done to obtain all original research studies (in English) in which SLE patients had capillaroscopy. Forty such studies are identified. This article firstly provides a résumé of the results of these studies according to capillaroscopic parameters (density, dimensions, morphology, haemorrhages), semi-quantitative assessment and qualitative assessment of capillaroscopy in SLE patients. Secondly, the correlations between capillaroscopic parameters in SLE patients and clinical and laboratory parameters (including auto-immune parameters) are outlined. The following capillaroscopic parameters are found to be significantly more prevalent in SLE patients compared to healthy controls: tortuous capillaries, abnormal morphology and haemorrhages. Hairpin-shaped capillaries are significantly less prevalent than in healthy persons. The semi-quantitatively determined nailfold capillaroscopic score (NFC score) in SLE patients is also higher than in healthy controls. Several correlations between clinical and laboratory parameters and capillaroscopic parameters are identified in the review. Disease activity is correlated with NFC score in seven studies, with abnormal morphology (i.e. "meandering") in one study and with haemorrhages in one study. Frequent attacks of Raynaud's phenomenon (RP) and gangrene are significantly correlated with dilated capillaries. In two studies a possible correlation between anti-SSA antibodies and lower density of capillaries is withheld. About other immune parameters conflicting results are found. In one study a significant negative correlation is found between 24-hour proteinuria and abnormal morphology (i.e. "meandering"). For the first time, an overview of the nailfold capillaroscopic changes that have been described in SLE and their correlations with clinical and laboratory findings is given. Further large-scale research on the identification of capillaroscopic changes in SLE and their correlations with standardised clinical and laboratory parameters, is ongoing at the EULAR study group on microcirculation in rheumatic diseases.
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Affiliation(s)
- Maurizio Cutolo
- Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Via Balbi 5, Genoa, Italy.
| | - Karin Melsens
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Sara Wijnant
- Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Francesca Ingegnoli
- Division of Rheumatology, ASST Gaetano Pini, Department of Clinical Sciences and Community Health, University of Milan, Piazza Cardinal Andrea Ferrari 1, Milan, Italy.
| | - Kristof Thevissen
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium.
| | - Filip De Keyser
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Saskia Decuman
- Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Ulf Müller-Ladner
- Rheumatology and Clinical Immunology, University of Giessen/Kerckhoff-Klinik, Benekestraße 2-8, 61231 Bad Nauheim, Germany.
| | - Yves Piette
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium.
| | - Valeria Riccieri
- Department of Internal Medicine and Clinical Specialities, Sapienza University, Piazzale Aldo Moro 5, Rome, Italy.
| | - Nicola Ughi
- Division of Rheumatology, ASST Gaetano Pini, Department of Clinical Sciences and Community Health, University of Milan, Piazza Cardinal Andrea Ferrari 1, Milan, Italy
| | - Els Vandecasteele
- Department of Cardiology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Amber Vanhaecke
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, C. Heymanslaan 10, Ghent, Belgium; Department of Internal Medicine, Ghent University, C. Heymanslaan 10, Ghent, Belgium.
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12
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Vandecasteele E, Thevissen K, Melsens K, De Keyser F, De Pauw M, Deschepper E, Decuman S, Piette Y, Brusselle G, Smith V. Six-minute walk test in or out in evaluation of systemic sclerosis patients? Clin Exp Rheumatol 2017; 35 Suppl 106:122-129. [PMID: 28229829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 12/20/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) are the leading causes of death in systemic sclerosis (SSc) patients. Although the six-minute walk test (6MWT) is used for evaluating ILD and PAH in clinical practice, no data are available on six-minute walk distance (6MWD) and oxygen desaturation in SSc patients without ILD and PAH. METHODS Prospectively collected data of the 6MWTs at baseline and 6-month follow-up of 300 consecutive SSc patients, included in the Ghent University Hospital Systemic Sclerosis Unit between May 2006 and April 2015 were analysed. RESULTS The mean 6MWD of 165 SSc patients without ILD and PAH who performed a 6MWT at baseline or at the 6-month visit was 484±93m. Patients in the diffuse cutaneous (DcSSc) subgroup (435±94m) walked less than in the limited (LSSc) subgroup (499±91m, p=0.04) and tended to walk less than in the limited cutaneous (LcSSc) subgroup (483±92m, p=0.15). In 115 SSc patients without ILD and PAH who walked at both moments, there was no significant difference between the 6MWDs (mean difference -7.60m 95%CI [-19.93m; 4.73m], p=0.23) and the oxygen desaturation was not statistically different in 102 of them (mean difference 0.41% 95%CI [-0.49%; 1.31%], p=0.37). CONCLUSIONS In SSc without ILD and PAH, the 6MWD and oxygen desaturation is clinically stable over a 6 months period. The DcSSc subgroup walks less than the LSSc and the LcSSc subgroup.
