1
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Barbhaiya M, Zuily S, Naden R, Hendry A, Manneville F, Amigo MC, Amoura Z, Andrade D, Andreoli L, Artim-Esen B, Atsumi T, Avcin T, Belmont HM, Bertolaccini ML, Branch DW, Carvalheiras G, Casini A, Cervera R, Cohen H, Costedoat-Chalumeau N, Crowther M, de Jesus G, Delluc A, Desai S, De Sancho M, Devreese KM, Diz-Kucukkaya R, Duarte-Garcia A, Frances C, Garcia D, Gris JC, Jordan N, Leaf RK, Kello N, Knight JS, Laskin C, Lee AI, Legault K, Levine SR, Levy RA, Limper M, Lockshin MD, Mayer-Pickel K, Musial J, Meroni PL, Orsolini G, Ortel TL, Pengo V, Petri M, Pons-Estel G, Gomez-Puerta JA, Raimboug Q, Roubey R, Sanna G, Seshan SV, Sciascia S, Tektonidou MG, Tincani A, Wahl D, Willis R, Yelnik C, Zuily C, Guillemin F, Costenbader K, Erkan D. The 2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria. Arthritis Rheumatol 2023; 75:1687-1702. [PMID: 37635643 DOI: 10.1002/art.42624] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/14/2023] [Accepted: 05/30/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE To develop new antiphospholipid syndrome (APS) classification criteria with high specificity for use in observational studies and trials, jointly supported by the American College of Rheumatology (ACR) and EULAR. METHODS This international multidisciplinary initiative included 4 phases: 1) Phase I, criteria generation by surveys and literature review; 2) Phase II, criteria reduction by modified Delphi and nominal group technique exercises; 3) Phase III, criteria definition, further reduction with the guidance of real-world patient scenarios, and weighting via consensus-based multicriteria decision analysis, and threshold identification; and 4) Phase IV, validation using independent adjudicators' consensus as the gold standard. RESULTS The 2023 ACR/EULAR APS classification criteria include an entry criterion of at least one positive antiphospholipid antibody (aPL) test within 3 years of identification of an aPL-associated clinical criterion, followed by additive weighted criteria (score range 1-7 points each) clustered into 6 clinical domains (macrovascular venous thromboembolism, macrovascular arterial thrombosis, microvascular, obstetric, cardiac valve, and hematologic) and 2 laboratory domains (lupus anticoagulant functional coagulation assays, and solid-phase enzyme-linked immunosorbent assays for IgG/IgM anticardiolipin and/or IgG/IgM anti-β2 -glycoprotein I antibodies). Patients accumulating at least 3 points each from the clinical and laboratory domains are classified as having APS. In the validation cohort, the new APS criteria versus the 2006 revised Sapporo classification criteria had a specificity of 99% versus 86%, and a sensitivity of 84% versus 99%. CONCLUSION These new ACR/EULAR APS classification criteria were developed using rigorous methodology with multidisciplinary international input. Hierarchically clustered, weighted, and risk-stratified criteria reflect the current thinking about APS, providing high specificity and a strong foundation for future APS research.
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Affiliation(s)
- Medha Barbhaiya
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Stephane Zuily
- Vascular Medicine Division, French National Referral Center for Systemic and Autoimmune Diseases, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, F-54000, Nancy, France
| | - Ray Naden
- Department of Medicine and Obstetrics, Auckland City Hospital, Auckland, New Zealand
| | - Alison Hendry
- Department of General Medicine, Middlemore Hospital, Counties Manukau Health District, Auckland, New Zealand
| | - Florian Manneville
- CIC Clinical epidemiology, CHRU Nancy, Inserm, Université de Lorraine, Nancy, France
| | - Mary-Carmen Amigo
- Department of Internal Medicine, Service of Rheumatology, ABC Medical Center, Mexico DF, Mexico
| | - Zahir Amoura
- French National Reference Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome, Service de Medecine Interne 2, Hopital Pitie-Salpetriére; Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Universite, Paris, France
| | - Danieli Andrade
- Department of Rheumatology, University of Sao Paulo, Sao Paulo, Brazil
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - Bahar Artim-Esen
- Department of Rheumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology, and Nephrology, Hokkaido University, Sapporo, Japan
| | - Tadej Avcin
- Department of Allergology, Rheumatology, and Clinical Immunology, Children's Hospital, University Medical Center, University of Ljubljana, Ljubljana, Slovenia
| | - H Michael Belmont
- Department of Rheumatology, Hospital for Joint Disease, New York University, New York, New York
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, School of Cardiovascular and Metabolic Medicine & Sciences, King's College, London, UK
| | - D Ware Branch
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Graziela Carvalheiras
- Unidade de Imunologia Clínica, Departamento de Medicina Interna, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Alessandro Casini
- Division of Angiology and Hemostasis, University Hospital of Geneva, Geneva, Switzerland
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Hannah Cohen
- Department of Haematology, University College London, London, UK
| | - Nathalie Costedoat-Chalumeau
- Service de médecine interne, Centre de reference maladies autoimmunes et systémiques rares Île de France, APHP, Hopital Cochin, Université de Paris, Centre de recherche épidémiologie et biostatistiques de Sorbonne Paris Cité, F-75004 Paris, France
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Guilherme de Jesus
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aurelien Delluc
- Department of Medicine, University Ottawa, and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sheetal Desai
- Division of Rheumatology, University of California, Irvine, California
| | - Maria De Sancho
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, New York
| | - Katrien M Devreese
- Coagulation Laboratory, Department of Laboratory Medicine, Ghent University Hospital, and Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Reyhan Diz-Kucukkaya
- Department of Molecular Biology and Genetics, Istanbul University School of Science, Istanbul, Turkey
| | | | - Camille Frances
- Department of Dermatology-Allergology, Tenon Hospital, Paris, France
| | - David Garcia
- Department of Hematology, University of Washington, Seattle, Washington
| | - Jean-Christophe Gris
- Department of Hematology, CHRU-Nimes, UMR UA11 INSERM-University of Montpellier, France
| | - Natasha Jordan
- Department of Rheumatology, Addenbrooke's Hospital, Cambridge, UK
| | - Rebecca K Leaf
- Department of Hematology, Massachusetts General Hospital, Boston, Massachusetts
| | - Nina Kello
- Division of Rheumatology, Northwell Health, Great Neck, New York
| | - Jason S Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan
| | - Carl Laskin
- Division of Rheumatology, University of Toronto, TRIO Fertility, Toronto, Canada
| | - Alfred I Lee
- Department of Hematology, Yale School of Medicine, New Haven, Connecticut
| | - Kimberly Legault
- Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada
| | - Steve R Levine
- Downstate Stroke Center, State University of New York Downstate Health Sciences University, Kings County Hospital Center, and Maimonides Medical Center/Jaffe Stroke Center, Brooklyn, New York
| | - Roger A Levy
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil, and GlaxoSmithKline, Collegeville, Pennsylvania
| | - Maarten Limper
- Department of Medicine and Clinical Immunology, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Michael D Lockshin
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | | | - Jack Musial
- Department of Medicine, Jagiellonian University School of Medicine, Krakow, Poland
| | - Pier Luigi Meroni
- Immunorheumatology Research Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Thomas L Ortel
- Division of Hematology, Duke University Medical Center, Durham, North Carolina
| | - Vittorio Pengo
- Department of Cardiology, University Hospital, Padova, Italy
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Guillermo Pons-Estel
- Department of Rheumatology, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | | | - Quentin Raimboug
- Department of Nephrology, Bichat University Hospital, Paris, France
| | - Robert Roubey
- Department of Rheumatology, University of North Carolina, Chapel Hill, North Carolina
| | - Giovanni Sanna
- Department of Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Surya V Seshan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Turin, Italy, and University of Turin, Torino, Italy
| | - Maria G Tektonidou
- Joint Academic Rheumatology Program, First Propaedeutic and Internal Medicine Program, National and Kapodistrian University of Athens, Athens, Greece
| | - Angela Tincani
- Department of Rheumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Denis Wahl
- Vascular Medicine Division, French National Referral Center for Systemic and Autoimmune Diseases, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, F-54000, Nancy, France
| | - Rohan Willis
- Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, Texas
| | - Cecile Yelnik
- Department of Internal Medicine and Immunology, Université de Lille, CHU Lille, INSERM, UMR 1167, F-59000 Lille, France
| | - Catherine Zuily
- Department of Obstetrics, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, F-54000, Nancy, France
| | - Francis Guillemin
- CIC Clinical epidemiology, CHRU Nancy, Inserm, Université de Lorraine, Nancy, France
| | - Karen Costenbader
- Department of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
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2
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Barbhaiya M, Zuily S, Naden R, Hendry A, Manneville F, Amigo MC, Amoura Z, Andrade D, Andreoli L, Artim-Esen B, Atsumi T, Avcin T, Belmont HM, Bertolaccini ML, Branch DW, Carvalheiras G, Casini A, Cervera R, Cohen H, Costedoat-Chalumeau N, Crowther M, de Jesús G, Delluc A, Desai S, Sancho MD, Devreese KM, Diz-Kucukkaya R, Duarte-García A, Frances C, Garcia D, Gris JC, Jordan N, Leaf RK, Kello N, Knight JS, Laskin C, Lee AI, Legault K, Levine SR, Levy RA, Limper M, Lockshin MD, Mayer-Pickel K, Musial J, Meroni PL, Orsolini G, Ortel TL, Pengo V, Petri M, Pons-Estel G, Gomez-Puerta JA, Raimboug Q, Roubey R, Sanna G, Seshan SV, Sciascia S, Tektonidou MG, Tincani A, Wahl D, Willis R, Yelnik C, Zuily C, Guillemin F, Costenbader K, Erkan D. 2023 ACR/EULAR antiphospholipid syndrome classification criteria. Ann Rheum Dis 2023; 82:1258-1270. [PMID: 37640450 DOI: 10.1136/ard-2023-224609] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/21/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To develop new antiphospholipid syndrome (APS) classification criteria with high specificity for use in observational studies and trials, jointly supported by the American College of Rheumatology (ACR) and EULAR. METHODS This international multidisciplinary initiative included four phases: (1) Phase I, criteria generation by surveys and literature review; (2) Phase II, criteria reduction by modified Delphi and nominal group technique exercises; (3) Phase III, criteria definition, further reduction with the guidance of real-world patient scenarios, and weighting via consensus-based multicriteria decision analysis, and threshold identification; and (4) Phase IV, validation using independent adjudicators' consensus as the gold standard. RESULTS The 2023 ACR/EULAR APS classification criteria include an entry criterion of at least one positive antiphospholipid antibody (aPL) test within 3 years of identification of an aPL-associated clinical criterion, followed by additive weighted criteria (score range 1-7 points each) clustered into six clinical domains (macrovascular venous thromboembolism, macrovascular arterial thrombosis, microvascular, obstetric, cardiac valve, and hematologic) and two laboratory domains (lupus anticoagulant functional coagulation assays, and solid-phase enzyme-linked immunosorbent assays for IgG/IgM anticardiolipin and/or IgG/IgM anti-β2-glycoprotein I antibodies). Patients accumulating at least three points each from the clinical and laboratory domains are classified as having APS. In the validation cohort, the new APS criteria vs the 2006 revised Sapporo classification criteria had a specificity of 99% vs 86%, and a sensitivity of 84% vs 99%. CONCLUSION These new ACR/EULAR APS classification criteria were developed using rigorous methodology with multidisciplinary international input. Hierarchically clustered, weighted, and risk-stratified criteria reflect the current thinking about APS, providing high specificity and a strong foundation for future APS research.
