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Chevalier K, Chaigne B, Mouthon L. Authors reply: Clinical presentation, course, and prognosis of patients with mixed connective tissue disease. J Intern Med 2024; 295:576-578. [PMID: 38178549 DOI: 10.1111/joim.13765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Affiliation(s)
- Kevin Chevalier
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes et Autoinflammatoires Rares d'Ile de France de l'Est et de l'Ouest, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- APHP-CUP, Hôpital Cochin, Université Paris Cité, Paris, France
| | - Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes et Autoinflammatoires Rares d'Ile de France de l'Est et de l'Ouest, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- APHP-CUP, Hôpital Cochin, Université Paris Cité, Paris, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes et Autoinflammatoires Rares d'Ile de France de l'Est et de l'Ouest, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- APHP-CUP, Hôpital Cochin, Université Paris Cité, Paris, France
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Hospach T, Kallinich T, Rietschel C, Hufnagel M, Freudenhammer J, Rücklová K, Oommen PT. [Society for Pediatric and Adolescent Rheumatology (GKJR) diagnosis and treatment optimization board-New ways to the diagnosis and treatment of complex diseases : An analysis after 2 years testing in practice]. Z Rheumatol 2024; 83:28-33. [PMID: 37945990 DOI: 10.1007/s00393-023-01444-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/12/2023]
Abstract
With the diagnosis and treatment optimization board, the Society for Pediatric and Adolescent Rheumatology (GKJR) has developed a new format for expert-based discussion of rare and complex diseases. So far, 32 cases, predominantly from the areas of hyperinflammation, systemic lupus erythematosus, myositis and nonbacterial osteomyelitis, could be discussed in 8 conferences. The digital format enabled a high number of participants and the involvement of national and international experts. Rare diseases increasingly present modern medicine with challenges, which the GKJR meets with the new format.
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Affiliation(s)
- Toni Hospach
- Zentrum für pädiatrische Rheumatologie am Klinikum Stuttgart (ZEPRAS), Olgahospital, Kriegsbergstr 62, 70176, Stuttgart, Deutschland.
| | - Tilmann Kallinich
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité Universitätsmedizin und Deutsches Rheuma-Forschungszentrum (DRFZ), ein Leibniz Institut, Berlin, Deutschland
| | - Christoph Rietschel
- Kinder- und Jugendrheumatologie, Clementine Kinderhospital, Frankfurt/Main, Deutschland
| | - Markus Hufnagel
- Sektion Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
| | - Johanna Freudenhammer
- Sektion Pädiatrische Infektiologie und Rheumatologie, Klinik für Allgemeine Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
| | - Kristina Rücklová
- Zentrum für pädiatrische Rheumatologie am Klinikum Stuttgart (ZEPRAS), Olgahospital, Kriegsbergstr 62, 70176, Stuttgart, Deutschland
| | - Prasad T Oommen
- Klinik für Kinder-Onkologie, - Hämatologie und Klin. Immunologie, Bereich Päd. Rheumatologie, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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Selva-O’Callaghan A, Guillen-Del-Castillo A, Gil-Vila A, Trallero-Araguás E, Matas-García A, Milisenda JC, Pinal-Fernández I, Simeón-Aznar C. Systemic sclerosis associated myopathy: how to treat. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2023; 9:151-167. [PMID: 38737329 PMCID: PMC11086655 DOI: 10.1007/s40674-023-00206-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/14/2024]
Abstract
Purpose of review Systemic sclerosis (SSc) and myositis are two different entities that may coexist as an overlap syndrome. Immunological biomarkers such as anti-PM/Scl or anti-Ku reinforce the syndrome. This review is focused on the treatment of different and characteristic manifestations of this syndrome. Recent findings Among the different phenotypes of muscle involvement in patients with SSc, the fibrotic pattern and the sporadic inclusion body myositis must be identified early to avoid a futile immunosuppressive treatment. Other forms such as dermatomyositis, non-specific myositis and immune-mediated necrotizing myopathy need to receive conventional immunosuppressive therapy considering that high dose of glucocorticoids may induce a scleroderma renal crisis in patients with SSc. Physicians must be aware of the existence of a "double trouble" association of hereditary myopathy with an autoimmune phenomenon. Several autoantibodies, mainly anti-PM/Scl and anti-Ku may help to define specific phenotypes with characteristic clinical manifestations that need a more specific therapy. Vasculopathy is one of the underlying mechanisms that link SSc and myositis. Recent advances in this topic are reviewed. Summary Current treatment of SSc associated myopathy must be tailored to specific organs involved. Identifying the specific clinical, pathological, and immunological phenotypes may help to take the correct therapeutic decisions.
