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De Lorenzis E, Kakkar V, Di Donato S, Wilson M, Barnes T, Denton C, Derrett-Smith E, Douglas K, Helliwell P, Herrick AL, Saleem B, Nisar M, Morley C, Green L, Alcacer-Pitarch B, Del Galdo F. Clinical trajectories of hand function impairment in systemic sclerosis: an unmet clinical need across disease subsets. RMD Open 2024; 10:e003216. [PMID: 38216288 PMCID: PMC10806527 DOI: 10.1136/rmdopen-2023-003216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/15/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Hand involvement is an early manifestation of systemic sclerosis (SSc), culprit of diagnosis and classification, and recognised major driver of disability. Impairment of hand function burdens both limited and diffuse cutaneous subsets and therefore could be targeted as 'basket' endpoint in SSc. Nevertheless, its natural history in current standard of care is not well characterised, limiting the design of targeted trials. The aim of this study is to describe prevalence, natural history and clinical factors associated with hand function deterioration in a longitudinal, multicentre, observational SSc cohort. METHODS Hand function was captured through the validated Cochin Hand Function Scale in patients consecutively enrolled in a multicentre observational study and observed over 24 months. Minimal clinically important differences and patient acceptable symptom state were analysed as previously described. RESULTS Three hundred and ninety-six consecutive patients were enrolled from 10 centres; 201 with complete follow-up data were included in the analysis. Median (IQR) disease duration was 5 (2-11) years. One hundred and five (52.2%) patients reported clinically significant worsening. Accordingly, the proportion of patients reporting unacceptable hand function increased over 2 years from 27.8% to 35.8% (p<0.001). Least absolute shrinkage and selection operator analysis identified male gender, disease subset, Raynaud's Condition Score, tenosynovitis and pain, as some of the key factors associated with worsening hand involvement. CONCLUSIONS Hand function deteriorates over time in more than 50% of SSc patients despite available therapies. The analysis of factors associated with hand function worsening supports the involvement of both inflammation, vascular and fibrotic processes in hand involvement, making it a hallmark clinical manifestation of SSc. Our data are poised to inform the design of intervention studies to target this major driver of disability in SSc.
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Affiliation(s)
- Enrico De Lorenzis
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Division of Rheumatology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Vishal Kakkar
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Stefano Di Donato
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Michelle Wilson
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Theresa Barnes
- Department of Rheumatology, Countess of Chester Hospital NHS Foundation Trust, Liverpool, UK
| | - Chris Denton
- Department of Rheumatology, Royal Free London NHS Foundation Trust, London, UK
| | - Emma Derrett-Smith
- Department of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Karen Douglas
- Department of Rheumatology, The Dudley Group NHS Foundation Trust, Dudley, UK
| | - Philip Helliwell
- Department of Rheumatology, St. Luke's Hospital, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ariane L Herrick
- Centre for Musculoskeletal Research, The University of Manchester, Salford Royal NHS Foundation Trust,Manchester Academic Health Science Centre, Manchester, UK
| | - Benazir Saleem
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Department of Rheumatology, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Muhammad Nisar
- Department of Rheumatology, Luton & Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Catherine Morley
- Department of Rheumatology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Lorraine Green
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Begonya Alcacer-Pitarch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Francesco Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Xu M, Harel D, Carrier ME, Kwakkenbos L, Bartlett SJ, Gottesman K, Guillot G, Hummers L, Malcarne VL, Richard M, Thombs BD. Differential Item Functioning on the Cochin Hand Function Scale Among People With Systemic Sclerosis by Language, Sex, and Disease Subtype: A Scleroderma Patient-Centered Intervention Network (SPIN) Cohort Study. Arthritis Care Res (Hoboken) 2023. [PMID: 37489073 DOI: 10.1002/acr.25199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/27/2023] [Accepted: 07/18/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE To evaluate the degree that the Cochin Hand Function Scale (CHFS) generates scores that are comparable across language, sex, and disease subtype. METHODS We included participants enrolled in the Scleroderma Patient-centered Intervention Network (SPIN) Cohort who completed the CHFS at their baseline assessment between April 2014 and September 2020. Confirmatory factor analysis (CFA) was used to test unidimensionality, and multiple indicator multiple cause (MIMIC) models were used for differential item functioning (DIF) analysis based on language, sex, and disease subtype. Both intraclass correlation coefficient (ICC) and Pearson's correlation were calculated using factor scores obtained from unadjusted and DIF-adjusted MIMIC models to evaluate agreement and correlation between scores. RESULTS A total of 2,155 participants were included. CFA with covarying error terms supported a good fit of the model (χ2 [127] = 1,754.671; P < 0.001; Tucker-Lewis index = 0.985; comparative fit index = 0.987; root mean square error of approximation = 0.077). Nine items displayed statistically significant DIF for language of administration, 10 items for sex, and 10 items for disease subtype. However, the overall impact of DIF was negligible when comparing factor scores that did and did not account for DIF (ICC = 0.999; r = 0.999). CONCLUSION The CHFS has score comparability in systemic sclerosis regardless of participants' language, sex, and disease subtype.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Brett D Thombs
- Jewish General Hospital and McGill University, Montreal, Quebec, Canada
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Frech TM, Poole JL, Murtaugh M, Matucci-Cerinic M. Expanding the Treatment Team. Rheum Dis Clin North Am 2023; 49:377-387. [PMID: 37028841 DOI: 10.1016/j.rdc.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
The optimal systemic sclerosis (SSc) care plan includes an occupational therapist and physical therapist as well as wound care experts and a registered dietitian if indicated. Screening instruments for functional and work disability, hand and mouth limitations, malnutrition, and dietary intake can identify the need for ancillary support services. Telemedicine can assist in developing effective ancillary treatment plans. Reimbursement for services may limit access for patients with SSc to expand their care team but a focus on prevention rather than management of damage is recognized as an important unmet need in SSc. In this review, the role of a comprehensive care team for SSc is discussed.