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Affiliation(s)
| | | | - Karin Melsens
- Department of Internal Medicine, Ghent University, Belgium
| | - Filip De Keyser
- Department of Rheumatology, Ghent University Hospital; and Department of Internal Medicine, Ghent University, Belgium
| | - Michel De Pauw
- Department of Cardiology, Ghent University Hospital, Belgium
| | - Ellen Deschepper
- Biostatistics Unit, Department of Public Health, Ghent University, Belgium
| | - Saskia Decuman
- Department of Internal Medicine, Ghent University, Belgium
| | - Yves Piette
- Department of Rheumatology, Ghent University Hospital, Belgium
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Belgium
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital; and Department of Internal Medicine, Ghent University, Belgium
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13
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Mostmans Y, Cutolo M, Giddelo C, Decuman S, Melsens K, Declercq H, Vandecasteele E, De Keyser F, Distler O, Gutermuth J, Smith V. The role of endothelial cells in the vasculopathy of systemic sclerosis: A systematic review. Autoimmun Rev 2017; 16:774-786. [PMID: 28572048 DOI: 10.1016/j.autrev.2017.05.024] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [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: 04/08/2017] [Accepted: 04/13/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Systemic sclerosis (SSc) is an autoimmune connective tissue disorder characterized by fibroproliferative vasculopathy, immunological abnormalities and progressive fibrosis of multiple organs including the skin. In this study, all English speaking articles concerning the role of endothelial cells (ECs) in SSc vasculopathy and representing biomarkers are systematically reviewed and categorized according to endothelial cell (EC) (dys)function in SSc. METHODS A sensitive search on behalf of the EULAR study group on microcirculation in Rheumatic Diseases was developed in Pubmed, The Cochrane Library and Web of Science to identify articles on SSc vasculopathy and the role of ECs using the following Mesh terms: (systemic sclerosis OR scleroderma) AND pathogenesis AND (endothelial cells OR marker). All selected papers were read and discussed by two independent reviewers. The selection process was based on title, abstract and full text level. Additionally, both reviewers further searched the reference lists of the articles selected for reading on full text level for supplementary papers. These additional articles went through the same selection process. RESULTS In total 193 resulting articles were selected and the identified biomarkers were categorized according to description of EC (dys)function in SSc. The most representing and reliable biomarkers described by the selected articles were adhesion molecules for EC activation, anti-endothelial cell antibodies for EC apoptosis, vascular endothelial growth factor (VEGF), its receptor VEGFR-2 and endostatin for disturbed angiogenesis, endothelial progenitors cells for defective vasculogenesis, endothelin-1 for disturbed vascular tone control, Von Willebrand factor for coagulopathy and interleukin (IL)-33 for EC-immune system communication. Emerging, relatively new discovered biomarkers described in the selected articles, are VEGF165b, IL-17A and the adipocytokines. Finally, myofibroblasts involved in tissue fibrosis in SSc can derive from ECs or epithelial cells through a process known as endothelial-to-mesenchymal transition. CONCLUSION This systematic review emphasizes the growing evidence that SSc is primarily a vascular disease where EC dysfunction is present and prominent in different aspects of cell survival (activation and apoptosis), angiogenesis and vasculogenesis and where disturbed interactions between ECs and various other cells contribute to SSc vasculopathy.
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Affiliation(s)
- Y Mostmans
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Dermatology, Laarbeeklaan 101, 1090 Brussels, Belgium; Department of Immunology and Allergology (CIA) Centre Hospitalier Universitaire (CHU) Brugmann, Université Libre de Bruxelles (ULB), Van Gehuchtenplein 4, 1020 Brussels, Belgium.
| | - M Cutolo
- Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy
| | - C Giddelo
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Dermatology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - S Decuman
- Ghent University, Department of Internal Medicine, Ghent, Belgium
| | - K Melsens
- Ghent University, Department of Internal Medicine, Ghent, Belgium; Ghent University Hospital, Department of Rheumatology, Ghent, Belgium
| | - H Declercq
- Department of Basic Medical Sciences, Tissue Engineering and Biomaterials Group, Ghent University, Ghent, Belgium
| | - E Vandecasteele
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - F De Keyser
- Ghent University, Department of Internal Medicine, Ghent, Belgium; Ghent University Hospital, Department of Rheumatology, Ghent, Belgium
| | - O Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - J Gutermuth
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Dermatology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - V Smith
- Ghent University, Department of Internal Medicine, Ghent, Belgium; Ghent University Hospital, Department of Rheumatology, Ghent, Belgium
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14
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Vandecasteele E, Drieghe B, Melsens K, Thevissen K, De Pauw M, Deschepper E, Decuman S, Bonroy C, Piette Y, De Keyser F, Brusselle G, Smith V. Screening for pulmonary arterial hypertension in an unselected prospective systemic sclerosis cohort. Eur Respir J 2017; 49:49/5/1602275. [PMID: 28495691 DOI: 10.1183/13993003.02275-2016] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 02/06/2017] [Indexed: 11/05/2022]
Abstract
Screening for pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) improves outcomes. The DETECT screening algorithm is recommended in a high-risk SSc subgroup. This study aims to compare prospectively the positive predictive value of screening using the DETECT algorithm and the 2009 European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines, and to compare their cost-effectiveness in an unselected, day-to-day SSc population. Post hoc, screening according to the 2015 ESC/ERS guidelines using echocardiographic parameters alone ("2015 echo screening") or combined with the DETECT algorithm ("2015 combined screening") in high-risk subjects was analysed.195 consecutive SSc patients included in the Ghent University Hospital SSc cohort were screened using different algorithms.The referral rate for right heart catheterisation was 32% (63 out of 195 patients) (46/4/13/34/40 patients using the DETECT algorithm/2009 guidelines/both/2015 echo screening/2015 combined screening). Right heart catheterisation was performed in 53 patients (84%) (36 (78%)/four (100%)/13 (100%)/28 (82%)/32 (80%) patients recommended by the DETECT algorithm/2009 guidelines/both/2015 echo screening/2015 combined screening). PAH was diagnosed in three patients (incidence 1.5%·year-1, 95% CI 0.5-4.4), in whom all algorithms recommended a right heart catheterisation. The positive predictive value was 6% (95% CI 2-17%; three out of 49 patients) for the DETECT algorithm, 18% (95% CI 6-41%; three out of 17 patients) for the 2009 guidelines, 23% (95% CI 8-50%; three out of 13 patients) for both, 11% (95% CI 4-27%; three out of 28 patients) for the 2015 echo screening and 9% (95% CI 3-24%; three out of 32 patients) for the 2015 combined screening. The cost was EUR224/80/90/112 per patient using the DETECT algorithm/2009 guidelines/2015 echo screening/2015 combined screening.Echocardiography may remain a candidate first step for PAH screening in SSc.