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Affiliation(s)
- A Selva-O’Callaghan
- Systemic Autoimmune Diseases Unit. Internal Medicine Departament. Universitat Autónoma de Barcelona. Vall d’Hebron Hospital. Barcelona. Spain
| | - A Guillen-Del-Castillo
- Systemic Autoimmune Diseases Unit. Internal Medicine Departament. Universitat Autónoma de Barcelona. Vall d’Hebron Hospital. Barcelona. Spain
| | - A Gil-Vila
- Systemic Autoimmune Diseases Unit. Internal Medicine Departament. Universitat Autónoma de Barcelona. Vall d’Hebron Hospital. Barcelona. Spain
| | | | - A Matas-García
- Muscle Research Unit, Internal Medicine Service, Hospital Clinic de Barcelona (HCB), Universidad de Barcelona and Center for Biomedical Research on Rare Diseases (CIBERER). Barcelona. Spain
| | - JC Milisenda
- Muscle Research Unit, Internal Medicine Service, Hospital Clinic de Barcelona (HCB), Universidad de Barcelona and Center for Biomedical Research on Rare Diseases (CIBERER). Barcelona. Spain
| | - I Pinal-Fernández
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C Simeón-Aznar
- Systemic Autoimmune Diseases Unit. Internal Medicine Departament. Universitat Autónoma de Barcelona. Vall d’Hebron Hospital. Barcelona. Spain
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Guillen-Del-Castillo A, Simeón-Aznar CP. Identifying the risk of cancer-associated systemic sclerosis. Joint Bone Spine 2023; 90:105618. [PMID: 37482176 DOI: 10.1016/j.jbspin.2023.105618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/09/2023] [Accepted: 07/15/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Alfredo Guillen-Del-Castillo
- Unit of Systemic Autoimmune Diseases, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
| | - Carmen Pilar Simeón-Aznar
- Unit of Systemic Autoimmune Diseases, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
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Volkmann ER, McMahan ZH, Smith V, Jouneau S, Miede C, Alves M, Herrick AL. Risk of Malnutrition in Patients With Systemic Sclerosis-Associated Interstitial Lung Disease Treated With Nintedanib in the Randomized, Placebo-Controlled SENSCIS Trial. Arthritis Care Res (Hoboken) 2023; 75:2501-2507. [PMID: 37357024 DOI: 10.1002/acr.25176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To assess adverse events (AEs) in relation to baseline body mass index (BMI) and the risk of malnutrition in patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD) treated with nintedanib. METHODS Among patients with SSc-ILD randomized to receive nintedanib or placebo in the SENSCIS trial, we assessed AEs in subgroups by baseline BMI ≤20 kg/m2 and BMI >20 kg/m2 , and the risk of malnutrition using a modified version of the Malnutrition Universal Screening Tool (MUST), over 52 weeks. RESULTS The AE profile of nintedanib was similar between subgroups with a baseline BMI ≤20 kg/m2 (n = 61) and a baseline BMI >20 kg/m2 (n = 515). In these subgroups, respectively, AEs led to treatment discontinuation in 16.7% and 15.9% of the nintedanib group and 13.5% and 8.0% of the placebo group, respectively. Based on the modified MUST, the proportions of patients who had a low risk of malnutrition at baseline and at their last assessment were 74.0% in the nintedanib group and 78.1% in the placebo group, while the proportions who were classified as at low risk at baseline but at high risk by their last assessment were 4.5% in the nintedanib group and 1.0% in the placebo group. CONCLUSION In the SENSCIS trial, most patients with SSc-ILD remained at low risk of malnutrition over 52 weeks, but the proportion at high risk was higher in patients who received treatment with nintedanib compared to those who received placebo. Management of disease manifestations and AEs that may be associated with weight loss is important to reduce the risk of malnutrition in patients with SSc-ILD.
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Affiliation(s)
| | | | - Vanessa Smith
- Ghent University Hospital, Ghent University, and VIB Inflammation Research Center, Ghent, Belgium
| | - Stéphane Jouneau
- Competences Centre for Rare Pulmonary Diseases, and Univ Rennes, CHU Rennes, Inserm, EHESP, IRSET, Rennes, France
| | | | - Margarida Alves
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Ariane L Herrick
- The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester, UK
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Richardson C, Perin J, Zeger S, Wigley FM, Hummers LK, Casciola-Rosen L, Rosen A, Shah AA. Cumulative disease damage and anti-PM/Scl antibodies are associated with a heavy burden of calcinosis in systemic sclerosis. Rheumatology (Oxford) 2023; 62:3636-3643. [PMID: 36469337 PMCID: PMC10629791 DOI: 10.1093/rheumatology/keac682] [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: 05/20/2022] [Revised: 11/17/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Ectopic calcification (calcinosis) is a common complication of SSc, but a subset of SSc patients has a heavy burden of calcinosis. We examined whether there are unique risk factors for a heavy burden of calcinosis, as compared with a light burden or no calcinosis. METHODS We reviewed the medical records of all patients in the Johns Hopkins Scleroderma Center Research Registry with calcinosis to quantify calcinosis burden using pre-specified definitions. We performed latent class analysis to identify SSc phenotypic classes. We used multinomial logistic regression to determine whether latent phenotypic classes and autoantibodies were independent risk factors for calcinosis burden. RESULTS Of all patients, 29.4% (997/3388) had calcinosis, and 13.5% (130/963) of those with calcinosis had a heavy burden. The latent phenotypic class with predominantly diffuse skin disease and higher disease severity (characterized by pulmonary hypertension, interstitial lung disease, cardiomyopathy, severe RP, gastrointestinal involvement, renal crisis, myopathy and/or tendon friction rubs) was associated with an increased risk of both a heavy burden [odds ratio (OR) 6.92, 95% CI 3.66, 13.08; P < 0.001] and a light burden (OR 2.88, 95% CI 2.11, 3.95; P < 0.001) of calcinosis compared with the phenotypic class with predominantly limited skin disease. Autoantibodies to PM/Scl were strongly associated with a heavy burden of calcinosis (OR 17.31, 95% CI 7.72, 38.81; P < 0.001) and to a lesser degree a light burden of calcinosis (OR 3.59, 95% CI 1.84, 7.00; P < 0.001). CONCLUSIONS Calcinosis burden is associated with cumulative SSc-related tissue damage. Independent of disease severity, autoantibodies to PM/Scl are also associated with a heavy burden of calcinosis.
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Affiliation(s)
- Carrie Richardson
- Department of Medicine (Rheumatology), Northwestern University, Chicago, IL, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Scott Zeger
- Departments of Biostatistics, Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fredrick M Wigley
- Department of Medicine (Rheumatology), Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura K Hummers
- Department of Medicine (Rheumatology), Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Livia Casciola-Rosen
- Department of Medicine (Rheumatology), Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Antony Rosen
- Department of Medicine (Rheumatology), Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ami A Shah
- Department of Medicine (Rheumatology), Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Connolly CM, Paik JJ. Myopathy in systemic sclerosis. Curr Opin Rheumatol 2023; 35:341-348. [PMID: 37650694 PMCID: PMC10538402 DOI: 10.1097/bor.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE OF REVIEW Systemic sclerosis associated myopathy (SSc-AM) is a complex, heterogenous disease that is associated with poor outcomes. SSc-AM lacks a clear definition, and continues to be poorly recognized. The purpose of this review is to provide a contemporary overview of the clinical, serological and pathophysiologic findings in SSc-AM to guide optimal recognition and management of this challenging disease manifestation. RECENT FINDINGS There have been several advances in diagnostic techniques to facilitate characterization of SSc-AM, including muscle MRI, in which findings were correlated to distinct histopathologic categories of muscle involvement in SSc, histopathologic findings of prominent fibrosis or inflammation on biopsy, and the identification of novel autoantibodies associated with SSc-AM, which may be associated with distinct clinical phenotypes. In one of the largest studies to date, 17% of a well phenotyped SSc cohort were found to have myopathy, which was an independent risk of death, even after adjusting for potential confounders, further highlighting the importance of timely recognistion and management of SSc-AM. SUMMARY There is increasing recognition of the importance of SSc-AM. Novel diagnostic tools provide the opportunity for more detailed insights into pathophysiologic mechanisms, which may facilitate the development of a rigorous consensus definition of SSc-AM.