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Affiliation(s)
- Medha Barbhaiya
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Stephane Zuily
- Vascular Medicine Division, French National Referral Center for Systemic and Autoimmune Diseases, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, Nancy, France
| | - Ray Naden
- Department of Medicine and Obstetrics, Auckland City Hospital, Auckland, New Zealand
| | - Alison Hendry
- Department of General Medicine, Middlemore Hospital, Auckland, New Zealand
| | - Florian Manneville
- CIC Clinical Epidemiology, CHRU Nancy, Inserm, Université de Lorraine, Nancy, France
| | - Mary-Carmen Amigo
- Department of Internal Medicine, Service of Rheumatology, ABC Medical Center, Mexico, Mexico
| | - Zahir Amoura
- French National Reference Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome, Service de Medecine Interne 2, Hopital Pitie-Salpetriére; Centre d'Immunologie et des Maladies Infectieuses, Sorbonne Universite, Paris, France
| | - Danieli Andrade
- Department of Rheumatology, University of Sao Paulo, Sao Paulo, Brazil
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - Bahar Artim-Esen
- Department of Rheumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology, and Nephrology, Hokkaido University, Sapporo, Japan
| | - Tadej Avcin
- Department of Allergology, Rheumatology, and Clinical Immunology, Children's Hospital, University Medical Center, University of Ljubljana, Ljubljana, Slovenia
| | - H Michael Belmont
- Department of Rheumatology, Hospital for Joint Disease, New York University, New York, New York, USA
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, School of Cardiovascular and Metabolic Medicine & Sciences, King's College, London, UK
| | - D Ware Branch
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah, USA
| | - Graziela Carvalheiras
- Unidade de Imunologia Clínica, Departamento de Medicina Interna, Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Alessandro Casini
- Division of Angiology and Hemostasis, University Hospital of Geneva, Geneva, Switzerland
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Hannah Cohen
- Department of Haematology, University College London, London, UK
| | - Nathalie Costedoat-Chalumeau
- Service de médecine interne, Centre de reference maladies autoimmunes et systémiques rares Île de France, APHP, Hopital Cochin, Université de Paris, Centre de recherche épidémiologie et biostatistiques de Sorbonne Paris Cité, Paris, France
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Guilherme de Jesús
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Aurelien Delluc
- Department of Medicine, University Ottawa, and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sheetal Desai
- Division of Rheumatology, University of California, Irvine, California, USA
| | - Maria De Sancho
- Division of Hematology and Oncology, Weill Cornell Medicine, New York, New York, USA
| | - Katrien M Devreese
- Coagulation Laboratory, Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Reyhan Diz-Kucukkaya
- Department of Molecular Biology and Genetics, Istanbul University School of Science, Istanbul, Turkey
| | | | - Camille Frances
- Department of Dermatology-Allergology, Tenon Hospital, Paris, France
| | - David Garcia
- Department of Hematology, University of Washington, Seattle, Washington, USA
| | - Jean-Christophe Gris
- Department of Hematology, CHRU-Nimes, UMR UA11 INSERM-University of Montpellier, Montpellier, France
| | - Natasha Jordan
- Department of Rheumatology, Addenbrooke's Hospital, Cambridge, UK
| | - Rebecca K Leaf
- Department of Hematology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nina Kello
- Division of Rheumatology, Northwell Health, Great Neck, New York, New York, USA
| | - Jason S Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Carl Laskin
- Division of Rheumatology, University of Toronto, TRIO Fertility, Toronto, Ontario, Canada
| | - Alfred I Lee
- Department of Hematology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kimberly Legault
- Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada
| | - Steve R Levine
- Downstate Stroke Center, State University of New York Downstate Health Sciences University, Kings County Hospital Center, and Maimonides Medical Center/Jaffe Stroke Center, Brooklyn, New York, USA
| | - Roger A Levy
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
- GlaxoSmithKline, Collegeville, Pennsylvania, USA
| | - Maarten Limper
- Department of Medicine and Clinical Immunology, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Michael D Lockshin
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Jack Musial
- Department of Medicine, Jagiellonian University School of Medicine, Krakow, Poland
| | - Pier Luigi Meroni
- Immunorheumatology Research Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Giovanni Orsolini
- Department of Rheumatology, University Hospitals of Verona, Verona, Italy
| | - Thomas L Ortel
- Division of Hematology, Duke University Medical Center, Durham, North Carolina, USA
| | - Vittorio Pengo
- Department of Cardiology, University Hospital, Padova, Italy
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Guillermo Pons-Estel
- Department of Rheumatology, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | | | - Quentin Raimboug
- Department of Nephrology, Bichat University Hospital, Paris, France
| | - Robert Roubey
- Department of Rheumatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Giovanni Sanna
- Department of Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Surya V Seshan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Savino Sciascia
- Department of Clinical and Biological Sciences, Center of Research of Immunopathology and Rare Diseases, SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Turin, Italy
- University of Turin, Torino, Italy
| | - Maria G Tektonidou
- Joint Academic Rheumatology Program, First Propaedeutic and Internal Medicine Program, National and Kapodistrian University of Athens, Athens, Greece
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - Denis Wahl
- Vascular Medicine Division, French National Referral Center for Systemic and Autoimmune Diseases, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, Nancy, France
| | - Rohan Willis
- Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Cécile Yelnik
- Department of Internal Medicine and Immunology, Université de Lille, CHU Lille, INSERM, UMR 1167, Lille, France
| | - Catherine Zuily
- Department of Obstetrics, Université de Lorraine, Inserm, DCAC, and CHRU-Nancy, Nancy, France
| | - Francis Guillemin
- CIC Clinical Epidemiology, CHRU Nancy, Inserm, Université de Lorraine, Nancy, France
| | - Karen Costenbader
- Department of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
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Khadilkar P, Chougule D, Tipnis T, Khopkar U, Nadkar M, Rajadhyaksha A, Kini S, Kharkar V, Athvale A, Athvale T, Madkaikar M, Pradhan V. A comparative study of modulatory interaction between cytokines and apoptotic proteins among Scleroderma patients with and without pulmonary involvement. Cytokine 2023; 166:156183. [PMID: 37011542 DOI: 10.1016/j.cyto.2023.156183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/02/2023] [Accepted: 03/13/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) are the most eminent forms of pulmonary involvement in Scleroderma. In this study we investigate the interaction between cytokines and apoptotic proteins in treatment naive Scleroderma (SSc) patients with and without pulmonary involvement. METHODS Newly diagnosed treatment naïve Scleroderma (SSc) patients (n = 100) and healthy controls (n = 100) were enrolled. Patients were classified as ILD-SSc, PAH-SSc and non-pulmonary SSc (np-SSc). Study variables like mRSS score, autoantibody profile, serum cytokines, serum TGF-β (1,2,3) and apoptotic proteins were assessed for these patients. RESULTS Scleroderma patients showed elevated levels of serum cytokines, but significantly lower IL-22 and TGF- β1 when compared to healthy controls (p < 0.05). Apoptotic proteins were significantly elevated among Scleroderma patients, but the patient groups also showed significant lower caspase 1/3/9 levels when compared to healthy controls (p < 0.05). ILD-SSc patients reported higher mRSS score (p = 0.0436) when compared with PAH-SSc and np-SSc. In ILD-SSc patients, finger tightening (p = 0.0481) and calcinosis/lesions (p = 0.0481) were significant clinical presentations whereas, digital ulcers were significantly prominent in np-SSc patients (p = 0.0132). Elevated TGF-β3 levels (p = 0.02) in SSC-ILD and reduced IL-4 levels (p = 0.02) in SSC-PAH were significant cytokines as compared to np-SSc. Significant correlations were obtained among serum cytokines and apoptotic proteins in Scleroderma patients with and without pulmonary involvement. (p < 0.05) CONCLUSION: Our study highlights the correlation between mRSS score, cytokines and apoptotic proteins in SSc patients with pulmonary involvement. A longitudinal follow up in these patients with assessment of these immunological parameters may be helpful in monitoring the disease.
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Affiliation(s)
- Prasad Khadilkar
- Department of Clinical & Experimental Immunology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Durga Chougule
- Department of Clinical & Experimental Immunology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Tanaya Tipnis
- Department of Clinical & Experimental Immunology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Uday Khopkar
- Department of Skin, STD and Leprosy, G.S. Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Milind Nadkar
- Department of Medicine, TNMC & BYLN Hospital, Mumbai, India
| | | | - Seema Kini
- Department of Medicine, G.S. Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Vidya Kharkar
- Department of Skin, STD and Leprosy, G.S. Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Amita Athvale
- Department of Pulmonary Medicine, G.S. Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Tanya Athvale
- Department of Pulmonary Medicine, G.S. Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Manisha Madkaikar
- Department of Pediatric Immunology and Leukocyte Biology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India
| | - Vandana Pradhan
- Department of Clinical & Experimental Immunology, Indian Council of Medical Research- National Institute of Immunohaematology, Mumbai, India.
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4
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Bozzao F, Tomietto P, Baratella E, Kodric M, Cifaldi R, Della Porta R, Prearo I, Pirronello SMG, Confalonieri P, Ruaro B, Fischetti F, Fabris B. Clinical Characterization and Predictive Factors for Progression in a Cohort of Patients with Interstitial Lung Disease and Features of Autoimmunity: The Need for a Revision of IPAF Classification Criteria. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:794. [PMID: 37109752 PMCID: PMC10146211 DOI: 10.3390/medicina59040794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/03/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: The "interstitial pneumonia with autoimmune features" (IPAF) criteria have been criticized because of the exclusion of usual interstitial pneumonia (UIP) patients with a single clinical or serological feature. To classify these patients, the term UIPAF was proposed. This study aims to describe clinical characteristics and predictive factors for progression of a cohort of interstitial lung disease (ILD) patients with at least one feature of autoimmunity, applying criteria for IPAF, specific connective tissue diseases (CTD), and a definition of UIPAF when possible. Methods: We retrospectively evaluated data on 133 consecutive patients with ILD at onset associated with at least one feature of autoimmunity, referred by pulmonologists to rheumatologists from March 2009 to March 2020. Patients received 33 (16.5-69.5) months of follow-up. Results: Among the 101 ILD patients included, 37 were diagnosed with IPAF, 53 with ILD-onset CTD, and 11 with UIPAF. IPAF patients had a lower prevalence of UIP pattern compared to CTD-ILD and UIPAF patients (10.8% vs. 32.1% vs. 100%, p < 0.01). During the follow-up, 4 IPAF (10.8%) and 2 UIPAF (18.2%) patients evolved into CTD-ILD. IPAF patients presented features not included in IPAF criteria, such as sicca syndrome (8.1%), and were more frequently affected by systemic hypertension (p < 0.01). Over one year, ILD progression (greater extent of fibrosis on HRCT and/or decline in PFTs) was less frequent in the IPAF group compared to CTD-ILD and UIPAF (32.3% vs. 58.8% vs. 72.7, p = 0.02). A UIP pattern and an IPAF predicted a faster (OR: 3.80, p = 0.01) and a slower (OR: 0.28, p = 0.02) ILD progression, respectively. Conclusions: IPAF criteria help identify patients who might develop a CTD-ILD, even though a single clinical or serological feature is respected. Future revisions of IPAF criteria should include sicca syndrome and separate UIP-pattern into a different definition (UIPAF), given its association with a different prognosis, independently from ILD classification.
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Affiliation(s)
- Francesco Bozzao
- Internal Medicine Department, Azienda ULSS 2 “Marca Trevigiana”, 31100 Treviso, Italy
| | - Paola Tomietto
- Internal Medicine Department, Rheumatology Unit, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34128 Trieste, Italy
| | - Elisa Baratella
- Institute of Radiology, Department of Medical Surgical and Health Sciences, Cattinara Hospital, University of Trieste, 34128 Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34128 Trieste, Italy
| | - Metka Kodric
- Pneumology Unit, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34128 Trieste, Italy
| | - Rossella Cifaldi
- Pneumology Unit, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34128 Trieste, Italy
| | - Rossana Della Porta
- Pneumology Unit, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34128 Trieste, Italy
| | - Ilaria Prearo
- Vascular Medicine Unit, University Hospital LMU Munich, 81377 Munich, Germany
| | | | - Paola Confalonieri
- Pneumology Unit, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34128 Trieste, Italy
| | - Barbara Ruaro
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34128 Trieste, Italy
- Pneumology Unit, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34128 Trieste, Italy
| | - Fabio Fischetti
- Internal Medicine Department, Rheumatology Unit, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34128 Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34128 Trieste, Italy
| | - Bruno Fabris
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34128 Trieste, Italy
- Internal Medicine Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34128 Trieste, Italy
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5
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Johnson SR, Foeldvari I. Approach to Systemic Sclerosis Patient Assessment. Rheum Dis Clin North Am 2023; 49:193-210. [PMID: 37028831 DOI: 10.1016/j.rdc.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Systemic sclerosis (SSc) is a heterogeneous disease comprising of a wide spectrum of ages of onset, sex-based differences, ethnic variations, disease manifestations, differential serologic profiles, and variable response to therapy resulting in reduced health-related quality of life, disability, and survival. The ability to subset groups of patients with SSc can assist with refining the diagnosis, guide appropriate monitoring, inform aggressiveness of immunosuppression, and predict prognosis. The ability to subset patients with SSc has several important practical implications for patient care.
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6
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Aboabat A, Ahmad Z, Steiman A, Johnson SR. Quality Measures in Systemic Sclerosis. Diagnostics (Basel) 2023; 13:diagnostics13040579. [PMID: 36832067 PMCID: PMC9955321 DOI: 10.3390/diagnostics13040579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 02/07/2023] Open
Abstract
Quality improvement is an emerging field, that applies principles of improvement science and utilizes measurement methods with the aim of improving patient care. Systemic sclerosis (SSc) is a systemic autoimmune rheumatic disease associated with increased healthcare burden, cost, morbidity, and mortality. Gaps in delivering care to patients with SSc have been consistently observed. In this article, we introduce the discipline of quality improvement and its use of quality measures. We summarize and comparatively evaluate three sets of quality measures that have been proposed to evaluate the quality of care of patients with SSc. Finally, we highlight the areas of unmet needs and indicate future directions for quality improvement and quality measures in SSc.
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Affiliation(s)
- Aos Aboabat
- Toronto Scleroderma Program, Mount Sinai Hospital, Toronto Western Hospital, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Zareen Ahmad
- Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Amanda Steiman
- Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Sindhu R. Johnson
- Toronto Scleroderma Program, Mount Sinai Hospital, Toronto Western Hospital, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON M5T 1R8, Canada
- Correspondence: ; Tel.: +1-416-603-6417; Fax: +1-416-603-4348
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7
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Sambataro G, Vancheri C, Sambataro D. Interstitial Pneumonia with Autoimmune Features (IPAF): time to redefine the classification criteria. Expert Rev Clin Immunol 2023; 19:131-133. [PMID: 36208215 DOI: 10.1080/1744666x.2023.2134119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Gianluca Sambataro
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. "Policlinico-San Marco," University of Catania, Catania, Italy.,Rheumatology Outpatient Clinic, Artroreuma SRL, Mascalucia, Italy
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Disease, A.O.U. "Policlinico-San Marco," University of Catania, Catania, Italy
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8
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Jerjen R, Nikpour M, Krieg T, Denton CP, Saracino AM. Systemic sclerosis in adults. Part I: Clinical features and pathogenesis. J Am Acad Dermatol 2022; 87:937-954. [PMID: 35131402 DOI: 10.1016/j.jaad.2021.10.065] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/06/2021] [Accepted: 10/21/2021] [Indexed: 11/27/2022]
Abstract
Systemic sclerosis (SSc), also referred to as systemic scleroderma or scleroderma, is a rare, complex immune-mediated connective tissue disease characterized by progressive skin fibrosis and other clinically heterogenous features. The etiopathogenesis of SSc involves vasculopathy and immune system dysregulation occurring on a permissive genetic and epigenetic background, ultimately leading to fibrosis. Recent developments in our understanding of disease-specific autoantibodies and bioinformatic analyses has led to a reconsideration of the purely clinical classification of diffuse and limited cutaneous SSc subgroups. Autoantibody profiles are predictive of skin and internal organ involvement and disease course. Early diagnosis of SSc, with commencement of disease-modifying treatment, has the potential to improve patient outcomes. In SSc, many of the clinical manifestations that present early signs of disease progression and activity are cutaneous, meaning dermatologists can and should play a key role in the diagnosis and management of this significant condition. The first article in this continuing medical education series discusses the epidemiology, clinical characteristics, and pathogenesis of SSc in adults, with an emphasis on skin manifestations, the important role of dermatologists in recognizing these, and their correlation with systemic features and disease course.
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Affiliation(s)
- Rebekka Jerjen
- Department of Dermatology, The Alfred Hospital, Melbourne, Australia
| | - Mandana Nikpour
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia; Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Thomas Krieg
- Department Dermatology and Translational Matrix Biology, CMMC and CECAD, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Christopher P Denton
- Division of Medicine, Centre for Rheumatology and Connective Tissues Diseases, University College London, London, United Kingdom; Department of Rheumatology, Royal Free NHS Foundation Trust, London, United Kingdom
| | - Amanda M Saracino
- Department of Dermatology, The Alfred Hospital, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, Australia.