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Affiliation(s)
| | - Benny Drieghe
- Dept of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Karin Melsens
- Dept of Internal Medicine, Ghent University, Ghent, Belgium
| | | | - Michel De Pauw
- Dept of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Ellen Deschepper
- Biostatistics Unit, Dept of Public Health, Ghent University, Ghent, Belgium
| | - Saskia Decuman
- Dept of Internal Medicine, Ghent University, Ghent, Belgium
| | - Carolien Bonroy
- Dept of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Yves Piette
- Dept of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Filip De Keyser
- Dept of Internal Medicine, Ghent University, Ghent, Belgium.,Dept of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Guy Brusselle
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Vanessa Smith
- Dept of Internal Medicine, Ghent University, Ghent, Belgium.,Dept of Rheumatology, Ghent University Hospital, Ghent, Belgium
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15
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Melsens K, De Keyser F, Decuman S, Piette Y, Vandecasteele E, Smith V. Disease activity indices in systemic sclerosis: a systematic literature review. Clin Exp Rheumatol 2016; 34 Suppl 100:186-192. [PMID: 27385265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 05/18/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Reviewing disease activity indices (DAI) in systemic sclerosis (SSc) and reporting their validation status. METHODS Literature was systematically reviewed on studies documenting the development of DAI, assessing the validation status of DAI and studies using a DAI in their analysis. The qualitative and quantitative validation status of existing DAI was assessed based on OMERACT and on definitions of the American College of Rheumatology (ACR) committee on quality measures. RESULTS Three DAI in SSc have been proposed in literature: the European Scleroderma Study Group (EScSG) activity index, the 12-point DAI and the Combined Response Index for Systemic Sclerosis (CRISS). The EScSG activity index is yet applied as an outcome measure in 48 different studies. The EScSG activity index and the CRISS are provisional partially validated DAI. CONCLUSIONS Future studies are needed to fully validate the EScSG activity index and the CRISS and to assess the validation status of the 12-point DAI.
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Affiliation(s)
- Karin Melsens
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, Belgium.
| | - Filip De Keyser
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University; and Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Saskia Decuman
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Yves Piette
- Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | | | - Vanessa Smith
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University; and Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University, Belgium
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16
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Melsens K, De Keyser F, Decuman S, Brusselle G, De Pauw M, Deschepper E, De Wilde K, Elewaut D, Piette Y, Vandecasteele E, Smith V. Assessment of sensitivity to change of the European Scleroderma Study Group activity index. Clin Exp Rheumatol 2016; 34 Suppl 100:148-151. [PMID: 27463733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 05/18/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The European Scleroderma Study Group (EScSG) activity index meets nearly all the OMERACT-standards of truth, discrimination and feasibility. The sensitivity to change remains to be attested. This study assesses sensitivity to change of the EScSG activity index in patients with early and severe diffuse cutaneous Systemic Sclerosis (dcSSc) treated with rituximab. METHODS 12-month follow-up (open-label study) of 14 consecutive patients with early dcSSc. Patients received an infusion of two times 1000 mg rituximab at month 0 and 6, together with 100 mg methylprednisolone. Clinical read outs (modified Rodnan skin score [mRSS], lung function and echocardiography) and EScSG activity index were performed at month 0, 3, 6 and 12. Mixed models analyses (MMA) were used to evaluate changes in parameters over time. RESULTS There was a clinically significant change in skin score with a mean (SD) mRSS of 24.8 (4.44) at baseline and 10.4 (3.12) at month 12 (MMA p<0.001). Also the EScSG activity index decreased significantly, with a mean (SD) of 4.3 (1.79) at baseline and 0.7 (0.83) at month 12 (MMA p<0.001). The estimated mean change of the EScSG activity index was -3.6 (95%CI -4.9; -2.4) over 12 months. Indices of internal organ involvement remained stable throughout the study. CONCLUSIONS A significant improvement of the EScSG activity index was observed, in line with the significant improvement of the mRSS and the stabilisation of internal organ involvement. To our knowledge, this is the first study to attest sensitivity to change of the EScSG activity index in the subset of 'early' dcSSc. TRIAL REGISTRATION ClinicalTrials.gov Registration, http://clinicaltrials.gov, number NCT00379431.
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Affiliation(s)
- Karin Melsens
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, Belgium.
| | - Filip De Keyser
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University; and Department of Rheumatology, Ghent University Hospital, Belgium
| | - Saskia Decuman
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Belgium
| | - Michel De Pauw
- Department of Cardiology, Ghent University Hospital, Belgium
| | - Ellen Deschepper
- Department of Public Health, Biostatistics Unit, Ghent University, Belgium
| | - Katelijne De Wilde
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Dirk Elewaut
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University; Department of Rheumatology, Ghent University Hospital; and Begium Unit of Molecular Immunology and Inflammation, Inflammation Research Centre-VIB, Ghent, Belgium
| | - Yves Piette
- Department of Rheumatology, Ghent University Hospital, Belgium
| | | | - Vanessa Smith
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University; and Department of Rheumatology, Ghent University Hospital, Belgium
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17
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Vandecasteele E, Melsens K, De Keyser F, De Pauw M, Deschepper E, Decuman S, Piette Y, Brusselle G, Smith V. FRI0277 Six-Minute Walk Test in Systemic Sclerosis Patients without Interstitial Lung Disease and Pulmonary Arterial Hypertension: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2364] [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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Lambrecht V, Cutolo M, De Keyser F, Decuman S, Ruaro B, Sulli A, Deschepper E, Smith V. SAT0565 Reliability of The Quantitative Assessment of Peripheral Blood Perfusion by Laser Speckle Contrast Analysis in A Systemic Sclerosis Cohort: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4943] [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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19