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Affiliation(s)
- Caoilfhionn M. Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Julie J. Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Makol A, Nagaraja V, Amadi C, Pugashetti JV, Caoili E, Khanna D. Recent innovations in the screening and diagnosis of systemic sclerosis-associated interstitial lung disease. Expert Rev Clin Immunol 2023; 19:613-626. [PMID: 36999788 PMCID: PMC10698514 DOI: 10.1080/1744666x.2023.2198212] [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: 02/07/2023] [Accepted: 03/29/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Interstitial lung disease (ILD) is the leading cause of mortality in patients with systemic sclerosis (SSc). Risk of developing progressive ILD is highest among patients with diffuse cutaneous disease, positive anti-topoisomerase I antibody, and elevated acute phase reactants. With the FDA approval of two medications and a pipeline of novel therapeutics in trials, early recognition and intervention is critical. High-resolution computed tomography of the chest is the current gold standard test for diagnosis of ILD. Yet, it is not offered as a screening tool to all patients due to which ILD can be missed in up to a third of patients. There is a need to develop and validate more innovative screening modalities. AREAS COVERED In this review, we provide an overview of screening and diagnosis of SSc-ILD, highlighting the recent innovations particularly the role of soluble serologic, radiomic (quantitative lung imaging, lung ultrasound), and breathomic (exhaled breath analysis) biomarkers in the early detection of SSc-ILD. EXPERT OPINION There is remarkable progress in the development of new radiomics and serum biomarkers in diagnosing SSc-ILD. There is an urgent need for conceptualizing and testing composite ILD screening strategies that incorporate these biomarkers.
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Affiliation(s)
- Ashima Makol
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vivek Nagaraja
- Division of Rheumatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Chiemezie Amadi
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Janelle Vu Pugashetti
- Division of Pulmonary and Critical Care Medicine; University of Michigan, Ann Arbor, Michigan, USA
| | - Elaine Caoili
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Dinesh Khanna
- Michigan Scleroderma Program
- Division of Rheumatology; Department of Internal Medicine; University of Michigan, Ann Arbor, Michigan, USA
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Pugashetti JV, Khanna D, Kazerooni EA, Oldham J. Clinically Relevant Biomarkers in Connective Tissue Disease-Associated Interstitial Lung Disease. Immunol Allergy Clin North Am 2023; 43:411-433. [PMID: 37055096 PMCID: PMC10584384 DOI: 10.1016/j.iac.2023.01.012] [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] [Indexed: 03/06/2023]
Abstract
Interstitial lung disease (ILD) complicates connective tissue disease (CTD) with variable incidence and is a leading cause of death in these patients. To improve CTD-ILD outcomes, early recognition and management of ILD is critical. Blood-based and radiologic biomarkers that assist in the diagnosis CTD-ILD have long been studied. Recent studies, including -omic investigations, have also begun to identify biomarkers that may help prognosticate such patients. This review provides an overview of clinically relevant biomarkers in patients with CTD-ILD, highlighting recent advances to assist in the diagnosis and prognostication of CTD-ILD.
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Affiliation(s)
- Janelle Vu Pugashetti
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan.
| | - Dinesh Khanna
- Scleroderma Program, Division of Rheumatology, Department of Internal Medicine, University of Michigan
| | - Ella A Kazerooni
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan; Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan
| | - Justin Oldham
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan; Department of Epidemiology, University of Michigan
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Le Pavec J, Launay D, Cottin V, Reynaud-Gaubert M. [Lung transplantation for systemic sclerosis-associated interstitial lung disease]. Rev Mal Respir 2023; 40 Suppl 1:e73-e79. [PMID: 36725441 DOI: 10.1016/j.rmr.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- J Le Pavec
- Service de Pneumologie et de Transplantation Pulmonaire, Groupe Hospitalier Marie-Lannelongue-Paris Saint Joseph, Le Plessis-Robinson, France; Université Paris-Saclay, Le Kremlin Bicêtre, France; UMR_S 999, Université Paris-Sud, Inserm, Groupe hospitalier Marie-Lannelongue-Saint Joseph, Le Plessis-Robinson, France.