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9
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Ellezam B, Leclair V, Troyanov Y, Bersali I, Giannini M, Hoa S, Bourré-Tessier J, Nadon V, Drouin J, Karamchandani J, O'Ferrall E, Lannes B, Satoh M, Fritzler MJ, Senécal JL, Hudson M, Meyer A, Landon-Cardinal O. Capillary pathology with prominent basement membrane reduplication is the hallmark histopathological feature of scleromyositis. Neuropathol Appl Neurobiol 2022; 48:e12840. [PMID: 35894636 DOI: 10.1111/nan.12840] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 06/15/2022] [Accepted: 07/06/2022] [Indexed: 11/27/2022]
Abstract
AIMS To perform ultrastructural and histopathological analysis of muscle biopsies from a large group of systemic sclerosis (SSc) patients, including some with early/mild SSc features, and examine whether capillary pathology differentiates 'scleromyositis' (SM) from other auto-immune myositis (AIM) subsets. METHODS Muscle biopsies from a total of 60 SM patients and 43 AIM controls from two independent cohorts were examined by electron microscopy, collagen-4 immunofluorescence (Col4IF) and routine light microscopy. RESULTS Ultrastructural examination revealed prominent capillary basement membrane (BM) reduplication (4+ layers in >50% of capillaries) in 65% of SM vs 0% of AIM controls (p<0.001). In SM cases without prominent BM reduplication, capillary dilation was the most distinctive feature, present in 8% of capillaries in SM vs 2% in controls (p=0.001). Accumulation of ensheathed pericyte processes was another characteristic feature of SM and closely correlated with the degree of BM reduplication (r=0.833, p<0.001). On light microscopy, BM marker Col4IF revealed more frequent capillary enlargement in SM than in controls (84% vs 21%, p<0.001). SM cases were classified as non-inflammatory myopathy (36%), non-specific myositis (33%) or immune-mediated necrotizing myopathy (31%), but despite this histopathological heterogeneity, prominent BM reduplication remained a constant finding. In the 16 SM patients with early/mild SSc features, 63% showed prominent BM reduplication. CONCLUSIONS These results show that capillary pathology, and in particular prominent capillary BM reduplication, is the hallmark histopathological feature of SM even in patients with early/mild SSc and support the concept of SM as an organ manifestation of SSc and a distinct subset of AIM.
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Affiliation(s)
- Benjamin Ellezam
- Division of Pathology, CHU Sainte-Justine, Montréal, Québec, Canada; Department of Pathology and Cell Biology, Université de Montréal, Montréal, Québec, Canada
| | - Valérie Leclair
- Division of Rheumatology, Jewish General Hospital; Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Yves Troyanov
- Division of Rheumatology, Hôpital du Sacré-Coeur; Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Imane Bersali
- Service de physiologie - explorations fonctionnelles musculaires, service de rhumatologie et Centre de référence des maladies autoimmunes rares, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Margherita Giannini
- Service de physiologie - explorations fonctionnelles musculaires, service de rhumatologie et Centre de référence des maladies autoimmunes rares, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Sabrina Hoa
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM); Autoimmunity Research Laboratory, CHUM Research Center; Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Josiane Bourré-Tessier
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM); Autoimmunity Research Laboratory, CHUM Research Center; Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Valérie Nadon
- Division of Rheumatology, Hôpital Notre-Dame; Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Julie Drouin
- Division of Rheumatology, Centre Hospitalier Affilié Universitaire Régional (CHAUR) du CIUSSS Mauricie Centre-du-Québec; Department of Medicine, Université de Montréal, Québec, Canada
| | - Jason Karamchandani
- Department of Pathology, Montreal Neurological Institute and Hospital, Montréal, Québec, Canada
| | - Erin O'Ferrall
- Department of Neurology and Neurosurgery and Department of Pathology, McGill University and the Montreal Neurological Institute and Hospital, Montréal, Québec, Canada
| | - Béatrice Lannes
- Service de Pathologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Minoru Satoh
- Department of Clinical Nursing, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Marvin J Fritzler
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Luc Senécal
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM); Autoimmunity Research Laboratory, CHUM Research Center; Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Marie Hudson
- Division of Rheumatology, Jewish General Hospital; Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Alain Meyer
- Service de physiologie - explorations fonctionnelles musculaires, service de rhumatologie et Centre de référence des maladies autoimmunes rares, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Océane Landon-Cardinal
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM); Autoimmunity Research Laboratory, CHUM Research Center; Department of Medicine, Université de Montréal, Montréal, Québec, Canada
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10
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Damoiseaux J, Potjewijd J, Smeets RL, Bonroy C. Autoantibodies in the disease criteria for systemic sclerosis: The need for specification for optimal application. J Transl Autoimmun 2022; 5:100141. [PMID: 35028553 PMCID: PMC8741499 DOI: 10.1016/j.jtauto.2022.100141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/02/2022] [Indexed: 01/03/2023] Open
Abstract
The ACR/EULAR classification criteria for systemic sclerosis (SSc) entail three autoantibodies: anti-centromere antibodies (ACA), anti-topoisomerase I antibodies (ATA), and anti-RNA-polymerase III antibodies (ARA). The importance of ACA and ATA in the classification criteria is evidence based, but the diagnostic value is overestimated by clinicians. Fortunately, these autoantibodies are characterized by good agreement between different immuno-assays. Inclusion of ARA, however, is based on limited evidence and is related to limited agreement between different immuno-assays. Harmonization of immuno-assays in terms of interpretation based on likelihood ratio's may improve future classification criteria for SSc and this needs to be achieved by close collaboration between clinicians, laboratory specialists and the diagnostic industry.
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Affiliation(s)
- Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Judith Potjewijd
- Department of Internal Medicine, Division Nephrology and Clinical Immunology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ruben L. Smeets
- Department of Laboratory Medicine, Radboudumc Laboratory for Diagnostics, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Laboratory Medicine—Medical Immunology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Carolien Bonroy
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
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11
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Mahmoudian A, Lohmander LS, Mobasheri A, Englund M, Luyten FP. Early-stage symptomatic osteoarthritis of the knee - time for action. Nat Rev Rheumatol 2021; 17:621-632. [PMID: 34465902 DOI: 10.1038/s41584-021-00673-4] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 02/07/2023]
Abstract
Osteoarthritis (OA) remains the most challenging arthritic disorder, with a high burden of disease and no available disease-modifying treatments. Symptomatic early-stage OA of the knee (the focus of this Review) urgently needs to be identified and defined, as efficient early-stage case finding and diagnosis in primary care would enable health-care providers to proactively and substantially reduce the burden of disease through proper management including structured education, exercise and weight management (when needed) and addressing lifestyle-related risk factors for disease progression. Efforts to define patient populations with symptomatic early-stage knee OA on the basis of validated classification criteria are ongoing. Such criteria, as well as the identification of molecular and imaging biomarkers of disease risk and/or progression, would enable well-designed clinical studies, facilitate interventional trials, and aid the discovery and validation of cellular and molecular targets for novel therapies. Treatment strategies, relevant outcomes and ethical issues also need to be considered in the context of the cost-effective management of symptomatic early-stage knee OA. To move forwards, a multidisciplinary and sustained international effort involving all major stakeholders is required.
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Affiliation(s)
- Armaghan Mahmoudian
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium.,Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - L Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Ali Mobasheri
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Martin Englund
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Frank P Luyten
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium.
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12
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Ellezam B, Leclair V, Troyanov Y, Meyer A, Hudson M, Landon-Cardinal O. Capillary basement membrane reduplication in myositis patients with mild clinical features of systemic sclerosis supports the concept of 'scleromyositis'. Acta Neuropathol 2021; 142:395-397. [PMID: 34115197 DOI: 10.1007/s00401-021-02335-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 02/01/2023]
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13
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Landon-Cardinal O, Baril-Dionne A, Hoa S, Meyer A, Leclair V, Bourré-Tessier J, Mansour AM, Zarka F, Makhzoum JP, Nehme J, Rich E, Goulet JR, Grodzicky T, Koenig M, Joyal F, Richard I, Hudson M, Targoff I, Satoh M, Fritzler MJ, Troyanov Y, Senécal JL. Recognising the spectrum of scleromyositis: HEp-2 ANA patterns allow identification of a novel clinical subset with anti-SMN autoantibodies. RMD Open 2021; 6:rmdopen-2020-001357. [PMID: 32892170 PMCID: PMC7509989 DOI: 10.1136/rmdopen-2020-001357] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/17/2020] [Accepted: 08/10/2020] [Indexed: 12/28/2022] Open
Abstract
Objective To describe systemic sclerosis (SSc) with myopathy in patients without classic SSc-specific and SSc-overlap autoantibodies (aAbs), referred to as seronegative scleromyositis. Methods Twenty patients with seronegative scleromyositis diagnosed by expert opinion were analysed retrospectively for SSc features at myositis diagnosis and follow-up, and stratified based on HEp-2 nuclear patterns by indirect immunofluorescence (IIF) according to International Consensus of Autoantibody Patterns. Specificities were analysed by protein A−assisted immunoprecipitation. Myopathy was considered an organ involvement of SSc. Results SSc sine scleroderma was a frequent presentation (45%) at myositis diagnosis. Myositis was the most common first non-Raynaud manifestation of SSc (55%). Lower oesophagal dysmotility was present in 10 of 11 (91%) investigated patients. At follow-up, 80% of the patients met the American College of Rheumatology/EULAR SSc classification criteria. Two-thirds of patients had a positive HEp-2 IIF nuclear pattern (all with titers ≥1/320), defining three novel scleromyositis subsets. First, antinuclear antibody (ANA)-negative scleromyositis was associated with interstitial lung disease (ILD) and renal crisis. Second, a speckled pattern uncovered multiple rare SSc-specific aAbs. Third, the nuclear dots pattern was associated with aAbs to survival of motor neuron (SMN) complex and a novel scleromyositis subset characteriszed by calcinosis but infrequent ILD and renal crisis. Conclusions SSc skin involvement is often absent in early seronegative scleromyositis. ANA positivity, Raynaud phenomenon, SSc-type capillaroscopy and/or lower oesophagal dysmotility may be clues for scleromyositis. Using HEp-2 IIF patterns, three novel clinicoserological subsets of scleromyositis emerged, notably (1) ANA-negative, (2) ANA-positive with a speckled pattern and (3) ANA-positive with nuclear dots and anti-SMN aAbs.
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Affiliation(s)
- Océane Landon-Cardinal
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM); Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Alexandra Baril-Dionne
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM); Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Sabrina Hoa
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM); Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Alain Meyer
- Centre de Référence des Maladies Autoimmunes Rares, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Valérie Leclair
- Division of Rheumatology, Department of Medicine, Jewish General Hospital; Department of Medicine, McGill University, Montreal, QC, Canada
| | - Josiane Bourré-Tessier
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM); Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Anne-Marie Mansour
- Division of Internal Medicine, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Farah Zarka
- Division of Internal Medicine, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Jean-Paul Makhzoum
- Division of Internal Medicine, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Jessica Nehme
- Division of Geriatrics, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Eric Rich
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM); Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Jean-Richard Goulet
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM); Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Tamara Grodzicky
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM); Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Martial Koenig
- Division of Internal Medicine, CHUM; Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - France Joyal
- Division of Internal Medicine, CHUM; Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Isabelle Richard
- Centre intégré de santé et de services sociaux Abitibi Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Marie Hudson
- Division of Rheumatology, Department of Medicine, Jewish General Hospital; Department of Medicine, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Ira Targoff
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Minoru Satoh
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Marvin J Fritzler
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Yves Troyanov
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM); Department of Medicine, Université de Montréal, Montreal, QC, Canada.,Division of Rheumatology, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Jean-Luc Senécal
- Division of Rheumatology, Centre hospitalier de l'Université de Montréal (CHUM); Department of Medicine, Université de Montréal, Montreal, QC, Canada.,Autoimmunity Research Laboratory, CHUM Research Center, Montreal, QC, Canada
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14
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Ennis D, Ahmad Z, Anderson MA, Johnson SR. Botulinum toxin in the management of primary and secondary Raynaud's phenomenon. Best Pract Res Clin Rheumatol 2021; 35:101684. [PMID: 33965340 DOI: 10.1016/j.berh.2021.101684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Raynaud's phenomenon (RP) is common in rheumatic diseases. In the setting of systemic sclerosis (SSc), it can be complicated by digital ischemia that includes ulceration and gangrene. Systemic adverse effects may preclude the use of oral or topical vasodilators for the treatment of RP and its complications. In this article, we review effectiveness/efficacy of botulinum toxin injection in primary and secondary RP. We discuss botulinum toxin formulations, dosage, sites of administration, and adverse effects. The evidence for botulinum toxin in the treatment of primary and SSc-associated RP is promising. Consistency across patient populations, treatment options (botulinum serotype, dose, and injection site), and outcome measures will be essential for further research.
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Affiliation(s)
- Daniel Ennis
- Mary Pack Vasculitis Clinic, Division of Rheumatology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Zareen Ahmad
- Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Melanie A Anderson
- University Health Network Library and Information Services, Toronto, Ontario, Canada.
| | - Sindhu R Johnson
- Toronto Scleroderma Program, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, Toronto Western Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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15
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Johnson SR, van den Hoogen F, Devakandan K, Matucci-Cerinic M, Pope JE. Systemic sclerosis: To subset or not to subset, that is the question. Eur J Rheumatol 2020; 7:S222-S227. [PMID: 33164736 DOI: 10.5152/eurjrheum.2020.19116] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 03/06/2020] [Indexed: 01/15/2023] Open
Abstract
Systemic sclerosis (SSc) is a heterogeneous disease with variability in autoantibody profiles, skin and internal organ involvement, disease trajectory, and survival. The ability to identify more homogeneous subsets of SSc patients has informed patient care and been an essential aspect of SSc research. In this article, the historic evolution of subsetting systems in SSc are described including clinically based SSc subsetting systems, their utility, strengths, and limitations. There is a shifting paradigm of SSc subsets, including biologic classification of SSc subsets and fully data-driven approaches to SSc subset classification, taking into consideration the needs of the SSc global community in the modern era and the ability to prognosticate patients with SSc.