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Vandecasteele E, De Pauw M, De Keyser F, Decuman S, Deschepper E, Piette Y, Brusselle G, Smith V. Six-minute walk test in systemic sclerosis: A systematic review and meta-analysis. Int J Cardiol 2016; 212:265-73. [DOI: 10.1016/j.ijcard.2016.03.084] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/19/2016] [Indexed: 01/17/2023]
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20
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Lambrecht V, Cutolo M, De Keyser F, Decuman S, Ruaro B, Sulli A, Deschepper E, Smith V. Reliability of the quantitative assessment of peripheral blood perfusion by laser speckle contrast analysis in a systemic sclerosis cohort. Ann Rheum Dis 2016; 75:1263-4. [PMID: 27005682 DOI: 10.1136/annrheumdis-2015-208857] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/03/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Valérie Lambrecht
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Filip De Keyser
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Saskia Decuman
- Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Barbara Ruaro
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Ellen Deschepper
- Biostatistics Unit, Department of Public Health, Ghent University, Ghent, Belgium
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium Department of Internal Medicine, Ghent University, Ghent, Belgium
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Smith V, Beeckman S, Herrick AL, Decuman S, Deschepper E, De Keyser F, Distler O, Foeldvari I, Ingegnoli F, Müller-Ladner U, Riccieri V, Riemekasten G, Sulli A, Voskuyl A, Cutolo M. An EULAR study group pilot study on reliability of simple capillaroscopic definitions to describe capillary morphology in rheumatic diseases. Rheumatology (Oxford) 2016; 55:883-90. [PMID: 26843483 DOI: 10.1093/rheumatology/kev441] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To propose simple capillaroscopic definitions for interpretation of capillaroscopic morphologies and to assess inter-rater reliability. METHODS The simple definitions proposed were: normal--hairpin, tortuous or crossing; abnormal--not hairpin, not tortuous and not crossing; not evaluable--whenever rater undecided between normal and abnormal. Based upon an aimed kappa of 0.80 and default prevalences of normal (0.4), abnormal (0.4) and not evaluable (0.2) capillaries, 90 single capillaries were presented to three groups of raters: experienced independent raters, n = 5; attendees of the sixth EULAR capillaroscopy course, n = 34; novices after a 1-h course, n = 11. Inter-rater agreement was assessed by calculation of proportion of agreement and by kappa coefficients. RESULTS Mean kappa based on 90 capillaries was 0.47 (95% CI: 0.39, 0.54) for expert raters, 0.40 (95% CI: 0.36, 0.44) for attendees and 0.46 (95% CI: 0.41, 0.52) for novices, with overall agreements of 67% (95% CI: 63, 71), 63% (95% CI: 60, 65) and 67% (95% CI: 63, 70), respectively. Comparing only normal vs the combined groups of abnormal and not evaluable capillaries did increase the kappa: 0.51 (95% CI: 0.37 ,: 0.65), 0.53 (95% CI: 0.49, 0.58) and 0.55 (95% CI: 0.49, 0.62). On the condition that the capillaries were classifiable, the mean kappa was 0.62 (95% CI: 0.50, 0.74) for expert raters (n = 65), 0.76 (95% CI: 0.69, 0.83) for attendees (n = 20) and 0.81 (95% CI: 0.74, 0.89) for novices (n = 44). CONCLUSION This multicentre, international study showed moderate reliability of simple capillaroscopic definitions for describing morphology of capillaries by rheumatologists with varying levels of expertise. Novices were capable of distinguishing normal from abnormal capillaries by means of a 1-h training session. In future studies, the class not evaluable may be obsolete.
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Affiliation(s)
- Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Department of Internal Medicine, Ghent University, Ghent, Belgium,
| | - Sam Beeckman
- Department of Rheumatology, Ghent University Hospital, Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Ariane L Herrick
- Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Saskia Decuman
- Department of Rheumatology, Ghent University Hospital, Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Ellen Deschepper
- Biostatistics Unit, Department of Public Health, Ghent University, Ghent, Belgium
| | - Filip De Keyser
- Department of Rheumatology, Ghent University Hospital, Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Oliver Distler
- Division of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Centre for Treatment of Scleroderma and Uveitis in Childhood and Adolescence, Teaching Unit of the Asklepios Campus of the Semmelweis Medical School, Budapest, An der Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - Francesca Ingegnoli
- Division of Rheumatology, Istituto Gaetano Pini, Department of Clinical Sciences & Community Health, University of Milano, Milano, Italy
| | - Ulf Müller-Ladner
- Rheumatology and Clinical Immunology, University of Giessen/Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Valeria Riccieri
- Department of Internal Medicine and Medical Specialities, University Sapienza Rome, Rome, Italy
| | | | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy and
| | - Alexandre Voskuyl
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, Italy and
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Vandecasteele EH, De Pauw M, Brusselle G, Decuman S, Piette Y, De Keyser F, Smith V. The heart and pulmonary arterial hypertension in systemic sclerosis. Acta Clin Belg 2016; 71:1-18. [PMID: 27075793 DOI: 10.1080/17843286.2015.1108538] [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] [Indexed: 10/22/2022]
Abstract
Systemic sclerosis (SSc) is an autoimmune connective tissue disease characterized by vasculopathy and progressive fibrosis of the skin and visceral organs (gastrointestinal tract, heart, kidneys and lungs). Although the prevalence is low, SSc is a disease with high morbidity and mortality. Since pulmonary arterial hypertension (PAH) associated with SSc (SSc-PAH) and clinically evident cardiac involvement is associated with increased mortality, the cardiac complications and PAH in SSc are reviewed. Both diffuse cutaneous (DcSSc) and limited cutaneous (LcSSc) subgroups are at risk for cardiac involvement and SSc-PAH. Cardiac involvement can be divided in pericardial involvement, myocardial involvement and rhythm disturbances and mostly occurs asymptomatically. However, when symptomatic, it is associated with a poor prognosis. Screening for asymptomatic cardiac involvement should be considered in SSc in order to initiate treatment in an early stage. However, there are no randomized controlled trials on treatment options for cardiac involvement in SSc. SSc-PAH is a devastating complication of SSc, which can develop early in DcSSc and LcSSc. Screening for PAH should be performed since screening leads to earlier diagnosis and earlier treatment is associated with a better prognosis. Today, screening is performed by clinical judgement and echocardiography. Recently the DETECT algorithm, a 2-step screening algorithm is proposed in a SSc-subgroup at increased risk for PAH, but further validation is needed. Despite current treatment options with prostacyclins, endothelin-1 receptor antagonists and phosphodiesterase type-5 inhibitors, mortality remains high. Several promising new treatment options for PAH are evaluated in phase II and III clinical trials.