| | - D Launay
- University Lille, Inserm, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; University Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France
| | - V Cottin
- Université de Lyon, INRA, IVPC, Lyon, Centre national de référence des maladies pulmonaires rares, hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - M Reynaud-Gaubert
- Service de Pneumologie et Equipe de Transplantation Pulmonaire, Centre Hospitalo-Universitaire Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
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Matas-García A, Guillén-Del-Castillo A, Kisluk B, Selva-O'Callaghan A, Espinosa G, Prieto-González S, Moreno Lozano P, Garrabou G, Grau-Junyent JM, Simeon-Aznar CP, Milisenda JC. Clinico-pathological phenotypes of systemic sclerosis-associated myopathy: analysis of a large multicentre cohort. Rheumatology (Oxford) 2023; 62:SI82-SI90. [PMID: 35713496 DOI: 10.1093/rheumatology/keac361] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The objective of this study was to analyse the clinico-serological and histological phenotypes of patients with SSc with associated myopathy. METHODS From November 2002 to September 2020, 52 patients with SSc underwent a muscle biopsy for suspected myopathy. We established two subgroups according to the histological findings based on the presence of isolated fibrosis or fibrosis together with significant inflammation. These patterns were designated as fibrosing and inflammatory, respectively. Clinical data, antibody profile, electrophysiologic studies, muscle biopsy findings and data regarding treatment, mortality and survival were compared between the two groups. RESULTS Fourteen biopsies had a fibrosing pattern, whereas 26 showed an inflammatory pattern that could be classified (according to the predominant pattern) into DM (n = 7), necrotizing myopathy (n = 4) and non-specific myositis (n = 15). Additionally, 12 muscle biopsies were reported as neurogenic atrophy (n = 2), or normal muscle or minimal changes (n = 10). Compared with the inflammatory group, SSc patients with the fibrosing pattern presented a higher prevalence of ischaemic heart disease (38.5% vs 3.8%, P = 0.011), conduction abnormalities or arrhythmias (61.5% vs 26.9%, P = 0.036), anti-topo I antibodies (42.9% vs 11.5%, P = 0.044), greater median ESR (53.5 mm/h vs 32.5 mm/h, P = 0.013), with poor response to treatment and a higher mortality (42.9% vs 3.8%, P = 0.004) and lower cumulative survival (P = 0.035). CONCLUSIONS Patients with SSc-associated myopathy require a comprehensive approach that encompasses clinical, serological and histopathological aspects, given their outcome predictive capacity. At least two different phenotypes can be drawn, considering clinico-pathological features. Significant differences are delineated between both a fibrotic and an inflammatory phenotype.
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Affiliation(s)
- Ana Matas-García
- Muscle Research Unit, Internal Medicine Service, Hospital Clínic de Barcelona (HCB), Universidad de Barcelona and Center for Biomedical Research on Rare Diseases (CIBERER)
| | - Alfredo Guillén-Del-Castillo
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, Hospital Universitari Vall d'Hebron (HVH), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Boris Kisluk
- Rheumathology Service, Hospital Escuela Eva Perón, Santa Fe, Argentina
| | - Albert Selva-O'Callaghan
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, Hospital Universitari Vall d'Hebron (HVH), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Sergio Prieto-González
- Muscle Research Unit, Internal Medicine Service, Hospital Clínic de Barcelona (HCB), Universidad de Barcelona and Center for Biomedical Research on Rare Diseases (CIBERER)
| | - Pedro Moreno Lozano
- Muscle Research Unit, Internal Medicine Service, Hospital Clínic de Barcelona (HCB), Universidad de Barcelona and Center for Biomedical Research on Rare Diseases (CIBERER)
| | - Glòria Garrabou
- Muscle Research Unit, Internal Medicine Service, Hospital Clínic de Barcelona (HCB), Universidad de Barcelona and Center for Biomedical Research on Rare Diseases (CIBERER)
| | - Josep María Grau-Junyent
- Muscle Research Unit, Internal Medicine Service, Hospital Clínic de Barcelona (HCB), Universidad de Barcelona and Center for Biomedical Research on Rare Diseases (CIBERER)
| | - Carmen Pilar Simeon-Aznar
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, Hospital Universitari Vall d'Hebron (HVH), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - José C Milisenda
- Muscle Research Unit, Internal Medicine Service, Hospital Clínic de Barcelona (HCB), Universidad de Barcelona and Center for Biomedical Research on Rare Diseases (CIBERER)
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Chaigne B, Léonard-Louis S, Mouthon L. Systemic sclerosis associated myopathy. Clin Exp Rheumatol 2023; 22:103261. [PMID: 36549354 DOI: 10.1016/j.autrev.2022.103261] [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: 11/15/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
Scleroderma associated myopathy (SScAM) is a common but heterogeneous musculoskeletal manifestation of systemic sclerosis (SSc) for which there is still no clear definition. Still, SScAM is associated with disability, poor quality of life and mortality. This review discusses the most updated literature of SScAM including clinical and antibody associations, recent updates on histopathological findings, prognosis and treatment.
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Affiliation(s)
- Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), France; APHP-CUP, Hôpital Cochin, Université de Paris, F-75014 Paris, France.
| | | | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), France; APHP-CUP, Hôpital Cochin, Université de Paris, F-75014 Paris, France
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Lescoat A. Very Early Diagnosis of Systemic Sclerosis: Deciphering the heterogeneity of systemic sclerosis in the very early stages of the disease. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2023; 8:3-6. [PMID: 36743816 PMCID: PMC9896197 DOI: 10.1177/23971983221129211] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/09/2022] [Indexed: 11/15/2022]
Abstract
The early diagnosis of systemic sclerosis has been a major challenge for the scleroderma community in the past 50 years. The recent publication of the predictive value of the VEDOSS (Very Early Diagnosis of Systemic Sclerosis) criteria in the Lancet Rheumatology in December 2021 has provided an unprecedented insight in the early stages of the disease. This editorial discusses the main findings from this 2021 VEDOSS publication and highlights key unanswered questions to be proposed on the research agenda in very early systemic sclerosis.
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Affiliation(s)
- Alain Lescoat
- Department of Internal Medicine
and Clinical Immunology, CHU Rennes, University of Rennes 1, Rennes,
France
- CHU Rennes, Inserm, EHESP,
Institut de Recherche en Santé, Environnement et Travail UMR_S 1085, Rennes,
France
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Giannini M, Ellezam B, Leclair V, Lefebvre F, Troyanov Y, Hudson M, Senécal JL, Geny B, Landon-Cardinal O, Meyer A. Scleromyositis: A distinct novel entity within the systemic sclerosis and autoimmune myositis spectrum. Implications for care and pathogenesis. Front Immunol 2023; 13:974078. [PMID: 36776390 PMCID: PMC9910219 DOI: 10.3389/fimmu.2022.974078] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/19/2022] [Indexed: 01/27/2023] Open
Abstract
Systemic sclerosis and autoimmune myositis are both associated with decreased quality of life and increased mortality. Their prognosis and management largely depend on the disease subgroups. Indeed, systemic sclerosis is a heterogeneous disease, the two predominant forms of the disease being limited and diffuse scleroderma. Autoimmune myositis is also a heterogeneous group of myopathies that classically encompass necrotizing myopathy, antisynthetase syndrome, dermatomyositis and inclusion body myositis. Recent data revealed that an additional disease subset, denominated "scleromyositis", should be recognized within both the systemic sclerosis and the autoimmune myositis spectrum. We performed an in-depth review of the literature with the aim of better delineating scleromyositis. Our review highlights that this concept is supported by recent clinical, serological and histopathological findings that have important implications for patient management and understanding of the disease pathophysiology. As compared with other subsets of systemic sclerosis and autoimmune myositis, scleromyositis patients can present with a characteristic pattern of muscle involvement (i.e. distribution of muscle weakness) along with multisystemic involvement, and some of these extra-muscular complications are associated with poor prognosis. Several autoantibodies have been specifically associated with scleromyositis, but they are not currently integrated in diagnostic and classification criteria for systemic sclerosis and autoimmune myositis. Finally, striking vasculopathic lesions at muscle biopsy have been shown to be hallmarks of scleromyositis, providing a strong anatomopathological substratum for the concept of scleromyositis. These findings bring new insights into the pathogenesis of scleromyositis and help to diagnose this condition, in patients with subtle SSc features and/or no autoantibodies (i.e. "seronegative" scleromyositis). No guidelines are available for the management of these patients, but recent data are showing the way towards a new therapeutic approach dedicated to these patients.