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Affiliation(s)
- Sindhu R Johnson
- Toronto Scleroderma Program, Department of Medicine, Mount Sinai Hospital, Toronto Western Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Frank van den Hoogen
- Department of Rheumatology, St. Maartenskliniek and Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Keshini Devakandan
- Toronto Scleroderma Program, Department of Medicine, Mount Sinai Hospital, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Marco Matucci-Cerinic
- Division of Rheumatology AOUC, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Janet E Pope
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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16
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Ngcozana T, Ong VH, Denton CP. Improving access to digital ulcer care through nurse-led clinic: a service evaluation. Musculoskeletal Care 2020; 18:92-97. [PMID: 31961999 DOI: 10.1002/msc.1433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Digital ulcers (DU) remain one of the most burdensome co-morbidities in systemic sclerosis. The objectives of the study were to describe patient-level stratification and to evaluate a nurse-led DU clinic service development. METHODS A nurse-led digital ulcer clinic was established to identify patients with DU and manage them. Patients were recruited through scleroderma clinics, GP referrals, and self-referrals. The clinic involved patients being treated with appropriate treatment. Patients were stratified according to their DU risk level based on number and severity of ulcers. Among these, 22 patients were asked to complete a patient satisfaction survey. Data were analyzed descriptively. RESULTS Seventy-five patients were seen in the clinic, 46 (61%) were 56 years of age and above. Patients were identified as high (23%), medium (51%) or low risk (26%) for development of DU. The duration of DU history was from 7 months to 40 years. Prior to attending the nurse-led DU clinic, 90% of patients had received up to six courses of antibiotics for their DU, 76% had attended A&E, and 90% had unscheduled appointments. 90% had been seen by the GP due to DU and subsequently required hospital admissions. During the nurse-led clinic follow-up, only two patients had emergency admission. All patients reported that their needs in personal care of DU were met. CONCLUSION There are a significant number of people with SSc who have DUs affecting their quality of life as well as needing more healthcare services. A dedicated specialist nurse-led DU clinic may improve overall care of patients.
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Affiliation(s)
- Tanaka Ngcozana
- Rheumatology Department, Royal Free NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Voon H Ong
- Rheumatology Department, Royal Free NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Christopher P Denton
- Rheumatology Department, Royal Free NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
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17
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Zhong L, Pope M, Shen Y, Hernandez JJ, Wu L. Prevalence and incidence of systemic sclerosis: A systematic review and meta‐analysis. Int J Rheum Dis 2019; 22:2096-2107. [DOI: 10.1111/1756-185x.13716] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/12/2019] [Accepted: 09/09/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Lixian Zhong
- Irma Lerma Rangel College of Pharmacy Texas A&M University College Station TX USA
| | - Melinda Pope
- Irma Lerma Rangel College of Pharmacy Texas A&M University College Station TX USA
| | - Ye Shen
- College of Public Health University of Georgia Athens Georgia
| | - Jose J. Hernandez
- Irma Lerma Rangel College of Pharmacy Texas A&M University College Station TX USA
| | - Lin Wu
- Research & Learning Services Health Sciences Library University of Tennessee Health Science Center Memphis TN USA
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18
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Damoiseaux J, Andrade LEC, Carballo OG, Conrad K, Francescantonio PLC, Fritzler MJ, Garcia de la Torre I, Herold M, Klotz W, Cruvinel WDM, Mimori T, von Muhlen C, Satoh M, Chan EK. Clinical relevance of HEp-2 indirect immunofluorescent patterns: the International Consensus on ANA patterns (ICAP) perspective. Ann Rheum Dis 2019; 78:879-889. [PMID: 30862649 PMCID: PMC6585284 DOI: 10.1136/annrheumdis-2018-214436] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/23/2019] [Indexed: 12/21/2022]
Abstract
The indirect immunofluorescence assay (IIFA) on HEp-2 cells is widely used for detection of antinuclear antibodies (ANA). The dichotomous outcome, negative or positive, is integrated in diagnostic and classification criteria for several systemic autoimmune diseases. However, the HEp-2 IIFA test has much more to offer: besides the titre or fluorescence intensity, it also provides fluorescence pattern(s). The latter include the nucleus and the cytoplasm of interphase cells as well as patterns associated with mitotic cells. The International Consensus on ANA Patterns (ICAP) initiative has previously reached consensus on the nomenclature and definitions of HEp-2 IIFA patterns. In the current paper, the ICAP consensus is presented on the clinical relevance of the 29 distinct HEp-2 IIFA patterns. This clinical relevance is primarily defined within the context of the suspected disease and includes recommendations for follow-up testing. The discussion includes how this information may benefit the clinicians in daily practice and how the knowledge can be used to further improve diagnostic and classification criteria.
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Affiliation(s)
- Jan Damoiseaux
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Orlando Gabriel Carballo
- Department of Immunology, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.,Laboratory of Immunology, Hospital General de Agudos Carlos G Durand, Buenos Aires, Argentina
| | - Karsten Conrad
- Immunology, Medical Faculty TU Dresden, Dresden, Germany
| | | | | | | | - Manfred Herold
- Rheumatology Unit, Clinical Department of General Internal Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Werner Klotz
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate school of Medicine, Kyoto, Japan
| | | | - Minoru Satoh
- Department of Clinical Nursing, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Edward K Chan
- Department of Oral Biology, University of Florida, Gainesville, Florida, USA
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19
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Increased prevalence of anti-DFS70 antibodies in young females: experience from a large international multi-center study on blood donors. ACTA ACUST UNITED AC 2019; 57:999-1005. [DOI: 10.1515/cclm-2018-1233] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 12/27/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Isolated antibodies to DFS70 have been described in healthy individuals and are rarely found in patients with antinuclear antibody-associated autoimmune rheumatic diseases (AARD). However, no data is available on geographic differences in the prevalence of anti-DFS70 antibodies. We aimed to study the prevalence of anti-DFS70 antibodies in blood donor samples from several countries representing various ethnical backgrounds and geographic regions in the world.
Methods
Sera from apparently healthy blood donors (n≥300 per site) were collected in seven countries (USA, Italy, Spain, Germany, UK, Belgium and Brazil). All samples (n=2628) were tested for anti-DFS70 antibodies by QUANTA Flash DFS70 (Inova Diagnostics, Inc., San Diego, CA, USA).
Results
The prevalence of anti-DFS70 antibodies varied from 4/321 (1.2%, Italy) to 42/497 (8.5%, USA). Consequently, the prevalence of the antibodies was significantly higher in USA compared to all other countries (p<0.05). In addition, the prevalence in the combined cohort (all sites) was higher in young blood donors (<35 years; 5.0% vs. 2.7%; p=0.0017) and among females (4.5% vs. 3.0%; p=0.0446). However, when cohorts from different countries were corrected for age and gender, no significant difference between the countries were found.
Conclusions
This is the first study to analyze the prevalence of anti-DFS70 antibodies in different geographic areas using a standardized assay. Our findings show that the antibodies are most prevalent in young females.
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20
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Johnson SR, Khanna D, Daikh D, Cervera R, Costedoat-Chalumeau N, Gladman DD, Hahn BH, Hiepe F, Sánchez-Guerrero J, Massarotti E, Boumpas DT, Costenbader KH, Jayne D, Dörner T, Kamen DL, Mosca M, Ramsey-Goldman R, Smolen JS, Wofsy D, Aringer M. Use of Consensus Methodology to Determine Candidate Items for Systemic Lupus Erythematosus Classification Criteria. J Rheumatol 2018; 46:721-726. [DOI: 10.3899/jrheum.180478] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2018] [Indexed: 12/20/2022]
Abstract
Objective.Given the complexity and heterogeneity of systemic lupus erythematosus (SLE), high-performing classification criteria are critical to advancing research and clinical care. A collaborative effort by the European League Against Rheumatism and the American College of Rheumatology was undertaken to generate candidate criteria, and then to reduce them to a smaller set. The objective of the current study was to select a set of criteria that maximizes the likelihood of accurate classification of SLE, particularly early disease.Methods.An independent panel of international SLE experts and the SLE classification criteria steering committee (conducting SLE research in Canada, Mexico, United States, Austria, Germany, Greece, France, Italy, and Spain) ranked 43 candidate criteria. A consensus meeting using nominal group technique (NGT) was conducted to reduce the list of criteria for consideration.Results.The expert panel NGT exercise reduced the candidate criteria for SLE classification from 43 to 21. The panel distinguished potential “entry criteria,” which would be required for classification, from potential “additive criteria.” Potential entry criteria were antinuclear antibody (ANA) ≥ 1:80 (HEp-2 immunofluorescence), and low C3 and/or low C4. The use of low complement as an entry criterion was considered potentially useful in cases with negative ANA. Potential additive criteria included lupus nephritis by renal biopsy, autoantibodies, cytopenias, acute and chronic cutaneous lupus, alopecia, arthritis, serositis, oral mucosal lesions, central nervous system manifestations, and fever.Conclusion.The NGT exercise resulted in 21 candidate SLE classification criteria. The next phases of SLE classification criteria development will require refinement of criteria definitions, evaluation of the ability to cluster criteria into domains, and evaluation of weighting of criteria.
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21
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Johnson SR, Tomlinson GA, Granton JT, Hawker GA, Feldman BM. Applied Bayesian Methods in the Rheumatic Diseases. Rheum Dis Clin North Am 2018; 44:361-370. [PMID: 29622302 DOI: 10.1016/j.rdc.2018.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The use of applied Bayesian methods is increasing in rheumatology. Using the Bayes theorem, past evidence is updated with new data. Preexisting data are expressed as a prior probability distribution or prior. New observations are expressed as a likelihood. Through explicit incorporation of preexisting data and new data, this process informs how this new information should change the way we think. In this article, the authors highlight the use of applied Bayesian methods in the study of rheumatic diseases.
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Affiliation(s)
- Sindhu R Johnson
- Division of Rheumatology, Department of Medicine, Toronto Western Hospital, Mount Sinai Hospital, 155 College Street, Toronto, Ontario M5T 3M6, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada.
| | - George A Tomlinson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Department of Medicine, Division of Support Systems and Outcomes, Toronto General Hospital Research Institute, University Health Network, Mount Sinai Hospital, Eaton North, 13th Floor, Room 238, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - John T Granton
- Division of Respirology, Department of Medicine, Toronto General Hospital, University Health Network, MUNK Building, 11-1170, 200 Elizabeth Avenue, Toronto, Ontario M5G 2C4, Canada; Division of Critical Care Medicine, Department of Medicine, Toronto General Hospital, University Health Network, MUNK Building, 11-1170, 200 Elizabeth Avenue, Toronto, Ontario M5G 2C4, Canada
| | - Gillian A Hawker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Rheumatology, Department of Medicine, Women's College Hospital, 76 Grenville Street, 8th Floor East, Room 815, Toronto, Ontario M5S 1B2, Canada
| | - Brian M Feldman
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Division of Rheumatology, Department of Paediatrics, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
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22
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Infantino M, Shovman O, Pérez D, Grossi V, Manfredi M, Benucci M, Damiani A, Gilburd B, Azoulay D, Serrano A, Shoenfeld Y. A better definition of the anti-DFS70 antibody screening by IIF methods. J Immunol Methods 2018; 461:110-116. [DOI: 10.1016/j.jim.2018.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/05/2018] [Accepted: 07/05/2018] [Indexed: 11/15/2022]
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23
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Tedeschi SK, Johnson SR, Boumpas D, Daikh D, Dörner T, Jayne D, Kamen D, Lerstrøm K, Mosca M, Ramsey-Goldman R, Sinnette C, Wofsy D, Smolen JS, Naden RP, Aringer M, Costenbader KH. Developing and Refining New Candidate Criteria for Systemic Lupus Erythematosus Classification: An International Collaboration. Arthritis Care Res (Hoboken) 2018; 70:571-581. [PMID: 28692774 PMCID: PMC5996759 DOI: 10.1002/acr.23317] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/06/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To define candidate criteria within multiphase development of systemic lupus erythematosus (SLE) classification criteria, jointly supported by the American College of Rheumatology and the European League Against Rheumatism. Prior steps included item generation and reduction by Delphi exercise, further narrowed to 21 items in a nominal group technique exercise. Our objectives were to apply an evidence-based approach to the 21 candidate criteria, and to develop hierarchical organization of criteria within domains. METHODS A literature review identified the sensitivity and specificity of the 21 candidate criteria. Data on the performance of antinuclear antibody (ANA) as an entry criterion and operating characteristics of the candidate criteria in early SLE patients were evaluated. Candidate criteria were hierarchically organized into clinical and immunologic domains, and definitions were refined in an iterative process. RESULTS Based on the data, consensus was reached to use a positive ANA of ≥1:80 titer (HEp-2 cells immunofluorescence) as an entry criterion and to have 7 clinical and 3 immunologic domains, with hierarchical organization of criteria within domains. Definitions of the candidate criteria were specified. CONCLUSION Using a data-driven process, consensus was reached on new, refined criteria definitions and organization based on operating characteristics. This work will be followed by a multicriteria decision analysis exercise to weight criteria and to identify a threshold score for classification on a continuous probability scale.
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Affiliation(s)
- Sara K. Tedeschi
- Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
| | | | | | - David Daikh
- University of California San Francisco, San Francisco, USA
- VA Medical Center, San Francisco, USA
| | | | - David Jayne
- University of Cambridge, Department of Medicine, UK
| | - Diane Kamen
- Medical University of South Carolina, Charleston, USA
| | | | | | | | - Corine Sinnette
- Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
| | - David Wofsy
- University of California San Francisco, San Francisco, USA
| | | | | | - Martin Aringer
- University Medical Center Carl Gustav Carus, Technical University of Dresden, Germany
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24
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Ndosi M, Alcacer-Pitarch B, Allanore Y, Del Galdo F, Frerix M, García-Díaz S, Hesselstrand R, Kendall C, Matucci-Cerinic M, Mueller-Ladner U, Sandqvist G, Torrente-Segarra V, Schmeiser T, Sierakowska M, Sierakowska J, Sierakowski S, Redmond A. Common measure of quality of life for people with systemic sclerosis across seven European countries: a cross-sectional study. Ann Rheum Dis 2018; 77:1032-1038. [PMID: 29463517 PMCID: PMC6029637 DOI: 10.1136/annrheumdis-2017-212412] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/09/2018] [Accepted: 01/30/2018] [Indexed: 12/01/2022]
Abstract
Objectives The aim of this study was to adapt the Systemic Sclerosis Quality of Life Questionnaire (SScQoL) into six European cultures and validate it as a common measure of quality of life in systemic sclerosis (SSc). Methods This was a seven-country (Germany, France, Italy, Poland, Spain, Sweden and UK) cross-sectional study. A forward–backward translation process was used to adapt the English SScQoL into target languages. SScQoL was completed by patients with SSc, then data were validated against the Rasch model. To correct local response dependency, items were grouped into the following subscales: function, emotion, sleep, social and pain and reanalysed for fit to the model, unidimensionality and cross-cultural equivalence. Results The adaptation of the SScQoL was seamless in all countries except Germany. Cross-cultural validation included 1080 patients with a mean age 58.0 years (SD 13.9) and 87% were women. Local dependency was evident in individual country data. Grouping items into testlets corrected the local dependency in most country specific data. Fit to the model, reliability and unidimensionality was achieved in six-country data after cross-cultural adjustment for Italy in the social subscale. The SScQoL was then calibrated into an interval level scale. Conclusion The individual SScQoL items have translated well into five languages and overall, the scale maintained its construct validity, working well as a five-subscale questionnaire. Measures of quality of life in SSc can be directly compared across five countries (France, Poland Spain, Sweden and UK). Data from Italy are also comparable with the other five countries although require an adjustment.