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Willems LM, Redmond AC, Stamm TA, Boström C, Decuman S, Kennedy AT, Brozd J, Roškar S, Smith V, Vliet Vlieland TPM, van den Ende CHM. Content of non-pharmacological care for systemic sclerosis and educational needs of European health professionals: a EUSHNet survey. Clin Exp Rheumatol 2015; 33:S153-S159. [PMID: 26339894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 06/15/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To describe the non-pharmacological care in systemic sclerosis (SSc) provided by European health professionals (HPs) including referrals, treatment targets, interventions, and educational needs. METHODS In this observational study, European HPs working in SSc care were invited to complete an online survey through announcements by EUSTAR (European League Against Rheumatism (EULAR) Scleroderma Trials and Research) and FESCA (Federation of European Scleroderma Associations), the EULAR HPs' newsletter, websites of national patient and HP associations, and by personal invitation. RESULTS In total, 56 HPs, from 14 different European countries and 7 different disciplines, responded to the survey. A total of 133 specific indications for referral were reported, 72% of which could be linked to the International Classification of Functioning, Disability and Health domain "body functions and structures". Of the 681 reported treatment targets 45% was related to "body functions and structures". In total, 105 different interventions were reported as being used to address these treatment targets. Almost all (98%) respondents reported having educational needs, with the topics of management of stiffness (67%), pain (60%), and impaired hand function (56%) being mentioned most frequently. CONCLUSIONS Non-pharmacological care in SSc varies in Europe with respect to the content of interventions, reasons for referral, and treatment targets. Reasons for referral to HPs are not well-aligned to HPs subsequent treatment targets in SSc care suggesting suboptimal communication between physicians and HPs. The wide variations reported indicate a need to consolidate geographically disparate expertise within countries and to develop and improve standards of non-pharmacological care in SSc.
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Affiliation(s)
- Linda M Willems
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
| | - Anthony C Redmond
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds; and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Tanja A Stamm
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Carina Boström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Saskia Decuman
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ann Tyrrell Kennedy
- Federation of the European Scleroderma Associations (FESCA) aisbl., Tournai, Belgium
| | | | - Sanja Roškar
- Private Practice of Physical Therapy, Zagreb, Croatia
| | - Vanessa Smith
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University; and Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
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Decuman S, Smith V, Grypdonck M, De Keyser F, Verhaeghe S. Factors influencing the occupational trajectory of patients with systemic sclerosis: a qualitative study. Clin Exp Rheumatol 2015; 33:S26-S30. [PMID: 25797634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 01/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To describe, from the patient's point of view, the factors influencing the occupational trajectory of patients with systemic sclerosis (SSc). METHODS This was a qualitative study designed using grounded theory with constant comparison. Data were collected through semi-structured interviews with 14 patients who fulfilled the American College of Rheumatology or Leroy-Medsger criteria for SSc. RESULTS Based on our interviews, we found that the occupational trajectory of patients with SSc is influenced by the continuous interplay between four groups of factors. The first group concerns the values patients attribute to work, including identity, normality, financial value, social contact, and structure. The meaning of these values and how they relate to each other underlies the desire to work. A second group of factors is those influencing the balance between daily life, work participation, and medical condition (e.g. job content, flexibility in organising work, and the willingness to ask for accommodations at work). The occupational trajectory is also influenced by external factors, including availability of support, know-ledge of the disease, pressure to work, contact with medical professionals, and existing regulations and the patient's knowledge about them. Finally, the occupational trajectory is influenced by personal factors, including socio-demographics, psychological assets, and disease- and work-related personal factors. CONCLUSIONS The decisions patients with SSc take concerning work depend on an interplay between many factors and, especially, on the patients' personal interpretation of these factors. These need to be taken into account when helping patients with SSc determine their occupational trajectory.
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Affiliation(s)
- Saskia Decuman
- Faculty of Medicine and Health Sciences, Department of Internal Medicine, Ghent University; and Department of Rheumatology, Ghent University Hospital, Belgium.
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Belgium
| | - Maria Grypdonck
- Faculty of Medicine and Health Sciences, Department of Public Health - Nursing Science, Ghent University, Belgium
| | - Filip De Keyser
- Faculty of Medicine and Health Sciences, Department of Internal Medicine, Ghent University; and Department of Rheumatology, Ghent University Hospital, Belgium
| | - Sofie Verhaeghe
- Faculty of Medicine and Health Sciences, Department of Public Health - Nursing Science, Ghent University, Belgium
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Vandecasteele E, Decuman S, De Pauw M, Deschepper E, Brusselle G, De Keyser F, Smith V. AB0691 Six-Minute Walk Test in Systemic Sclerosis: A Systematic Review and Meta-Analysis: Table 1. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2770] [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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Smith V, Beeckman S, Herrick A, Decuman S, Deschepper E, Riccieri V, Sulli A, De Keyser F, Müller-Ladner U, Ingegnoli F, Cutolo M. AB1086 An Eular Study Group Pilot Study on Reliability of “Simple” Capillaroscopic Definitions to Describe Capillary Morphology in Rheumatic Diseases. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1484] [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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Ruaro B, Smith V, Sulli A, Decuman S, Pizzorni C, Cutolo M. Methods for the morphological and functional evaluation of microvascular damage in systemic sclerosis. Korean J Intern Med 2015; 30:1-5. [PMID: 25589827 PMCID: PMC4293547 DOI: 10.3904/kjim.2015.30.1.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 11/10/2014] [Indexed: 11/27/2022] Open
Abstract
Systemic sclerosis is a connective tissue disease characterized by alterations in microvascular structure and function. In these patients, numerous studies have demonstrated a relationship between capillary morphology and peripheral blood perfusion. Nailfold videocapillaroscopy reveals the peripheral microvascular morphology and thus allows classification and scoring of capillary abnormalities with respect to different microangiopathy patterns (early, active, and late). Laser Doppler flowmetry and laser speckle contrast analysis can be used to estimate cutaneous blood flow through microvessels and to assess and quantify blood perfusion at peripheral sites. These two methods are also used to identify changes in digital blood perfusion after the infusion of vasodilators.