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Affiliation(s)
- Margherita Giannini
- Service de Physiologie et explorations fonctionnelles, University Hospital of Strasbourg, Strasbourg, France,Centre de Référence des Maladies Autoimmunes Rares, University Hospital of Strasbourg, Strasbourg, France,Unité de Recherche 3072 (UR3072), Centre de Recherche en Biomédecine, University of Strasbourg, Strasbourg, France
| | - Benjamin Ellezam
- Division of Pathology, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Department of Pathology and Cell Biology, Université de Montréal, Montréal, QC, Canada
| | - Valérie Leclair
- Division of Rheumatology, Jewish General Hospital, Department of Medicine, McGill University, Montréal, QC, Canada
| | - Frédéric Lefebvre
- Division of Rheumatology, Centre Hospitalier de l’Université de Montréal (CHUM), Autoimmunity Research Laboratory, CHUM Research Center, Montréal, QC, Canada,Department of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Yves Troyanov
- Division of Rheumatology, Hôpital du Sacré-Coeur, Department of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Marie Hudson
- Division of Rheumatology, Jewish General Hospital, Department of Medicine, McGill University, Montréal, QC, Canada
| | - Jean-Luc Senécal
- Division of Rheumatology, Centre Hospitalier de l’Université de Montréal (CHUM), Autoimmunity Research Laboratory, CHUM Research Center, Montréal, QC, Canada,Department of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Bernard Geny
- Service de Physiologie et explorations fonctionnelles, University Hospital of Strasbourg, Strasbourg, France,Unité de Recherche 3072 (UR3072), Centre de Recherche en Biomédecine, University of Strasbourg, Strasbourg, France
| | - Océane Landon-Cardinal
- Division of Rheumatology, Centre Hospitalier de l’Université de Montréal (CHUM), Autoimmunity Research Laboratory, CHUM Research Center, Montréal, QC, Canada,Department of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Alain Meyer
- Service de Physiologie et explorations fonctionnelles, University Hospital of Strasbourg, Strasbourg, France,Unité de Recherche 3072 (UR3072), Centre de Recherche en Biomédecine, University of Strasbourg, Strasbourg, France,Service de rhumatologie, Centre de Référence des Maladies Autoimmunes Rares, University Hospital of Strasbourg, Strasbourg, France,*Correspondence: Alain Meyer,
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15
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Zhang X, Zhang H, Zhao J, Li Y, Wang H, Li C. Diagnostic accuracy and predictive value of autoantibody profiles in patients with systemic sclerosis: a single-center study. Clin Rheumatol 2023; 42:1297-1306. [PMID: 36604358 DOI: 10.1007/s10067-022-06487-3] [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: 07/26/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine diagnostic accuracy and evaluate the predictive value of autoantibody profiles in patients with systemic sclerosis (SSc). METHODS A total of 140 patients with SSc (125 female, mean age 54.2 ± 14.2 years) were analyzed by a multiplex line immunoassay (Euroimmun) for autoantibodies against 12 SSc-related antigens. Associations between the presence of the autoantibodies and demographic clinical manifestations of patients with SSc were investigated. RESULTS The sensitivity and specificity of this assay were as follows: 32.9% and 99.4% for anti-Scl-70, 29.3% and 88.9% for anti-CENP A, 28.6% and 87.8% for anti-CENP B, 7.1% and 97.8% for anti-RP11, 5.7% and 100% for anti-RP155, 2.9% and 99.4% for anti-NOR 90, 2.9% and 98.9% for anti-Th/To, 1.4% and 96.7% for anti-PM-Scl-100, 5.0% and 98.3% for anti-PM-Scl-75, and 2.9% and 97.2% for anti-Ku, respectively. Anti-Scl-70 was significantly associated with sine scleroderma (P = 0.003), digital ulcers (P = 0.047), and Raynaud's phenomenon as the first clinical manifestation of onset (P = 0.017). SSc-ILD was more common in patients with anti-Scl-70 (P = 0.029) and less frequent in patients with anti-CENP A (P < 0.001) and anti-CENP B (P < 0.001). There was a significant association between PAH with anti-CENP A (P = 0.008) and anti-CENP B (P = 0.025). Renal involvement was significantly related to anti-NOR90 (P = 0.026) and anti-Th/To (P = 0.026). CONCLUSIONS This study confirmed the important role of autoantibodies in accurately diagnosing SSc. The autoimmune profile of patients with SSc was related to specific disease manifestations. Key Points • Autoantibody profiles were useful for diagnosing SSc and predicting clinical features of patients.
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Affiliation(s)
- Xiaoying Zhang
- Department of Rheumatology and Immunology, Peking University People's Hospital, No.11 Xizhimen South St., Beijing, 100044, China
| | - Huijuan Zhang
- Department of Rheumatology, She Xian Hospital, Handan, Hebei Province, China
| | - Jing Zhao
- Department of Rheumatology and Immunology, Peking University People's Hospital, No.11 Xizhimen South St., Beijing, 100044, China
| | - Yun Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, No.11 Xizhimen South St., Beijing, 100044, China
| | - Hongyan Wang
- Department of Rheumatology and Immunology, Peking University People's Hospital, No.11 Xizhimen South St., Beijing, 100044, China
| | - Chun Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, No.11 Xizhimen South St., Beijing, 100044, China.