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Affiliation(s)
- Mwidimi Ndosi
- Academic Rheumatology Unit, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Department of Nursing and Midwifery, University of the West of England, Bristol, UK
| | - Begonya Alcacer-Pitarch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Yannick Allanore
- Rheumatology A Department, Cochin Hospital, Paris Descartes University, Paris, France
| | - Francesco Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Marc Frerix
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Bad Nauheim, Germany
| | - Sílvia García-Díaz
- Rheumatology Department, Hospital General Hospitalet-Moisès Broggi, Sant Joan Despí, Spain
| | | | - Christine Kendall
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Bad Nauheim, Germany
| | - Marco Matucci-Cerinic
- Department of Experimental Medicine, University of Florence, Florence, Italy.,Department of Geriatric Medicine, Division of Rheumatology, Azienda Ospedaliero-Universitaria Careggi (AOUC), Florence, Italy
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Bad Nauheim, Germany
| | | | | | - Tim Schmeiser
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Bad Nauheim, Germany.,Department of Rheumatology and Immunology, St. Josef Hospital, Wuppertal, Germany
| | - Matylda Sierakowska
- Department of Integrated Medical Care, Medical University of Bialystok, Bialystok, Poland
| | - Justyna Sierakowska
- Department of Foreign Languages, Medical University of Bialystok, Bialystok, Poland
| | - Stanslaw Sierakowski
- Department of Rheumatology and Internal Diseases, Medical University of Bialystok, Bialystok, Poland
| | - Anthony Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
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25
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Revisiting Rosacea Criteria: Where Have We Been, Where Are We Going, and How Will We Get There? Dermatol Clin 2017; 36:161-165. [PMID: 29499799 DOI: 10.1016/j.det.2017.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Rosacea is one of the most common and misunderstood dermatologic conditions. Currently, rosacea criteria are based on expert opinion; the definition of rosacea is primarily a reflection of opinion that is prone to bias. It has been more than a decade since the initial criteria were created by the National Rosacea Society. Revisiting the criteria and incorporating evidence-based techniques used by rheumatology and psychiatry can improve the validity and reliability of rosacea criteria. Literature from other specialties is reviewed and a method proposed for developing valid criteria. Examples are provided to motivate and highlight the importance of implementing such techniques.
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26
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Galluccio F, Müller-Ladner U, Furst DE, Khanna D, Matucci-Cerinic M. Points to consider in renal involvement in systemic sclerosis. Rheumatology (Oxford) 2017; 56:v49-v52. [PMID: 28992172 DOI: 10.1093/rheumatology/kex201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Indexed: 01/21/2023] Open
Abstract
This article discusses points to consider when undertaking a clinical trial to test therapy for renal involvement in SSc, not including scleroderma renal crisis. Double-blind, randomized controlled trials vs placebo or standard background therapy should be strongly considered. Inclusion criteria should consider a pre-specified range of renal functions or stratification of renal function. Gender and age limitations are probably not necessary. Concomitant medications including vasodilators, immunosuppressants and endothelin receptor antagonists and confounding illnesses such as diabetes, kidney stones, hypertension and heart failure need to be considered. A measure of renal function should be strongly considered, while time to dialysis, mortality, prevention of scleroderma renal crisis and progression of renal disease can also be considered, although they remain to be validated. Detailed, pre-planned analysis should be strongly considered and should include accounting for missing data.
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Affiliation(s)
- Felice Galluccio
- Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence, AOU Careggi, Florence, Italy
| | - Ulf Müller-Ladner
- Department of Internal Medicine and Rheumatology, Justus-Liebig-University Giessen, Giessen.,Department of Rheumatology, Clinical Immunology, Osteology and Physical Medicine Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Daniel E Furst
- Department of Rheumatology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Dinesh Khanna
- University of Michigan Scleroderma Program, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Marco Matucci-Cerinic
- Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence, AOU Careggi, Florence, Italy
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27
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Araújo FC, Camargo CZ, Kayser C. Validation of the ACR/EULAR classification criteria for systemic sclerosis in patients with early scleroderma. Rheumatol Int 2017; 37:1825-1833. [DOI: 10.1007/s00296-017-3787-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 08/05/2017] [Indexed: 11/29/2022]
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28
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Short-Term Pulmonary Function Trends Are Predictive of Mortality in Interstitial Lung Disease Associated With Systemic Sclerosis. Arthritis Rheumatol 2017; 69:1670-1678. [DOI: 10.1002/art.40130] [Citation(s) in RCA: 189] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 04/13/2017] [Indexed: 12/16/2022]
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29
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Vitali C, Del Papa N. Classification and diagnostic criteria in Sjögren's syndrome: a long-standing and still open controversy. Ann Rheum Dis 2017; 76:1953-1954. [PMID: 28522453 DOI: 10.1136/annrheumdis-2017-211378] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 04/17/2017] [Accepted: 04/22/2017] [Indexed: 12/27/2022]
Affiliation(s)
- Claudio Vitali
- Rheumatology section, Istituto Santo Stefano, Villa San Giuseppe, Como, Italy.,Study Group on Sjögren's Syndrome, Gaetano Pini Hospital, Milan, Italy
| | - Nicoletta Del Papa
- Study Group on Sjögren's Syndrome, Gaetano Pini Hospital, Milan, Italy.,Day Hospital of Rheumatology, ASST Gaetano Pini-CTO, Milan, Italy
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30
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Bentow C, Rosenblum R, Correia P, Karayev E, Karayev D, Williams D, Kulczycka J, Fritzler MJ, Mahler M. Development and multi-center evaluation of a novel immunoadsorption method for anti-DFS70 antibodies. Lupus 2017; 25:897-904. [PMID: 27252267 DOI: 10.1177/0961203316641773] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Antinuclear antibodies (ANA) represent a hallmark in the diagnosis of ANA-associated rheumatic diseases (AARD). However, anti-DFS70 antibodies are present in a higher portion of the healthy individuals (HI) than in patients with AARD. Consequently, we developed a novel, highly specific indirect immunofluorescence (IIF) method that blocks anti-DFS70 antibodies from binding to HEp-2 cells and to evaluate the method in a multi-center study. METHODS A total of 18 samples from systemic lupus erythematosus patients (SLE, n = 7) and HI (n = 11) were used for the initial development of the immunoadsorption method. For the multi-center evaluation, samples with a dense fine speckled (DFS) pattern (n = 99) were collected at three different sites based on their established IIF screening procedure at the respective laboratories. Additionally, four characterized samples with established clinically relevant IIF patterns (centromere, nucleolar, speckled, homogeneous) were blended in five different ratios (10%, 25%, 50%, 75%, 90%) with a sample positive for anti-DFS70 antibodies, which by itself showed a dense fine speckled (DFS) IIF pattern. All samples were tested by IIF with NOVA Lite HEp-2 ANA and NOVA Lite HEp-2 Select on the NOVA View® instrument, and also tested by QUANTA Flash DFS70 chemiluminescent immunoassay (CIA) for confirmation of anti-DFS70 antibodies (Inova Diagnostics, San Diego, CA, USA). RESULTS For the development of the immunoadsorption method, only 1/7 ANA-positive samples from SLE patients, but 8/10 ANA-positive samples from healthy individuals turned negative using the immunoadsorption. Subsequently, 73/99 (73.7%) of the DFS pattern samples were positive by CIA for anti-DFS70 antibodies showing a strong quantitative Spearman's correlation (rho = 0.57 (95% CI, 0.39-0.71, p < 0.0001)) between light intensity units (LIU) measured by NOVA View and CIA. Intensities measured with NOVA Lite HEp-2 and NOVA Lite HEp-2 Select demonstrated significantly lower intensity values after inhibition with DFS70 antigen (p < 0.0001). When samples were processed to mimic samples with mixed patterns (DFS + clinically relevant pattern), the new immunoadsorption method demonstrated that all clinically relevant patterns remained unchanged whereas the LIUs from NOVA View analysis significantly decreased after inhibition (p < 0.0001). CONCLUSION The data showed that the NOVA Lite HEp-2 Select kit effectively inhibits anti-DFS70 antibody binding to its cellular target antigen.
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Affiliation(s)
- C Bentow
- Department of Research, Inova Diagnostics, Inc., San Diego, USA
| | - R Rosenblum
- Department of Research, Inova Diagnostics, Inc., San Diego, USA
| | - P Correia
- RDL Reference Laboratory, Los Angeles, USA
| | - E Karayev
- RDL Reference Laboratory, Los Angeles, USA
| | - D Karayev
- RDL Reference Laboratory, Los Angeles, USA
| | - D Williams
- Immunology Department, Southampton General Hospital, Southampton, UK
| | - J Kulczycka
- Department of Clinical Immunology and Transplantation, Center of Laboratory Medicine, Medical University of Gdansk, Gdansk, Poland
| | - M J Fritzler
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - M Mahler
- Department of Research, Inova Diagnostics, Inc., San Diego, USA
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Wang Y, Xie J, Liu Z, Fu H, Huo Q, Gu Y, Liu Y. Association of calreticulin expression with disease activity and organ damage in systemic lupus erythematosus patients. Exp Ther Med 2017; 13:2577-2583. [PMID: 28565882 DOI: 10.3892/etm.2017.4235] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 01/26/2017] [Indexed: 11/06/2022] Open
Abstract
Measurement of disease activity in patients with systemic lupus erythematosus (SLE) is important for monitoring disease progression and evaluating the therapeutic effects. The severity of organ damage correlates with clinical status and prognosis. Therefore, it is imperative to find an effective biomarker measuring disease activity and organ damage for SLE management. The present study investigated the possibility of serum calreticulin (CRT) in the assessment of disease activity and organ damage in SLE patients. Serum CRT levels from 80 patients with SLE, 55 patients with other autoimmune diseases and 60 healthy controls (HC) were measured by ELISA. Disease activity was assessed using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) scores. Organ damage was evaluated with the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. CRT levels in SLE were significantly higher than that in other autoimmune diseases and HC. CRT was correlated with SLEDAI-2K score (r=0.3345, P=0.0024), and with anti-double-stranded DNA (anti-dsDNA) (r=0.4483, P<0.0001). A significant negative correlation of CRT levels with complement 3 (r=-0.3635, P=0.0009) and complement 4 (r=-0.3507, P=0.0014) was observed in patients with SLE. Furthermore, the patients with SLE and a positive anti-Ro52 result had higher levels of CRT compared with those with a negative anti-Ro52 result (P<0.001). Elevated levels of CRT were also reported among patients with SLE who also indicated the presence of cumulative organ damage. In addition, increased expression of CRT correlated with the presence of lupus nephritis. In conclusion, the results of the current report provided that CRT may be used as a potential biomarker for clinical diagnosis and of prognosis, providing additional information regarding disease activity and organ damage alongside other traditional indices.
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Affiliation(s)
- Yichao Wang
- School of Medical Laboratory, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Jiaogui Xie
- Department of Hepatobiliary Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China.,Department of Urology, The Fifteenth Military Hospital of China, Wusu, Xinjiang 833000, P.R. China
| | - Zhili Liu
- School of Medical Laboratory, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Hongwei Fu
- School of Medical Laboratory, Tianjin Medical University, Tianjin 300070, P.R. China.,Department of Clinical Laboratory Medicine, Tianjin Medical University General Hospital, Tianjin 300050, P.R. China
| | - Qianyu Huo
- School of Medical Laboratory, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Yajun Gu
- School of Medical Laboratory, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Yunde Liu
- School of Medical Laboratory, Tianjin Medical University, Tianjin 300070, P.R. China
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Kim S, Kahn P, Robinson AB, Lang B, Shulman A, Oberle EJ, Schikler K, Curran ML, Barillas-Arias L, Spencer CH, Rider LG, Huber AM. Childhood Arthritis and Rheumatology Research Alliance consensus clinical treatment plans for juvenile dermatomyositis with skin predominant disease. Pediatr Rheumatol Online J 2017; 15:1. [PMID: 28077146 PMCID: PMC5225591 DOI: 10.1186/s12969-016-0134-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 12/29/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Juvenile dermatomyositis (JDM) is the most common form of the idiopathic inflammatory myopathies in children. A subset of children have the rash of JDM without significant weakness, and the optimal treatments for these children are unknown. The goal of this study was to describe the development of consensus clinical treatment plans (CTPs) for children with JDM who have active skin rashes, without significant muscle involvement, referred to as skin predominant JDM in this manuscript. METHODS The Children's Arthritis and Rheumatology Research Alliance (CARRA) is a North American consortium of pediatric rheumatology health care providers. CARRA members collaborated to determine consensus on typical treatments for JDM patients with skin findings without significant weakness, to develop CTPs for this subgroup of patients. We used a combination of Delphi surveys and nominal group consensus meetings to develop these CTPs. RESULTS Consensus was reached on patient characteristics and outcome assessment, and CTPs were developed and finalized for patients with skin predominant JDM. Treatment option A included hydroxychloroquine alone, Treatment option B included hydroxychloroquine and methotrexate, and Treatment option C included hydroxychloroquine, methotrexate and corticosteroids. CONCLUSIONS Three CTPs were developed for use in children with skin predominant JDM, which reflect typical treatment approaches. These are not considered to be specific recommendations or standard of care. Using the CARRA network and prospective data collection, we will be able to apply statistical methods in the future to allow comparisons of JDM patients following these consensus treatment plans.