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Affiliation(s)
- Barbara Ruaro
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Gent, Belgium
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Saskia Decuman
- Department of Rheumatology, Ghent University Hospital, Gent, Belgium
| | - Carmen Pizzorni
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy
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Decuman S, Smith V, Verhaeghe STL, Van Hecke A, De Keyser F. Work participation in patients with systemic sclerosis: a systematic review. Clin Exp Rheumatol 2014; 32:S-206-13. [PMID: 25372803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 01/08/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES With this systematic review an overview is given of what is known about work participation in patients with systemic sclerosis (SSc). METHODS The databases Pubmed, Cinahl, Nursing and Allied Health and PsychARTICLES have been checked from 1980 onwards. The search string consisted of all combinations of key words for work participation and SSc. Two investigators evaluated the eligibility for the articles. Reference lists were searched for other studies. RESULTS Eight quantitative and one qualitative study were scrutinised in depth. The percentage of patients not working ranges from 18% to 61%. A meta-analysis of the percentage patients not working was performed and a weight mean of 37% was found. The following parameters are associated with the work variable in multivariate analysis (number of studies in which the variable was independently associated with the work variable/number of studies in which the variable was multivariately assessed): global disability (4/5), health (3/5), educational level (2/4), disease duration (3/3), skin/lung involvement (1/3), age/fatigue/muscle involvement/hand function (1/2) and having a decreased income/race/social support/physically demanding job (1/1). In the qualitative study, management of the work situation, disclosure of limitations at the work force and adaptation of resources in daily life are discussed. CONCLUSIONS Most studies concerning work participation are at this very moment quantitative and cross-sectionally designed. Longitudinal studies are needed to assess causality and qualitative research may be opportune to have a more comprehensive view on the topic of work participation in patients with SSc.
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Affiliation(s)
- S Decuman
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, Belgium.
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Janssens X, Decuman S, De Keyser F. Assessment of activity limitations with the health assessment questionnaire predicts the need for support measures in patients with rheumatoid arthritis: a multicenter observational study. PLoS One 2014; 9:e106749. [PMID: 25188388 PMCID: PMC4154727 DOI: 10.1371/journal.pone.0106749] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 01/08/2014] [Accepted: 08/09/2014] [Indexed: 11/18/2022] Open
Abstract
Objective This study investigated whether the Health Assessment Questionnaire (HAQ) can be used as an instrument to assess the need for social support measures that address activity limitations and participation issues in patients with rheumatoid arthritis (RA). Methods This multicenter observational study included patients with RA and disease duration of at least one year, consulting their rheumatologist for routine evaluation of disease activity. In the single study visit data on demographics, disease history and current treatment were collected. DAS28 values were collected to evaluate current RA disease activity. Patients were asked to fill out the HAQ and SF-36 questionnaires. Receiver Operator Characteristics (ROC) curves were constructed to evaluate the performance of the HAQ, SF-36 and DAS28 in predicting the need for nine supporting measures available for chronically ill patients in the Belgian social security system. The expert opinion of the treating rheumatologist was used as a reference. Results The study included 316 patients with a mean age of 59.8±12.6 years, disease duration of 11.4±9.3 years, mean DAS28 values of 2.83±1.17. Mean HAQ score was 0.95±0.73, mean SF-36 score 56.5±21.3. HAQ scores >1 were observed in 39.4% of patients. The area under the HAQ ROC curve was consistently >0.7 and higher for the HAQ than for SF-36 or DAS28 for all support measures. Rheumatologists on average recommended 3.67 support measures. Conclusion The HAQ score was found to be a good predictor of the need for social support measures in patients with RA.
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Affiliation(s)
- Xavier Janssens
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- * E-mail:
| | - Saskia Decuman
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine, Ghent University, Ghent, Belgium
| | - Filip De Keyser
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
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Willems L, Redmond A, Stamm T, Boström C, Decuman S, Tyrrell Kennedy A, Brozd J, Roškar S, Smith V, van den Ende C. SAT0593-HPR Non-Pharmacological Care Provided in Clinical Practice to Treat Patients with Systemic Sclerosis: an International Survey Conducted on Behalf of the Eular Scleroderma Health Professionals Network (EUSHNET). Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2090] [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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Decuman S, Smith V, Grypdonck M, Verhaeghe S, De Keyser F. FRI0593-HPR Factors Influencing the Occupational Trajectory of Patients with Systemic Sclerosis: A Qualitative Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3081] [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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Smith V, Riccieri V, Pizzorni C, Decuman S, Deschepper E, Bonroy C, Sulli A, Piette Y, De Keyser F, Cutolo M. Nailfold capillaroscopy for prediction of novel future severe organ involvement in systemic sclerosis. J Rheumatol 2013; 40:2023-8. [PMID: 24128778 DOI: 10.3899/jrheum.130528] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Assessment of associations of nailfold videocapillaroscopy (NVC) scleroderma (systemic sclerosis; SSc) ("early," "active," and "late") with novel future severe clinical involvement in 2 independent cohorts. METHODS Sixty-six consecutive Belgian and 82 Italian patients with SSc underwent NVC at baseline. Images were blindly assessed and classified into normal, early, active, or late NVC pattern. Clinical evaluation was performed for 9 organ systems (general, peripheral vascular, skin, joint, muscle, gastrointestinal tract, lung, heart, and kidney) according to the Medsger disease severity scale (DSS) at baseline and in the future (18-24 months of followup). Severe clinical involvement was defined as category 2 to 4 per organ of the DSS. Logistic regression analysis (continuous NVC predictor variable) was performed. RESULTS The OR to develop novel future severe organ involvement was stronger according to more severe NVC patterns and similar in both cohorts. In simple logistic regression analysis the OR in the Belgian/Italian cohort was 2.16 (95% CI 1.19-4.47, p = 0.010)/2.33 (95% CI 1.36-4.22, p = 0.002) for the early NVC SSc pattern, 4.68/5.42 for the active pattern, and 10.14/12.63 for the late pattern versus the normal pattern. In multiple logistic regression analysis, adjusting for disease duration, subset, and vasoactive medication, the OR was 2.99 (95% CI 1.31-8.82, p = 0.007)/1.88 (95% CI 1.00-3.71, p = 0.050) for the early NVC SSc pattern, 8.93/3.54 for the active pattern, and 26.69/6.66 for the late pattern versus the normal pattern. CONCLUSION Capillaroscopy may be predictive of novel future severe organ involvement in SSc, as attested by 2 independent cohorts.