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Affiliation(s)
- Tracy M Frech
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Janet L Poole
- Occupational Therapy Graduate Program, Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA
| | - Maureen Murtaugh
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Marco Matucci-Cerinic
- Division of Rheumatology and Scleroderma Unit, AOU Careggi, Florence and Department of Experimental and Clinical Medicine, University of Florence, Italy
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Bairwa D, Kavadichanda CG, Dunga S, Mathew A, G A, M S G, Mamatha G, Thabah MM, Negi VS. Effect of skin phototype on quantitative nailfold capillaroscopy. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2022; 7:197-203. [PMID: 36211202 PMCID: PMC9537707 DOI: 10.1177/23971983221102688] [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: 03/24/2022] [Accepted: 05/05/2022] [Indexed: 10/03/2023]
Abstract
Objectives To determine the impact of Fitzpatrick scale-based skin phototype on visualization of capillary density using nailfold capillaroscopy in healthy Indian adults. Methods In this cross-sectional study, healthy adults were examined for nailfold capillaroscopy findings utilizing a portable capillary microscope at 800× magnification. Photographs of two contiguous areas measuring 1 mm2 each of the distal row of capillaries were captured. Images were captured from the central area of all fingers except thumb in both hands. Capillary density and morphology of nailfold capillaroscopies were assessed by two blinded assessors. The nailfold capillaroscopy parameters were compared between the Standard Fitzpatrick scale-based skin phototypes. Results A total of 118 healthy adults were enrolled in the study. Type III, IV, V, and VI skin phototypes were seen in 27 (22.90%), 32 (27.19%), 29 (24.58%), and 30 (25.42%) participants, respectively. All participants (100%) had normal nailfold capillaroscopy morphology and architecture. Zero capillaries were visible in 11 fingers among 5 patients (4.24%) and all of them had Type VI phototype. The median capillary density per mm was 5.19 (interquartile range = 4.37-6.75) with 90 (76.27%) participants having less than seven capillaries. The median average capillary density was significantly different (p-value < 0.0001) across Type III (8.13, interquartile range = 6.44-8.88), Type IV (5.67, interquartile range = 4.41-6.98), Type V (4.94, interquartile range = 4.19-5.38), and Type VI (4.53, interquartile range = 3.72-4.91) phototypes (p < 0.05). Conclusion The number of capillaries visualized during nailfold capillaroscopy decreases as the skin pigmentation increases. There is a need to redefine the nailfold capillaroscopy density and avascularity by taking skin phototype as one of the determinants before labeling a nailfold capillaroscopy finding with less visualized capillaries as abnormal.
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Affiliation(s)
- Devender Bairwa
- Department of Clinical Immunology,
Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER),
Pondicherry, India
| | - Chengappa G Kavadichanda
- Department of Clinical Immunology,
Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER),
Pondicherry, India
| | - Saikumar Dunga
- Department of Clinical Immunology,
Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER),
Pondicherry, India
| | - Anoop Mathew
- Department of Clinical Immunology,
Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER),
Pondicherry, India
| | - Aishwarya G
- Department of Clinical Immunology,
Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER),
Pondicherry, India
| | - Gayathri M S
- Department of Clinical Immunology,
Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER),
Pondicherry, India
| | - Gorijavolu Mamatha
- Department of Clinical Immunology,
Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER),
Pondicherry, India
| | - Molly Mary Thabah
- Department of Clinical Immunology,
Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER),
Pondicherry, India
| | - Vir Singh Negi
- All India Institute of Medical
Sciences, Bilaspur, India
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