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Affiliation(s)
- Susan Kim
- Division of Pediatric Rheumatology, Benioff Children's Hospital, University of California at San Francisco, 550 16th St, San Francisco, CA, USA.
| | - Philip Kahn
- Division of Pediatric Rheumatology, New York University Langone Medical Center, 550 First Avenue, New York, NY USA
| | - Angela B. Robinson
- Pediatric Rheumatology, Rainbow Babies and Children’s Hospital, 11100 Euclid Ave MS6008B, Cleveland, OH USA
| | - Bianca Lang
- Department of Pediatrics, IWK Health Centre and Dalhousie University, 5980 University Ave, Halifax, NS Canada
| | - Andrew Shulman
- Pediatric Rheumatology, Children’s Hospital of Orange County, 1201 W La Veta Ave, Irvine, CA USA
| | - Edward. J. Oberle
- Department of Pediatrics, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH USA
| | - Kenneth Schikler
- Divisions of Adolescent Medicine and Pediatric Rheumatology, Department of Pediatrics, University of Louisville School of Medicine, 571 South Floyd St, Louisville, KY USA
| | - Megan Lea Curran
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Rheumatology, Ann and Robert H. Lurie Children’s Hospital of Chicago, 225 E Chicago Ave, Chicago, IL USA
| | - Lilliana Barillas-Arias
- Department of Pediatrics, Rheumatology, Albany Medical Center, 43 New Scotland Ave, Albany, NY USA
| | - Charles H. Spencer
- Department of Pediatrics, The Research Institute at Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH USA
| | - Lisa G. Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, 10 Center Drive, Bethesda, MD USA
| | - Adam M. Huber
- Department of Pediatrics, IWK Health Centre and Dalhousie University, 5980 University Ave, Halifax, NS Canada
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Controversies: molecular vs. clinical systemic sclerosis classification. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2016. [DOI: 10.5301/jsrd.5000213] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Systemic sclerosis (SSc) is a multisystem chronic disease characterized by the three cardinal pathological features, including autoimmunity/inflammation, vasculopathy, and fibrosis, with unknown etiology. Individual patients manifest these three components to variable degrees, resulting in the diverse heterogeneity of clinical presentation. The classification of SSc patients into relatively homogenous subtypes is helpful in the setting of daily clinical practice and the field of clinical and basic research. The classification of SSc has been continuously discussed over four decades based on the clinical and laboratory features, especially the extent of skin sclerosis and disease-related autoantibodies. This clinical classification system enables clinicians to provide general advice regarding prognosis and risk for internal organ disease, but only permits estimates of outcomes informed by population-based studies. On the other hand, the recent decade has seen much progress in the understanding of molecular aspects of SSc complex pathology, raising a discussion on molecular classification of SSc. The development of molecular targeting therapies, especially biologics, further strengthens the importance of molecular classification which aids the identification of potential responders for each treatment. Although a careful validation study is required for molecular classification of SSc due to its large heterogeneity, the advance of molecular classification would introduce a further modification into SSc classification system in the near future. Importantly, clinical and molecular classifications are not mutually exclusive, therefore the combination would facilitate the development of a better classification system of this complex heterogeneous disorder that is useful in both the clinical setting and research studies.
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Bentow C, Fritzler MJ, Mummert E, Mahler M. Recognition of the dense fine speckled (DFS) pattern remains challenging: results from an international internet-based survey. AUTOIMMUNITY HIGHLIGHTS 2016; 7:8. [PMID: 27395414 PMCID: PMC4939145 DOI: 10.1007/s13317-016-0081-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 06/23/2016] [Indexed: 01/16/2023]
Abstract
PURPOSE The dense fine speckled (DFS) pattern as detected by indirect immunofluorescence (IIF) on HEp-2 cells has been associated with several inflammatory diseases but is most commonly observed in individuals that do not have an antinuclear antibody (ANA)-associated rheumatic disease and even in apparently healthy individuals. Consequently, the accurate identification and correct reporting of this IIF pattern is of utmost importance and accordingly has been recognized by several international study groups for the detection of ANA. Furthermore, the DFS IIF pattern has recently been recommended as a competency level recognition pattern by the International Consensus on Antinuclear Antibody (ANA) Pattern (ICAP, http://www.anapatterns.org/ ) Committee. The objective of this study was to use an internet-based survey to assess how accurately the DFS IIF pattern was recognized by experienced technologists. METHODS High-resolution digital IIF images were captured using the automated IIF NOVA View instrument (Inova Diagnostics, San Diego, CA). Ten images were posted in an anonymous, international, internet-based interpretive survey. Two hundred and thirty IIF technologists were invited to participate. Four of the images in the survey were from previously characterized serum samples with classical ANA IIF patterns (nucleolar, centromere, homogeneous, and speckled) and two of the images were from samples with a DFS IIF ANA pattern and isolated anti-DFS70 antibodies as determined by a chemiluminescence immunoassay. The remaining four images were from sera with the classic IIF ANA patterns referred to above and mixed with a monospecific anti-DFS70-positive sample. The survey included multiple choice selections: homogeneous, DFS, centromere, nucleolar, speckled, other, or unrecognizable. RESULTS 125 of the 230 participants who completed the survey had diverse levels of experience in IIF pattern recognition on HEp-2 cells ranging from <1 year to >10 years of experience (average >10 years). Participants had a high concordance in correctly classifying the classical ANA IIF patterns: ranging from 95.2 % for centromere to 74.4 % for nucleolar patterns. The unmixed DFS pattern was recognized with significantly lower accuracy (~50 %; p < 0.05). However, less than 10 % correctly identified mixed patterns derived from the sera containing both clinically relevant ANA and anti-DFS70 antibodies. CONCLUSIONS Recognizing the DFS ANA IIF pattern and mixed IIF patterns composed of DFS + clinically relevant ANA patterns poses a significant challenge. Consequently, it seems imperative that DFS-specific immunoassays should be used to confirm the presence of anti-DFS70 antibodies before definitive results are reported to physicians.
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Affiliation(s)
- Chelsea Bentow
- Department of Research and Development, Inova Diagnostics, 9900 Old Grove Road, San Diego, CA, 92131-1638, USA
| | - Marvin J Fritzler
- Cumming School of Medicine, University of Calgary, Calgary, T2N 4N1, Canada
| | - Eckart Mummert
- Department of Research and Development, Inova Diagnostics, 9900 Old Grove Road, San Diego, CA, 92131-1638, USA
| | - Michael Mahler
- Department of Research and Development, Inova Diagnostics, 9900 Old Grove Road, San Diego, CA, 92131-1638, USA.
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Prechl J, Papp K, Hérincs Z, Péterfy H, Lóránd V, Szittner Z, Estonba A, Rovero P, Paolini I, Del Amo J, Uribarri M, Alcaro MC, Ruiz-Larrañaga O, Migliorini P, Czirják L. Serological and Genetic Evidence for Altered Complement System Functionality in Systemic Lupus Erythematosus: Findings of the GAPAID Consortium. PLoS One 2016; 11:e0150685. [PMID: 26950932 PMCID: PMC4780778 DOI: 10.1371/journal.pone.0150685] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/18/2016] [Indexed: 11/30/2022] Open
Abstract
Systemic lupus erythematosus is a chronic autoimmune disease with multifactorial ethiopathogenesis. The complement system is involved in both the early and late stages of disease development and organ damage. To better understand autoantibody mediated complement consumption we examined ex vivo immune complex formation on autoantigen arrays. We recruited patients with SLE (n = 211), with other systemic autoimmune diseases (n = 65) and non-autoimmune control subjects (n = 149). Standard clinical and laboratory data were collected and serum complement levels were determined. The genotype of SNP rs1143679 in the ITGAM gene was also determined. Ex vivo formation of immune complexes, with respect to IgM, IgG, complement C4 and C3 binding, was examined using a functional immunoassay on autoantigen microarray comprising nucleic acids, proteins and lipids. Complement consumption of nucleic acids increased upon binding of IgM and IgG even when serum complement levels were decreased due to consumption in SLE patients. A negative correlation between serum complement levels and ex vivo complement deposition on nucleic acid autoantigens is demonstrated. On the contrary, complement deposition on tested protein and lipid autoantigens showed positive correlation with C4 levels. Genetic analysis revealed that the non-synonymous variant rs1143679 in complement receptor type 3 is associated with an increased production of anti-dsDNA IgG antibodies. Notwithstanding, homozygous carriers of the previously reported susceptible allele (AA) had lower levels of dsDNA specific IgM among SLE patients. Both the non-synonymous variant rs1143679 and the high ratio of nucleic acid specific IgG/IgM were associated with multiple organ involvement. In summary, secondary complement deficiency in SLE does not impair opsonization of nucleic-acid-containing autoantigens but does affect other antigens and potentially other complement dependent processes. Dysfunction of the receptor recognizing complement opsonized immune complexes promotes the development of class-switched autoantibodies targeting nucleic acids.
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Affiliation(s)
- József Prechl
- Diagnosticum Zrt, Budapest, Hungary.,MTA-ELTE Immunology Research Group, Eötvös Loránd University, Budapest, Hungary
| | - Krisztián Papp
- MTA-ELTE Immunology Research Group, Eötvös Loránd University, Budapest, Hungary
| | | | | | - Veronika Lóránd
- Department of Rheumatology and Immunology, Clinic Center, University of Pécs, Pécs, Hungary
| | - Zoltán Szittner
- MTA-ELTE Immunology Research Group, Eötvös Loránd University, Budapest, Hungary
| | - Andone Estonba
- Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country, Bilbao, Spain
| | - Paolo Rovero
- Department of NeuroFarBa, University of Florence, Florence, Italy
| | | | - Jokin Del Amo
- Progenika Biopharma S.A., a Grifols Company, Derio, Bizkaia, Spain
| | - Maria Uribarri
- Progenika Biopharma S.A., a Grifols Company, Derio, Bizkaia, Spain
| | | | - Otsanda Ruiz-Larrañaga
- Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country, Bilbao, Spain
| | - Paola Migliorini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - László Czirják
- Department of Rheumatology and Immunology, Clinic Center, University of Pécs, Pécs, Hungary
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Assandri R, Monari M, Montanelli A. Development of systemic sclerosis in patients with autoimmune hepatitis: an emerging overlap syndrome. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2016; 9:211-9. [PMID: 27458514 PMCID: PMC4947136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AIM We described two case reports of AIH/SSc overlap syndrome and reviewed literatures regarding this issue. BACKGROUND AIH is a chronic hepatitis of unknown aetiology characterized by continuing hepatocellular necrosis and inflammation. AIH overlap syndromes have been reported with other autoimmune diseases. PATIENTS AND METHODS According to the classification criteria for SSc, we conducted a retrospective chart review of 35 cases with biopsy-proven AIH over the past 5 years at our institution. We reviewed the MEDLINE database using the appropriate key-words. RESULTS A chart review of 35 cases (M/F ratio 1:2, mean age 47.6±10.3 years) revealed nine patients (9/35, 25.7%) with CTD (four males and three females with a mean age of 45.1±8.4 years). All patients had ANA. Four patients were SSA/Ro positive UCTD (1/35, 2.85%), and six patients developed SLE (6/35, 17.1%). Only two female patients (2/35, 5.7%) with specific SSc AAb developed a systemic sclerosis. We described a patient with AIH who was diagnosed with diffuse systemic sclerosis-sine scleroderma with positive anti-centromere B and SSA/Ro52 KDa antibodies. We also reported a patient with AIH who was diagnosed limited SSc with contemporary presence of anti-centromere A and anti-RNA polymerase III antibody. CONCLUSION We suggest that SSc may be considered to be one of the manifestations associated with AIH. Patients with AIH may have an increased risk to develop SSc and should be followed, especially when Raynaud phenomenon was found.
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Affiliation(s)
- Roberto Assandri
- Clinical investigation laboratory, Humanitas Clinical and Research Center, Via Alessandro Manzoni 56 20089 Rozzano (Miano) Italy
| | - Marta Monari
- Clinical investigation laboratory, Humanitas Clinical and Research Center, Via Alessandro Manzoni 56 20089 Rozzano (Miano) Italy
| | - Alessandro Montanelli
- Clinical Laboratory, Diagnostics Department, Spedali Civili of Brescia, Piazzale Spedali Civili 1 - Brescia, Italy
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Sáez-Comet L, Simeón-Aznar CP, Pérez-Conesa M, Vallejo-Rodríguez C, Tolosa-Vilella C, Iniesta-Arandia N, Colunga-Argüelles D, Egurbide-Arberas MV, Ortego-Centeno N, Vargas-Hitos JA, Freire-Dapena M, Rubio-Rivas M, Ríos-Blanco JJ, Trapiella-Martínez L, Fonollosa-Pla V. Applying the ACR/EULAR Systemic Sclerosis Classification Criteria to the Spanish Scleroderma Registry Cohort. J Rheumatol 2015; 42:2327-31. [PMID: 26472418 DOI: 10.3899/jrheum.150144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for systemic sclerosis (SSc) with previous American Rheumatology Association (ARA) criteria. METHODS This was a cross-sectional multicenter study comparing sensitivity of both criteria in the cutaneous subsets in the Spanish scleroderma registry (RESCLE) cohort. RESULTS In 1222 patients with SSc, the most prevalent items were Raynaud phenomenon (95%), skin thickening (91%), and abnormal capillaroscopy (89%). ARA criteria classified as SSc 63.5% of all patients, and 63%, 100%, 11.2%, and 0% in the limited, diffuse, sine, and pre-SSc subsets, respectively. ACR/EULAR criteria classified 87.5% of all patients and 98.5%, 100%, 41.8%, and 15.9% in the same subsets, respectively. CONCLUSION ACR/EULAR criteria are more sensitive than ARA criteria, especially in limited, sine, and pre-SSc subsets.