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Affiliation(s)
- Vanessa Smith
- From the Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine and Medical Specialities, University Sapienza, Rome; Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy; Department of Internal Medicine, Biostatistics Unit, Department of Public Health, Ghent University, and Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
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Janssens X, Decuman S, De Keyser F. Construction and psychometric properties of the Belgian Rheumatoid Arthritis Disability Assessment (BRADA) questionnaire: a new tool for the evaluation of activity limitations in patients with rheumatoid arthritis. Clin Exp Rheumatol 2013; 31:596-605. [PMID: 23899969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 02/05/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To describe the construction and psychometric properties of the Belgian Rheumatoid Arthritis Disability Assessment (BRADA) questionnaire, a self-report tool to evaluate chronic activity limitations in patients with rheumatoid arthritis (RA). The BRADA was developed to assess the eligibility of patients with RA for financial and social support measures. METHODS The BRADA questionnaire evaluates functioning in 6 functional domains (mobility, nutrition, self care, household tasks, awareness of danger and communication) over the past week and the past 3 months. To assess the psychometric properties of the BRADA, patients with moderate to severe RA filled out the BRADA, HAQ-DI and SF-36 questionnaires twice, with a four-week interval. At each visit, the total number of swollen and tender joints, and global disease activity were recorded. DAS 28 was measured at the first visit. Internal consistency of items per domain was evaluated with Cronbach's alpha method. Intraclass correlation coefficient (ICC) analysis was used to assess test-retest reliability. BRADA scores were compared to HAQ, SF-36 scores and disease activity parameters with Spearman's Rho correlation coefficients to assess construct validity. RESULTS Experts considered the content and face validity of BRADA to be adequate. Internal consistency was satisfactory for all functional domains (alpha >0.75), as was the test-retest reliability (ICC 0.78). BRADA scores showed excellent correlation with other validated questionnaires in RA (HAQ-DI, SF-36) and with measures of disease activity (VAS, DAS28)(p<0.001). CONCLUSIONS Its psychometric properties indicate that the BRADA questionnaire is a suitable instrument to evaluate disease-specific activity limitations in patients with RA.
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Affiliation(s)
- Xavier Janssens
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.
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Smith V, Pizzorni C, Decuman S, Bonroy C, Van Praet L, Deschepper E, De Keyser F, Cutolo M. FRI0267 Are worsening scleroderma capillaroscopic patterns associated with severe organ involvement in systemic sclerosis?: A pilot study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2724] [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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Janssens X, Decuman S, De Keyser F. FRI0458 Construction and validation of the belgian ra disability assessment (BRADA) questionnaire for evaluating activity limitations in patients with rheumatoid arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2915] [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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Smith V, Decuman S, Sulli A, Riccieri V, Bonroy C, Piette Y, Deschepper E, De Keyser F, Cutolo M. OP0225 Do worsening scleroderma capillaroscopic patterns predict novel future severe organ involvement in systemic sclerosis? A pilot study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1908] [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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Decuman S, Smith V, Verhaeghe S, Grypdonck M, De Keyser F. FRI0489-HPR Meaning of work in patients with systemic sclerosis: A qualitative study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2945] [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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Willems LM, Redmond AC, Braschi F, Stamm TA, Boström C, Decuman S, Tyrrell Kennedy A, Brozd J, Roškar S, Smith V, van den Ende CH. OP0100-HPR Educational Needs Among Health Professionals Working with Systemic Sclerosis: An International Survey Conducted on Behalf of the Eular Scleroderma Health Professionals Network (EUSHNet). Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.305] [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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Smith V, Piette Y, van Praet JT, Decuman S, Deschepper E, Elewaut D, De Keyser F. Two-year results of an open pilot study of a 2-treatment course with rituximab in patients with early systemic sclerosis with diffuse skin involvement. J Rheumatol 2012; 40:52-7. [PMID: 23118116 DOI: 10.3899/jrheum.120778] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To study safety and potential efficacy of a 2-treatment course (month 0/6) with rituximab (RTX) in early diffuse systemic sclerosis (dcSSc). METHODS Two years' followup (open-label study) was done of 8 patients with early dcSSc. Patients received an infusion of 1000 mg RTX 2 times at months 0 and 6, with 100 mg methylprednisolone. Clinical measurements, Disease Activity Score, functional status, and CD19+ peripheral blood count were performed at months 0, 3, 6, 12, 15, 18, and 24 and histopathological evaluation of the skin at months 0, 3, 12, and 24. RESULTS There was a clinically significant change in skin score, with a mean Modified Rodnan skin score of 24.8 at baseline (SD 3.4) and 13.6 at Month 24 [SD 5.6; mixed models analyses (MMA) p < 0.0001] and a significant decrease in Disease Activity Score (DAS), with a median of 4.5 at baseline (range 1.5-7.5) and 0.5 at Month 24 (range 0.0-5.5; MMA p < 0.0001). Indices of internal organ involvement remained stable throughout the study. RTX induced effective B cell depletion at baseline and Month 6 (< 5 CD19+ cells/μl blood). The blindly assessed hyalinized collagen score changed significantly over time (MMA p = 0.009), with a mean of 69.3 at baseline (SD 22.8) and 33.1 at 24 months (SD 27.0). Five serious adverse events were considered unrelated to the RTX treatment. CONCLUSION A 2-treatment course (months 0/6) with RTX appears to be well tolerated and may have potential efficacy for skin disease and stabilization of internal organ status in early dcSSc. Clinical Trials Registration NCT00379431.
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Affiliation(s)
- Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.