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16
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Hughes M, Herrick AL. Diagnosis and management of systemic sclerosis-related calcinosis. Expert Rev Clin Immunol 2023; 19:45-54. [PMID: 36333952 DOI: 10.1080/1744666x.2023.2144835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Calcinosis is common in patients with systemic sclerosis (SSc) and refers to the sub-epidermal deposition of calcium salts in the skin. SSc-related calcinosis is associated with significant morbidity, including through cutaneous ulceration and predisposition to become infected. AREAS COVERED After briefly addressing aetiopathogenesis, we describe the clinical burden of SSc-associated calcinosis and provide a structured and practical clinical approach to diagnosis and assessment, including discussion of the role of different imaging modalities. The multi-faceted treatment of SSc-associated calcinosis is presented under three broad headings of 'general measures,' and 'medical treatment' and 'surgical treatment.' We adopted a narrative approach to identify relevant manuscripts to inform our review. EXPERT OPINION SSc-related calcinosis is an area of major unmet clinical need and for too long has been a neglected area of research. Safe and effective treatments are badly needed to improve patient quality of life and outcomes. To facilitate future clinical trials, we require increased understanding of pathogenesis (to inform selection of potential targeted therapies) and reliable outcome measures, including those which will measure the impact and severity of calcinosis from the patient perspective. International collaborative research is ongoing to develop outcome measures and treatments for this potentially devastating complication of SSc.
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Affiliation(s)
- Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, the University of Manchester, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Ariane L Herrick
- Division of Musculoskeletal and Dermatological Sciences, the University of Manchester, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, UK
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17
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Álvarez Troncoso J, Nuño González A, Martínez Robles E, Sorriguieta Torre R, Robles Marhuenda Á. Tofacitinib Is an Effective Treatment for Refractory Scleromyositis Associated With Anti-PM/Scl. Cureus 2023; 15:e34125. [PMID: 36843820 PMCID: PMC9947514 DOI: 10.7759/cureus.34125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Abstract
Scleromyositis is a rare autoimmune disease characterized by overlapping scleroderma and myositis. This case report discusses the presentation and management of a 28-year-old male with scleromyositis presenting with myositis, arthritis, Raynaud's phenomenon, refractory calcinosis, interstitial lung disease, and myocarditis. This case highlights key points in the systematic approach to immunosuppressive treatment and proposes a novel therapeutic option.
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Affiliation(s)
- Jorge Álvarez Troncoso
- Internal Medicine, Systemic Autoimmune Diseases Unit, Hospital Universitario La Paz, Madrid, ESP
| | | | - Elena Martínez Robles
- Internal Medicine, Systemic Autoimmune Diseases Unit, Hospital Universitario La Paz, Madrid, ESP
| | - Raquel Sorriguieta Torre
- Internal Medicine, Systemic Autoimmune Diseases Unit, Hospital Universitario La Paz, Madrid, ESP
| | - Ángel Robles Marhuenda
- Internal Medicine, Systemic Autoimmune Diseases Unit, Hospital Universitario La Paz, Madrid, ESP
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18
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Zanatta E, Huscher D, Ortolan A, Avouac J, Airò P, Balbir-Gurman A, Siegert E, Matucci Cerinic M, Cozzi F, Riemekasten G, Hoffmann-Vold AM, Distler O, Gabrielli A, Heitmann S, Hunzelmann N, Montecucco C, Morovic-Vergles J, Ribi C, Doria A, Allanore Y. Phenotype of limited cutaneous systemic sclerosis patients with positive anti-topoisomerase I antibodies: data from the EUSTAR cohort. Rheumatology (Oxford) 2022; 61:4786-4796. [PMID: 35348643 DOI: 10.1093/rheumatology/keac188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/09/2022] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To characterize patients with positive anti-topoisomerase I (ATA) in lcSSc. METHODS SSc patients enrolled in the EUSTAR cohort with a disease duration of ≤3 years at database entry were considered. We assessed the risk of major organ involvement in the following groups: ATA-lcSSc vs ACA-lcSSc and vs ANA without specificity (ANA)-lcSSc, and ATA-lcSSc vs ATA-dcSSc. Cox regression models with time-dependent covariates were performed with the following outcomes: new-onset interstitial lung disease (ILD), ILD progression [forced vital capacity (FVC) decline ≥10% and ≥5% vs values at ILD diagnosis), primary myocardial involvement (PMI), pulmonary hypertension (PH), any organ involvement and all-cause mortality. RESULTS We included 1252 patients [194 ATA-lcSSc (15.5%)], with 7.7 years (s.d. 3.5) of follow-up. ILD risk was higher in ATA-lcSSc vs ACA- and ANA-lcSSc and similar to ATA-dcSSc, although with less frequent restrictive lung disease. The risk of FVC decline ≥10% (35% of ATA-lcSSc) was lower in ATA-lcSSc than in ATA-dcSSc, whereas FVC decline ≥5% occurs similarly between ATA-lcSSc (58% of patients) and other SSc subsets, including ATA-dcSSc. The risk of PMI was similar in ATA-lcSSc and ANA-lcSSc but lower than in ACA-lcSSc; no difference in PH and mortality risk was observed among lcSSc subsets. The risk of any organ involvement, PMI and PH was lower and the mortality tended to be lower in ATA-lcSSc vs ATA-dcSSc. CONCLUSION ATA-lcSSc patients have a high risk of ILD, albeit with a lower risk of progression compared with ATA-dcSSc, supporting careful screening for ILD in this subgroup.