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Aggarwal R, Ringold S, Khanna D, Neogi T, Johnson SR, Miller A, Brunner HI, Ogawa R, Felson D, Ogdie A, Aletaha D, Feldman BM. Distinctions between diagnostic and classification criteria? Arthritis Care Res (Hoboken) 2015; 67:891-7. [PMID: 25776731 DOI: 10.1002/acr.22583] [Citation(s) in RCA: 332] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 02/27/2015] [Accepted: 03/10/2015] [Indexed: 12/26/2022]
Affiliation(s)
| | | | | | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
| | - Sindhu R Johnson
- Toronto Western Hospital, Mount Sinai Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Amy Miller
- American College of Rheumatology, Atlanta, Georgia
| | | | | | - David Felson
- Boston University School of Medicine, Boston, Massachusetts
| | | | | | - Brian M Feldman
- Toronto Western and Mount Sinai Hospitals, The Hospital for Sick Children, and University of Toronto, Toronto, Ontario, Canada
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Haddad A, Johnson SR, Somaily M, Fazelzad R, Kron AT, Chau C, Chandran V. Psoriatic Arthritis Mutilans: Clinical and Radiographic Criteria. A Systematic Review. J Rheumatol 2015; 42:1432-8. [DOI: 10.3899/jrheum.141545] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2015] [Indexed: 02/08/2023]
Abstract
Objective.Research on psoriatic arthritis mutilans (PAM), the most severe form of psoriatic arthritis, is impeded by the lack of an accepted classification criteria. We performed a systematic review of the literature to identify and synthesize clinical and radiographic features associated with the definition of PAM.Methods.A systematic literature search limited to human studies was conducted without language restriction. Abstracts were independently screened by 2 investigators and studies that reported information on patients with PAM were included. A standardized form was used to independently collect clinical and radiographic items defining PAM, patient’s demographics, disease characteristics, and outcomes.Results.There were 8570 citations searched to identify 112 articles for full review and 58 articles for data abstraction. We identified 8 definitions of PAM that were used in 283 subjects with a mean age ± SD at diagnosis of PsA of 33.9 ± 8.2 years. Disease manifestations (prevalence) included dactylitis (29–64%), enthesitis (29–32%), axial disease (14–27%), and nail lesions (47%). PAM definitions include 1 (n = 2 studies) or more (n = 14 studies) joints involving interphalangeal, metacarpophalangeal, or metatarsophalangeal joints. The most prevalent PAM clinical features were digital telescoping (34%), digital shortening (33%), and flail joints (22%). The most prevalent PAM radiographic items were bone resorption (41%), pencil-in-cup change (16%), total joint erosions (14%), ankylosis (21%), and subluxation (7%).Conclusion.We have identified 8 definitions of PAM, and synthesized the clinical and radiographic items that are important for the classification of PAM. We have established the groundwork for future development classification criteria for PAM.
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Performance of the new ACR/EULAR classification criteria for systemic sclerosis in clinical practice. Rheumatology (Oxford) 2015; 54:1454-8. [DOI: 10.1093/rheumatology/keu530] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Indexed: 02/07/2023] Open
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Sakkas LI, Simopoulou T, Katsiari C, Bogdanos D, Chikanza IC. Early systemic sclerosis—opportunities for treatment. Clin Rheumatol 2015; 34:1327-31. [DOI: 10.1007/s10067-015-2902-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 02/15/2015] [Indexed: 12/17/2022]
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POPE JANETE. Systemic Sclerosis Classification: A Rose by Any Other Name Would Smell As Sweet? J Rheumatol 2015; 42:11-3. [DOI: 10.3899/jrheum.141103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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MASI ALFONSET, MEDSGER THOMASA. Progress in the Evolution of Systemic Sclerosis Classification Criteria and Recommendation for Additional Comparative Specificity Studies. J Rheumatol 2015; 42:8-10. [DOI: 10.3899/jrheum.141020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Visovatti SH, Distler O, Coghlan JG, Denton CP, Grünig E, Bonderman D, Müller-Ladner U, Pope JE, Vonk MC, Seibold JR, Torres-Martin JV, Doelberg M, Chadha-Boreham H, Rosenberg DM, McLaughlin VV, Khanna D. Borderline pulmonary arterial pressure in systemic sclerosis patients: a post-hoc analysis of the DETECT study. Arthritis Res Ther 2014; 16:493. [PMID: 25491468 PMCID: PMC4299685 DOI: 10.1186/s13075-014-0493-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 11/12/2014] [Indexed: 01/25/2023] Open
Abstract
Introduction Patients with mean pulmonary artery pressures (mPAP) of 21 to 24 mm Hg have a so-called borderline elevation of mPAP (BoPAP)—a condition thought to represent early-stage pulmonary arterial vasculopathy. Based on the DETECT study, this post-hoc analysis examined patient characteristics of systemic sclerosis (SSc) patients with normal mPAP, BoPAP and elevated mPAP, fulfilling pulmonary arterial hypertension (PAH) criteria. Methods Adult patients with a duration of SSc more than 3 years, a diffusing capacity of the lung for carbon monoxide less than 60% predicted, and no previous diagnosis of any form of pulmonary hypertension (PH) underwent screening tests followed by right heart catheterization. Subjects were divided into three groups: normal mPAP, BoPAP, and PAH. Exploratory comparative and binary logistic regression analyses were performed for the BoPAP versus normal mPAP and PAH versus BoPAP groups. Results Of 244 patients evaluated, 148 (60%) had normal mPAP, 36 (15%) had BoPAP, and 60 (25%) had definite PAH. Univariable logistic regression (ULR) showed the mean tricuspid regurgitation velocity in patients with BoPAP to be intermediate between normal mPAP and PAH. In the ULR analyses BoPAP versus normal mPAP and PAH versus BoPAP, the statistically significant predictors were, amongst others: demographic, clinical, pulmonary function, echocardiographic and hemodynamic variables. Conclusions In this exploratory post-hoc analysis of the DETECT study population patients with BoPAP could be distinguished from patients with normal mPAP and PAH, and it appears that BoPAP may be an intermediate stage on the continuum between normal PA pressures and PAH. Electronic supplementary material The online version of this article (doi:10.1186/s13075-014-0493-1) contains supplementary material, which is available to authorized users.
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Valentini G, Marcoccia A, Cuomo G, Vettori S, Iudici M, Bondanini F, Santoriello C, Ciani A, Cozzolino D, De Matteis GM, Cappabianca S, Vitelli F, Spanò A. Early systemic sclerosis: marker autoantibodies and videocapillaroscopy patterns are each associated with distinct clinical, functional and cellular activation markers. Arthritis Res Ther 2014; 15:R63. [PMID: 23718566 PMCID: PMC4060381 DOI: 10.1186/ar4236] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 02/20/2013] [Accepted: 05/29/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Early systemic sclerosis (SSc) is characterized by Raynaud's phenomenon together with scleroderma marker autoantibodies and/or a scleroderma pattern at capillaroscopy and no other distinctive feature of SSc. Patients presenting with marker autoantibodies plus a capillaroscopic scleroderma pattern seem to evolve into definite SSc more frequently than patients with either feature. Whether early SSc patients with only marker autoantibodies or capillaroscopic positivity differ in any aspect at presentation is unclear. METHODS Seventy-one consecutive early SSc patients were investigated for preclinical cardiopulmonary alterations. Out of these, 44 patients and 25 controls affected by osteoarthritis or primary fibromyalgia syndrome were also investigated for serum markers of fibroblast (carboxyterminal propeptide of collagen I), endothelial (soluble E-selectin) and T-cell (soluble IL-2 receptor alpha) activation. RESULTS Thirty-two of the 71 patients (45.1%) had both a marker autoantibody and a capillaroscopic scleroderma pattern (subset 1), 16 patients (22.5%) had only a marker autoantibody (subset 2), and 23 patients (32.4%) had only a capillaroscopic scleroderma pattern (subset 3). Patients with marker autoantibodies (n = 48, 67.6%) had a higher prevalence of impaired diffusing lung capacity for carbon monoxide (P = 0.0217) and increased serum levels of carboxyterminal propeptide of collagen I (P = 0.0037), regardless of capillaroscopic alterations. Patients with a capillaroscopic scleroderma pattern (n = 55, 77.5%) had a higher prevalence of puffy fingers (P = 0.0001) and increased serum levels of soluble E-selectin (P = 0.0003) regardless of marker autoantibodies. CONCLUSION These results suggest that the autoantibody and microvascular patterns in early SSc may each be related to different clinical-preclinical features and circulating activation markers at presentation. Longitudinal studies are warranted to investigate whether these subsets undergo a different disease course over time.
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Clinical and autoimmune profile of scleroderma patients from Western India. Int J Rheumatol 2014; 2014:983781. [PMID: 25386193 PMCID: PMC4216682 DOI: 10.1155/2014/983781] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/30/2014] [Accepted: 09/30/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Systemic sclerosis (SSc, scleroderma) is a disorder characterized by fibrosis of skin and visceral organs. Pathogenesis of scleroderma is complex and is incompletely understood as yet. Autoantibodies in SSc represent a serologic hallmark which have clinical relevance, with diagnostic and prognostic potential. Objectives. To study distribution of clinical manifestations and to identify frequency of autoantibodies among subtypes of scleroderma patients from Western India. Methodology. One hundred and ten scleroderma patients were clinically classified according to the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria. All these patients were in active stage of disease. Clinical manifestations were recorded at the time of presentation. Autoantibodies were tested in them by indirect immunofluorescence test and ELISA. Immunoglobulin levels were estimated by nephelometer. These parameters were further correlated with clinical presentation of the disease. Results. Scleroderma patients had M : F ratio of 1 : 10 where mean age at evaluation was 34.7 ± 10.7 years and a mean disease duration was 43.7 ± 35 months. Clinical subtypes showed that 45 patients (40.9%) had diffused cutaneous (dcSSc) lesions, 32 patients (29.1%) had limited cutaneous (lcSSc) lesions, and 33 patients (30%) had other autoimmune overlaps. The overall frequency of ANA in SSc patients studied was 85.5%. The frequency of anti-Scl70, anti-centromere, anti-endothelial cell antibodies (AECA), and anti-keratinocyte antibodies (AKA) was 62.7%, 22.7%, 30%, and 40.9%, respectively. Anti-Scl70 antibodies were significantly high (75.6% versus 46.9%) among dcSSc patients (P < 0.0115) whereas anti-centromere antibodies were significantly high (9% versus 38%) among lcSSc patients when these two subtypes were compared (P < 0.0044). Conclusion. This study supports that there are geoepidemiological variations among scleroderma patients for their clinical presentation, autoantibody profile, and immune parameters across the country.
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Khanna D, Furst DE, Allanore Y, Bae S, Bodukam V, Clements PJ, Cutolo M, Czirjak L, Denton CP, Distler O, Walker UA, Matucci-Cerinic M, Müller-Ladner U, Seibold JR, Singh M, Tyndall A. Twenty-two points to consider for clinical trials in systemic sclerosis, based on EULAR standards. Rheumatology (Oxford) 2014; 54:144-51. [PMID: 25125594 DOI: 10.1093/rheumatology/keu288] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE SSc is clinically and aetiopathogenically heterogeneous. Consensus standards for more uniform trial design and selection of outcome measures are needed. The objective of this study was to develop evidence-based points to consider (PTCs) for future clinical trials in SSc. METHODS Thirteen international SSc experts experienced in SSc clinical trial design were invited to participate. One researcher with experience in systematic literature review and three trainees were also included. A systematic review using PubMed and the Cochrane Central Register of Controlled Trials was conducted and PTCs when designing clinical trials in SSc were developed. As part of that development we conducted an Internet-based Delphi exercise regarding the main points to be made in the consensus statement. Consensus was defined as achieving a median score of ≥7 of 9. RESULTS By consensus, the experts decided to develop PTCs for each individual organ system. The current document provides a unifying outline on PTCs regarding general trial design, inclusion/exclusion criteria and analysis. Consensus was achieved regarding all the main points of the PTCs. CONCLUSION Using European League Against Rheumatism suggestions for PTCs, a general outline for PTCs for controlled clinical trials in SSc was developed. Specific outlines for individual organ systems are to be published separately. This general outline should lead to more uniform and higher-quality trials and clearly delineate areas where further research is needed.
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Affiliation(s)
- Dinesh Khanna
- Division of Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, Division of Rheumatology, University of California at Los Angeles, Los Angeles, CA, USA, Department of Rheumatology A, Paris Descartes University, Cochin Institut, INSERM U1016, Cochin Hospital, Paris, France, Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA, Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy, Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary, Centre for Rheumatology, Royal Free Hospital, London, UK, Department of Rheumatology, University Hospital Zurich, Zurich, Deparment of Rheumatology, Basel University, Basel, Switzerland, Department of Biomedicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Department of Medicine, Denothe Centre, University of Florence, Florence, Italy, Department of Rheumatology and Clinical Immunology, Justus-Liebrig University Giessen, Kerckhoff Clinic, Bad Beuheinn, Germany, Scleroderma Research Consultants, Avon, CT and Department of Internal Medicine, Rochester General Health System, Rochester, NY, USA
| | - Daniel E Furst
- Division of Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, Division of Rheumatology, University of California at Los Angeles, Los Angeles, CA, USA, Department of Rheumatology A, Paris Descartes University, Cochin Institut, INSERM U1016, Cochin Hospital, Paris, France, Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA, Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy, Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary, Centre for Rheumatology, Royal Free Hospital, London, UK, Department of Rheumatology, University Hospital Zurich, Zurich, Deparment of Rheumatology, Basel University, Basel, Switzerland, Department of Biomedicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Department of Medicine, Denothe Centre, University of Florence, Florence, Italy, Department of Rheumatology and Clinical Immunology, Justus-Liebrig University Giessen, Kerckhoff Clinic, Bad Beuheinn, Germany, Scleroderma Research Consultants, Avon, CT and Department of Internal Medicine, Rochester General Health System, Rochester, NY, USA.