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Smith V, Decuman S, Sulli A, Bonroy C, Piettte Y, Deschepper E, de Keyser F, Cutolo M. Do worsening scleroderma capillaroscopic patterns predict future severe organ involvement? a pilot study. Ann Rheum Dis 2012; 71:1636-9. [DOI: 10.1136/annrheumdis-2011-200780] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [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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Decuman S, Smith V, Verhaeghe S, Deschepper E, Vermeiren F, De Keyser F. Work participation and work transition in patients with systemic sclerosis: a cross-sectional study. Rheumatology (Oxford) 2011; 51:297-304. [PMID: 21972420 DOI: 10.1093/rheumatology/ker288] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To describe work participation and work transition due to health in patients with SSc. Associations are assessed between having made a work transition or not and factors possibly influencing that transition. METHODS This study included patients visiting the Scleroderma Clinic of the Ghent University Hospital, who regularly undergo an extensive evaluation. For this study, a questionnaire was used to collect work participation and work transition data. RESULTS Eighty-four patients in the adult working-age population were included. Thirty-eight (45%) out of 84 patients participated in the labour force. Forty-six (55%) out of 84 were not engaged in a paid job; in 34 (74%) out of 46 patients this was attributed to health issues. Seventy-six (90%) out of 84 patients made a work transition. Forty-seven (62%) out of 76 made that transition due to health reasons. The group that made a health-related work transition (47/84, 56%) was compared with the remaining group (37/84, 44%) that made no work transition or a work transition for reasons other than health. There was a significant difference in educational level, skin score, lung disease severity, disease activity, disease duration, scleroderma Health Assessment Questionnaire (sHAQ), visual analogue scale (VAS) for RP, VAS for intestinal disease, VAS for overall disease, VAS for pain, Medical Outcomes Study short form 36 (SF-36), work statute and willingness to participate in training. The multivariate analysis retained sHAQ, SF-36 and disease duration as associating variables. CONCLUSIONS Work participation is limited in patients with SSc and a majority make a work transition because of health problems. Demographic, disease- and work-related variables, as well as willingness to participate in training are associated with (the occurrence of) work transition.
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Affiliation(s)
- Saskia Decuman
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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Smith V, De Keyser F, Pizzorni C, Van Praet JT, Decuman S, Sulli A, Deschepper E, Cutolo M. Nailfold capillaroscopy for day-to-day clinical use: construction of a simple scoring modality as a clinical prognostic index for digital trophic lesions. Ann Rheum Dis 2010; 70:180-3. [DOI: 10.1136/ard.2010.132431] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Smith V, Pizzorni C, De Keyser F, Decuman S, Van Praet JT, Deschepper E, Sulli A, Cutolo M. Reliability of the qualitative and semiquantitative nailfold videocapillaroscopy assessment in a systemic sclerosis cohort: a two-centre study. Ann Rheum Dis 2010; 69:1092-6. [DOI: 10.1136/ard.2009.115568] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [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
ObjectiveInvestigation of the reliability of the qualitative and semiquantitative scoring of nailfold videocapillaroscopy (NVC) assessment between two raters in a systemic sclerosis (SSc) cohort.MethodsTwo raters from different centres blindly assessed the NVC images of 71 consecutive patients with SSc qualitatively as belonging to the scleroderma spectrum (SDS) category (‘early’, ‘active’, ‘late’ scleroderma pattern or ‘scleroderma-like’ pattern) or to the ‘normal’ category and semiquantitatively by calculating the mean score for capillary loss, giant capillaries, microhaemorrhages and capillary ramifications. Inter-rater/intrarater agreement was assessed by calculation of the proportion of agreement and by κ coefficients. Rater agreement of mean score values of hallmark parameters was assessed by intraclass correlation coefficients.ResultsThe inter-rater/intrarater proportion of agreement to qualitatively assess an image as belonging to the SDS category or not was 90% and 96%, whereas the agreement to distinguish between only ‘early’, ‘active’ and ‘late’ scleroderma NVC patterns was 62% and 81%. The agreement of the semiquantitative scoring, as assessed by intraclass correlation coefficient, was 0.96 and 0.95 for capillary loss, 0.84 and 0.95 for giant capillaries, 0.90 and 0.95 for microhaemorrhages and 0.64 and 0.95 for capillary ramifications.ConclusionsThis is the first study to demonstrate reliability of the qualitative and semiquantitative NVC assessment in an SSc cohort between raters at different centres. Reliability of NVC assessment is essential for use of this tool in multicentre SSc trials.
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Smith V, Van Praet JT, Vandooren B, Van der Cruyssen B, Naeyaert JM, Decuman S, Elewaut D, De Keyser F. Rituximab in diffuse cutaneous systemic sclerosis: an open-label clinical and histopathological study. Ann Rheum Dis 2010; 69:193-7. [PMID: 19103636 DOI: 10.1136/ard.2008.095463] [Citation(s) in RCA: 169] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The safety and potential efficacy of rituximab was examined in diffuse cutaneous systemic sclerosis (dc-SSc). METHODS A 24 week open-label study in which eight patients with dc-SSc received an infusion of 1000 mg rituximab administered at baseline and day 15, together with 100 mg methylprednisolone at each infusion. Assessment included CD19+ peripheral blood lymphocyte number, skin sclerosis score, indices of internal organ functioning, the health assessment questionnaire disability index, the 36-item Short Form health survey and histopathological evaluation of the skin. RESULTS Ritixumab induced effective B-cell depletion in all patients (<5 CD19+ cells/microl blood). There was a significant change in skin score at week 24 (p<0.001). Also, significant improvements were measured in the dermal hyalinised collagen content (p = 0.014) and dermal myofibroblast numbers (p = 0.011). Two serious adverse events occurred, which were thought to be unrelated to the rituximab treatment. CONCLUSIONS Rituximab appears to be well tolerated and may have potential efficacy for skin disease in dc-SSc.
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Affiliation(s)
- V Smith
- Department of Rheumatology, Ghent University Hospital 0K12-IB, De Pintelaan 185, B-9000, Gent, Belgium.
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