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Affiliation(s)
- Elisabetta Zanatta
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Augusta Ortolan
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Jérôme Avouac
- Service de Rhumatologie, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France
| | - Paolo Airò
- Rheumatology and Clinical Immunology, Spedali Civili, Brescia, Italy
| | - Alexandra Balbir-Gurman
- B. Shine Rheumatology Institute Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité-Universitatsmedizin Berlin, Berlin, Germany
| | - Marco Matucci Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence
| | - Franco Cozzi
- Internal Medicine Unit, Ospedale Classificato Villa Salus, Venice, Italy
| | - Gabriela Riemekasten
- Department of Rheumatology, Universitatsklinikum Schleswig Holstein-Campus Lübeck, Lübeck, Germany
| | | | - Oliver Distler
- Department of Rheumatology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Armando Gabrielli
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - Stefan Heitmann
- Department of Rheumatology, Marienhospital Stuttgart, Stuttgart
| | - Nicolas Hunzelmann
- Department of Dermatology, University of Cologne, Köln, Nordrhein-Westfalen, Germany
| | | | - Jadranka Morovic-Vergles
- Division of Clinical Immunology, Allergology and Rheumatology, Department of Internal Medicine, Dubrava University Hospital, Zagreb, Croatia
| | - Camillo Ribi
- Service d'immunologie et Allergie, Département de Médecine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Yannick Allanore
- Service de Rhumatologie, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France
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Aseeva EA, Lila AM, Soloviev SK, Nasonov EL, Glukhova SI. Clinical and immunological phenotypes of systemic lupus erythematosus, identified based on cluster analysis of data from 400 patients from V.A. Nasonova Research Institute of Rheumatology. MODERN RHEUMATOLOGY JOURNAL 2022. [DOI: 10.14412/1996-7012-2022-5-13-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objective: to identify clinical and immunological variants (phenotypes) of systemic lupus erythematosus (SLE) using cluster analysis.Patients and methods. The study included 400 patients with diagnosis of SLE according to the 2012 SLICC classification criteria. Patients underwent laboratory and immunological workup according to accepted standards of medical care for patients with SLE, and therapy was prescribed in accordance with disease activity.Results and discussion. Among patients, most were females (ratio of men and women – 1:10), and people of young age (34.2±11.5 years), with an average duration of illness of 6 [3; 12] years. In 98 (25%) patients with SLE, the disease debuted before the age of 18 years. Lupus nephritis (LN) was detected in 192 (48%) patients, SLE with antiphospholipid syndrome (APS) – in 48 (12%), SLE with Sjцgren's syndrome – in 44 (11%). For cluster analysis 30 clinical, 4 laboratory, 12 immunological and 10 therapeutic parameters were selected and a dendrogram was constructed with the calculation of the Euclidean distance using the Ward method. As a result, five clusters of SLE were identified: with the development of LN; with predominantly extrarenal manifestations; SLE combined with APS; SLE combined with Sjцgren's syndrome; SLE with a debut in childhood (up to 18 years of age). Clusters differed in clinical, laboratory and immunological parameters, as well as in therapy.Conclusion. Cluster analysis data made it possible to group the selected signs into five clinical and immunological variants (phenotypes) of SLE. Identification of SLE phenotypes as a set of characteristics that, individually or in combination, make it possible to determine differences between patients based on clinical, laboratory and immunological parameters, variants of the onset and course of the disease, response to therapy and prognosis, will contribute to a personalized approach in choosing the therapy, improving its long-term results, as well as quality of life and prognosis in patients with SLE.
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Affiliation(s)
- E. A. Aseeva
- V.A. Nasonova Research Institute of Rheumatology
| | - A. M. Lila
- Russian Medical Academy of Continuing Professional Education
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20
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Bratoiu I, Burlui AM, Cardoneanu A, Macovei LA, Richter P, Rusu-Zota G, Rezus C, Badescu MC, Szalontay A, Rezus E. The Involvement of Smooth Muscle, Striated Muscle, and the Myocardium in Scleroderma: A Review. Int J Mol Sci 2022; 23:ijms231912011. [PMID: 36233313 PMCID: PMC9569846 DOI: 10.3390/ijms231912011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/24/2022] [Accepted: 10/07/2022] [Indexed: 11/09/2022] Open
Abstract
Systemic sclerosis (SSc) is a complex autoimmune disease characterized by heterogeneous changes involving numerous organs and systems. The currently available data indicate that muscle injury (both smooth and striated muscles) is widespread and leads to significant morbidity, either directly or indirectly. From the consequences of smooth muscle involvement in the tunica media of blood vessels or at the level of the digestive tract, to skeletal myopathy (which may be interpreted strictly in the context of SSc, or as an overlap with idiopathic inflammatory myopathies), muscular injury in scleroderma translates to a number of notable clinical manifestations. Heart involvement in SSc is heterogenous depending on the definition used in the various studies. The majority of SSc patients experience a silent form of cardiac disease. The present review summarizes certain important features of myocardial, as well as smooth and skeletal muscle involvement in SSc. Further research is needed to fully describe and understand the pathogenic pathways and the implications of muscle involvement in scleroderma.
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Affiliation(s)
- Ioana Bratoiu
- Department of Rheumatology and Physiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
| | - Alexandra Maria Burlui
- Department of Rheumatology and Physiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- Correspondence: (A.M.B.); (C.R.)
| | - Anca Cardoneanu
- Department of Rheumatology and Physiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
| | - Luana Andreea Macovei
- Department of Rheumatology and Physiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
| | - Patricia Richter
- Department of Rheumatology and Physiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
| | - Gabriela Rusu-Zota
- Department of Pharmacology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
- Correspondence: (A.M.B.); (C.R.)