| | - Yannick Allanore
- Division of Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, Division of Rheumatology, University of California at Los Angeles, Los Angeles, CA, USA, Department of Rheumatology A, Paris Descartes University, Cochin Institut, INSERM U1016, Cochin Hospital, Paris, France, Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA, Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy, Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary, Centre for Rheumatology, Royal Free Hospital, London, UK, Department of Rheumatology, University Hospital Zurich, Zurich, Deparment of Rheumatology, Basel University, Basel, Switzerland, Department of Biomedicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Department of Medicine, Denothe Centre, University of Florence, Florence, Italy, Department of Rheumatology and Clinical Immunology, Justus-Liebrig University Giessen, Kerckhoff Clinic, Bad Beuheinn, Germany, Scleroderma Research Consultants, Avon, CT and Department of Internal Medicine, Rochester General Health System, Rochester, NY, USA. Division of Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, Division of Rheumatology, University of California at Los Angeles, Los Angeles, CA, USA, Department of Rheumatology A, Paris Descartes University, Cochin Institut, INSERM U1016, Cochin Hospital, Paris, France, Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA, Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy, Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary, Centre for Rheumatology, Royal Free Hospital, London, UK, Department of Rheumatology, University Hospital Zurich, Zurich, Deparment of Rheumatology, Basel University, Basel, Switzerland, Department of Biomedicine, Div
| | - Sangmee Bae
- Division of Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, Division of Rheumatology, University of California at Los Angeles, Los Angeles, CA, USA, Department of Rheumatology A, Paris Descartes University, Cochin Institut, INSERM U1016, Cochin Hospital, Paris, France, Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA, Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy, Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary, Centre for Rheumatology, Royal Free Hospital, London, UK, Department of Rheumatology, University Hospital Zurich, Zurich, Deparment of Rheumatology, Basel University, Basel, Switzerland, Department of Biomedicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Department of Medicine, Denothe Centre, University of Florence, Florence, Italy, Department of Rheumatology and Clinical Immunology, Justus-Liebrig University Giessen, Kerckhoff Clinic, Bad Beuheinn, Germany, Scleroderma Research Consultants, Avon, CT and Department of Internal Medicine, Rochester General Health System, Rochester, NY, USA
| | - Vijay Bodukam
- Division of Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, Division of Rheumatology, University of California at Los Angeles, Los Angeles, CA, USA, Department of Rheumatology A, Paris Descartes University, Cochin Institut, INSERM U1016, Cochin Hospital, Paris, France, Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA, Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy, Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary, Centre for Rheumatology, Royal Free Hospital, London, UK, Department of Rheumatology, University Hospital Zurich, Zurich, Deparment of Rheumatology, Basel University, Basel, Switzerland, Department of Biomedicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Department of Medicine, Denothe Centre, University of Florence, Florence, Italy, Department of Rheumatology and Clinical Immunology, Justus-Liebrig University Giessen, Kerckhoff Clinic, Bad Beuheinn, Germany, Scleroderma Research Consultants, Avon, CT and Department of Internal Medicine, Rochester General Health System, Rochester, NY, USA
| | - Philip J Clements
- Division of Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, Division of Rheumatology, University of California at Los Angeles, Los Angeles, CA, USA, Department of Rheumatology A, Paris Descartes University, Cochin Institut, INSERM U1016, Cochin Hospital, Paris, France, Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA, Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy, Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary, Centre for Rheumatology, Royal Free Hospital, London, UK, Department of Rheumatology, University Hospital Zurich, Zurich, Deparment of Rheumatology, Basel University, Basel, Switzerland, Department of Biomedicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Department of Medicine, Denothe Centre, University of Florence, Florence, Italy, Department of Rheumatology and Clinical Immunology, Justus-Liebrig University Giessen, Kerckhoff Clinic, Bad Beuheinn, Germany, Scleroderma Research Consultants, Avon, CT and Department of Internal Medicine, Rochester General Health System, Rochester, NY, USA
| | - Maurizio Cutolo
- Division of Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, Division of Rheumatology, University of California at Los Angeles, Los Angeles, CA, USA, Department of Rheumatology A, Paris Descartes University, Cochin Institut, INSERM U1016, Cochin Hospital, Paris, France, Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA, Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy, Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary, Centre for Rheumatology, Royal Free Hospital, London, UK, Department of Rheumatology, University Hospital Zurich, Zurich, Deparment of Rheumatology, Basel University, Basel, Switzerland, Department of Biomedicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Department of Medicine, Denothe Centre, University of Florence, Florence, Italy, Department of Rheumatology and Clinical Immunology, Justus-Liebrig University Giessen, Kerckhoff Clinic, Bad Beuheinn, Germany, Scleroderma Research Consultants, Avon, CT and Department of Internal Medicine, Rochester General Health System, Rochester, NY, USA
| | - Laszlo Czirjak
- Division of Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, Division of Rheumatology, University of California at Los Angeles, Los Angeles, CA, USA, Department of Rheumatology A, Paris Descartes University, Cochin Institut, INSERM U1016, Cochin Hospital, Paris, France, Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA, Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy, Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary, Centre for Rheumatology, Royal Free Hospital, London, UK, Department of Rheumatology, University Hospital Zurich, Zurich, Deparment of Rheumatology, Basel University, Basel, Switzerland, Department of Biomedicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Department of Medicine, Denothe Centre, University of Florence, Florence, Italy, Department of Rheumatology and Clinical Immunology, Justus-Liebrig University Giessen, Kerckhoff Clinic, Bad Beuheinn, Germany, Scleroderma Research Consultants, Avon, CT and Department of Internal Medicine, Rochester General Health System, Rochester, NY, USA
| | - Christopher P Denton
- Division of Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, Division of Rheumatology, University of California at Los Angeles, Los Angeles, CA, USA, Department of Rheumatology A, Paris Descartes University, Cochin Institut, INSERM U1016, Cochin Hospital, Paris, France, Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA, Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy, Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary, Centre for Rheumatology, Royal Free Hospital, London, UK, Department of Rheumatology, University Hospital Zurich, Zurich, Deparment of Rheumatology, Basel University, Basel, Switzerland, Department of Biomedicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Department of Medicine, Denothe Centre, University of Florence, Florence, Italy, Department of Rheumatology and Clinical Immunology, Justus-Liebrig University Giessen, Kerckhoff Clinic, Bad Beuheinn, Germany, Scleroderma Research Consultants, Avon, CT and Department of Internal Medicine, Rochester General Health System, Rochester, NY, USA
| | - Oliver Distler
- Division of Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, Division of Rheumatology, University of California at Los Angeles, Los Angeles, CA, USA, Department of Rheumatology A, Paris Descartes University, Cochin Institut, INSERM U1016, Cochin Hospital, Paris, France, Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA, Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy, Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary, Centre for Rheumatology, Royal Free Hospital, London, UK, Department of Rheumatology, University Hospital Zurich, Zurich, Deparment of Rheumatology, Basel University, Basel, Switzerland, Department of Biomedicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Department of Medicine, Denothe Centre, University of Florence, Florence, Italy, Department of Rheumatology and Clinical Immunology, Justus-Liebrig University Giessen, Kerckhoff Clinic, Bad Beuheinn, Germany, Scleroderma Research Consultants, Avon, CT and Department of Internal Medicine, Rochester General Health System, Rochester, NY, USA
| | - Ulrich A Walker
- Division of Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, Division of Rheumatology, University of California at Los Angeles, Los Angeles, CA, USA, Department of Rheumatology A, Paris Descartes University, Cochin Institut, INSERM U1016, Cochin Hospital, Paris, France, Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA, Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy, Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary, Centre for Rheumatology, Royal Free Hospital, London, UK, Department of Rheumatology, University Hospital Zurich, Zurich, Deparment of Rheumatology, Basel University, Basel, Switzerland, Department of Biomedicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Department of Medicine, Denothe Centre, University of Florence, Florence, Italy, Department of Rheumatology and Clinical Immunology, Justus-Liebrig University Giessen, Kerckhoff Clinic, Bad Beuheinn, Germany, Scleroderma Research Consultants, Avon, CT and Department of Internal Medicine, Rochester General Health System, Rochester, NY, USA
| | - Marco Matucci-Cerinic
- Division of Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, Division of Rheumatology, University of California at Los Angeles, Los Angeles, CA, USA, Department of Rheumatology A, Paris Descartes University, Cochin Institut, INSERM U1016, Cochin Hospital, Paris, France, Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA, Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy, Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary, Centre for Rheumatology, Royal Free Hospital, London, UK, Department of Rheumatology, University Hospital Zurich, Zurich, Deparment of Rheumatology, Basel University, Basel, Switzerland, Department of Biomedicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Department of Medicine, Denothe Centre, University of Florence, Florence, Italy, Department of Rheumatology and Clinical Immunology, Justus-Liebrig University Giessen, Kerckhoff Clinic, Bad Beuheinn, Germany, Scleroderma Research Consultants, Avon, CT and Department of Internal Medicine, Rochester General Health System, Rochester, NY, USA. Division of Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, Division of Rheumatology, University of California at Los Angeles, Los Angeles, CA, USA, Department of Rheumatology A, Paris Descartes University, Cochin Institut, INSERM U1016, Cochin Hospital, Paris, France, Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA, Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy, Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary, Centre for Rheumatology, Royal Free Hospital, London, UK, Department of Rheumatology, University Hospital Zurich, Zurich, Deparment of Rheumatology, Basel University, Basel, Switzerland, Department of Biomedicine, Div
| | - Ulf Müller-Ladner
- Division of Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, Division of Rheumatology, University of California at Los Angeles, Los Angeles, CA, USA, Department of Rheumatology A, Paris Descartes University, Cochin Institut, INSERM U1016, Cochin Hospital, Paris, France, Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA, Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy, Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary, Centre for Rheumatology, Royal Free Hospital, London, UK, Department of Rheumatology, University Hospital Zurich, Zurich, Deparment of Rheumatology, Basel University, Basel, Switzerland, Department of Biomedicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Department of Medicine, Denothe Centre, University of Florence, Florence, Italy, Department of Rheumatology and Clinical Immunology, Justus-Liebrig University Giessen, Kerckhoff Clinic, Bad Beuheinn, Germany, Scleroderma Research Consultants, Avon, CT and Department of Internal Medicine, Rochester General Health System, Rochester, NY, USA
| | - James R Seibold
- Division of Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, Division of Rheumatology, University of California at Los Angeles, Los Angeles, CA, USA, Department of Rheumatology A, Paris Descartes University, Cochin Institut, INSERM U1016, Cochin Hospital, Paris, France, Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA, Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy, Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary, Centre for Rheumatology, Royal Free Hospital, London, UK, Department of Rheumatology, University Hospital Zurich, Zurich, Deparment of Rheumatology, Basel University, Basel, Switzerland, Department of Biomedicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Department of Medicine, Denothe Centre, University of Florence, Florence, Italy, Department of Rheumatology and Clinical Immunology, Justus-Liebrig University Giessen, Kerckhoff Clinic, Bad Beuheinn, Germany, Scleroderma Research Consultants, Avon, CT and Department of Internal Medicine, Rochester General Health System, Rochester, NY, USA
| | - Manjit Singh
- Division of Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, Division of Rheumatology, University of California at Los Angeles, Los Angeles, CA, USA, Department of Rheumatology A, Paris Descartes University, Cochin Institut, INSERM U1016, Cochin Hospital, Paris, France, Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA, Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy, Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary, Centre for Rheumatology, Royal Free Hospital, London, UK, Department of Rheumatology, University Hospital Zurich, Zurich, Deparment of Rheumatology, Basel University, Basel, Switzerland, Department of Biomedicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Department of Medicine, Denothe Centre, University of Florence, Florence, Italy, Department of Rheumatology and Clinical Immunology, Justus-Liebrig University Giessen, Kerckhoff Clinic, Bad Beuheinn, Germany, Scleroderma Research Consultants, Avon, CT and Department of Internal Medicine, Rochester General Health System, Rochester, NY, USA
| | - Alan Tyndall
- Division of Rheumatology, University of Michigan Scleroderma Program, Ann Arbor, MI, Division of Rheumatology, University of California at Los Angeles, Los Angeles, CA, USA, Department of Rheumatology A, Paris Descartes University, Cochin Institut, INSERM U1016, Cochin Hospital, Paris, France, Department of Medicine, Crozer Chester Medical Center, Upland, PA, USA, Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy, Department of Immunology and Rheumatology, University of Pécs, Pécs, Hungary, Centre for Rheumatology, Royal Free Hospital, London, UK, Department of Rheumatology, University Hospital Zurich, Zurich, Deparment of Rheumatology, Basel University, Basel, Switzerland, Department of Biomedicine, Division of Rheumatology, Azienda Ospedaliero Universitaria Careggi, Department of Medicine, Denothe Centre, University of Florence, Florence, Italy, Department of Rheumatology and Clinical Immunology, Justus-Liebrig University Giessen, Kerckhoff Clinic, Bad Beuheinn, Germany, Scleroderma Research Consultants, Avon, CT and Department of Internal Medicine, Rochester General Health System, Rochester, NY, USA
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Sobanski V, Dauchet L, Lefèvre G, Lambert M, Morell-Dubois S, Sy T, Hachulla E, Hatron PY, Launay D, Dubucquoi S. Prevalence of anti-RNA polymerase III antibodies in systemic sclerosis: New data from a French cohort and a systematic review and meta-analysis. Arthritis Rheumatol 2014; 66:407-17. [PMID: 24504813 DOI: 10.1002/art.38219] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 09/26/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Studies assessing the prevalence of anti-RNA polymerase III (anti-RNAP III) antibodies in systemic sclerosis (SSc) have yielded a wide range of results. The aim of the present study was to describe a new SSc cohort tested for presence of anti-RNAP III and perform a systematic review and meta-analysis to assess the prevalence of anti-RNAP III in patients worldwide and the potential factors of variability. METHODS Seropositivity for anti-RNAP III was evaluated in a French cohort of SSc patients. A systematic review of the literature was carried out in PubMed and EMBase. Meta-analysis was performed using available data on prevalence, clinical characteristics of SSc patients, and the types of assays used for anti-RNAP III testing. RESULTS One hundred thirty-three French SSc patients were tested for anti-RNAP III, and a prevalence of 6-9% was found in these patients. Thirty studies representing a total population of 8,437 SSc patients were included in the meta-analysis. Prevalence of anti-RNAP III in this population was highly variable (range 0-41%). The overall pooled prevalence of anti-RNAP III was 11% (95% confidence interval 8-14), but heterogeneity was high among studies (I(2) = 93%, P < 0.0001). Geographic factors such as continent or country of study origin partially explained this heterogeneity and correlated with the prevalence. No other baseline SSc characteristics were significantly correlated with the prevalence of anti-RNAP III. CONCLUSION Data on our new cohort and our meta-analysis of the literature confirmed that anti-RNAP III prevalence in SSc varies among centers. Geographic factors were significantly associated with prevalence, which underscores the probable implication that genetic background and environmental factors play a role. Heterogeneity among studies remained largely unexplained.
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Affiliation(s)
- Vincent Sobanski
- Université Lille Nord de France, EA 2686, IMPRT IFR 114, Centre National de Référence de la Sclérodermie Systémique, and Hôpital Claude Huriez, Centre Hospitalier Régional Universitaire de Lille, Lille, France
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