| | - Minerva Codruta Badescu
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania
| | - Andreea Szalontay
- Department of Psychiatry, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
| | - Elena Rezus
- Department of Rheumatology and Physiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
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21
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Breillat P, Mariampillai K, Legendre P, Martins P, Dunogue B, Charuel JL, Miyara M, Goulvestre C, Paule R, Vanquaethem H, Ackermann F, Benveniste O, Nunes H, Mouthon L, Allenbach Y, Uzunhan Y. Anti-PM-Scl antibodies positive patients encompass three different groups with distinct prognosis. Rheumatology (Oxford) 2022; 62:1467-1475. [PMID: 36063462 DOI: 10.1093/rheumatology/keac508] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/03/2022] [Accepted: 08/23/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To help identify homogeneous subgroups among patients with anti-polymyositis-scleroderma-antibodies (PM-Scl-Abs) positive auto-immune diseases regardless of diagnostic classifications. METHODS This multicentric (four hospitals) retrospective study collected all consecutive patients (from 2011 to 2021) with positive testing for anti-PM-Scl-Abs in a context of connective tissue disease. Subgroups of patients with similar clinico-biological phenotypes were defined using unsupervised multiple correspondence analysis and hierarchical clustering analysis of the features recorded in the first year of follow-up. RESULTS One hundred and forty-two patients with anti-PM-Scl-Abs were evaluated and 129 patients were included in the clustering analysis and divided into 3 clusters. Cluster n°1 (n = 47) included patients with frequent skin thickening, digestive involvement and interstitial lung disease (ILD) with Non Specific Interstitial Pneumonia (NSIP). They were more likely to develop progressive fibrosing ILD. Cluster n°2 (n = 36) included patients who all featured NSIP with frequent Organizing pneumonia associated pattern and mechanic's hands. This subgroup had increased risk of relapse and ILD was characterized by a good functional outcome. Cluster n°3 (n = 46) was characterized by predominant or isolated musculoskeletal involvement and frequently matched undifferentiated connective tissue disease (UCTD) criteria. Although very frequent among Anti PM-Scl-Abs positive patients, muscle involvement was less discriminating compared with skin thickening and ILD pattern to classify patients into subgroups. CONCLUSION Anti-PM-Scl-Abs associated auto-immune diseases are segregated into 3 subgroups with distinct clinical phenotype and outcomes. Skin thickening and NSIP are determinant predictors in segregation of theses populations.
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Affiliation(s)
- Paul Breillat
- Département de Médecine Interne, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Centre de Référence pour les Maladies Auto-immunes Rares, Paris, France.,Sorbonne Université, Paris, France
| | - Kuberaka Mariampillai
- Sorbonne Université, INSERM, Association Institut de Myologie, Centre de Recherche en Myologie, UMRS 974, Paris, France
| | - Paul Legendre
- Département de Médecine Interne Hôpital Foch, Suresnes, France
| | - Pauline Martins
- Département de Médecine Interne, Hôpitaux La Rochelle Ré Aunis, La Rochelle, France
| | - Bertrand Dunogue
- Département de Médecine Interne, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Centre de Référence pour les Maladies Auto-immunes Rares, Paris, France
| | - Jean Luc Charuel
- Département d'Immunologie, Laboratoire d'immunochimie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Makoto Miyara
- Département d'Immunologie, Laboratoire d'immunochimie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Claire Goulvestre
- Laboratoire d'immunologie, Groupe Hospitalier Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Paule
- Département de Médecine Interne Hôpital Foch, Suresnes, France
| | - Helene Vanquaethem
- Clinique médicale, hôpital d'instruction des armées de Bégin, Saint-Mandé, France
| | - Felix Ackermann
- Département de Médecine Interne Hôpital Foch, Suresnes, France
| | - Olivier Benveniste
- Sorbonne Université, INSERM, Association Institut de Myologie, Centre de Recherche en Myologie, UMRS 974, Paris, France.,Département de Médecine Interne et Immunologie Clinique, Centre de Référence Maladies Neuro-Musculaires, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Hilario Nunes
- Département de Pneumologie, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, INSERM U1272, Université Sorbonne Paris Nord, Bobigny, France
| | - Luc Mouthon
- Département de Médecine Interne, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Centre de Référence pour les Maladies Auto-immunes Rares, Paris, France
| | - Yves Allenbach
- Sorbonne Université, INSERM, Association Institut de Myologie, Centre de Recherche en Myologie, UMRS 974, Paris, France.,Département de Médecine Interne et Immunologie Clinique, Centre de Référence Maladies Neuro-Musculaires, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Yurdagul Uzunhan
- Département de Pneumologie, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, INSERM U1272, Université Sorbonne Paris Nord, Bobigny, France
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22
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Abstract
PURPOSE OF REVIEW One of the key clinical challenges of systemic sclerosis (SSc) is diversity in clinical presentation, organ involvement and disease progression. Antinuclear autoantibodies (ANA) are central to the diagnosis of SSc. ANA specificities associated with distinct clinical patterns of organ and skin involvement. Understanding of the molecular differences and pathogenesis of scleroderma has helped further inform clinical acumen. Here, we provide an update on ANA on clinical profiling, management and future direction of SSc. RECENT FINDINGS There has been further development in delineating clinical patterns in ANA, genetic susceptibility and antigen triggers predisposing to ANA subtypes. Sub-group analysis of recent clinical trials shows differing treatment responses to novel therapeutics. SUMMARY ANA subtyping is likely to be firmly embedded into future classification systems. Beyond informing current management and monitoring of scleroderma patients, ANA subsets have implication on future research and clinical trial design.
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23
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Maritati F, Provenzano M, Lerario S, Corradetti V, Bini C, Busutti M, Grandinetti V, Cuna V, La Manna G, Comai G. Kidney transplantation in systemic sclerosis: Advances in graft, disease, and patient outcome. Front Immunol 2022; 13:878736. [PMID: 35958558 PMCID: PMC9360313 DOI: 10.3389/fimmu.2022.878736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
Systemic sclerosis (SSc) is an immune-mediated rheumatic disease characterized by vascular abnormalities, tissue fibrosis, and inflammation. Renal disease occurring in patients with SSc may have a variable clinicopathological picture. However, the most specific renal condition associated with this disease is the scleroderma renal crisis (SRC), characterized by acute onset of renal failure and severe hypertension. SRC develops in about 20% of cases of SSc, especially in those patients with diffuse cutaneous disease. The prognosis of this condition is often negative, with a rapid progression to end-stage renal disease (ESRD). The advent of the antihypertensive angiotensin-converting enzyme inhibitors in 1980 was associated with a significant improvement in patients’ survival and recovery of renal function. However, the prognosis of these patients can still be improved. The dialytic condition is associated with early death, and mortality is significantly higher than among patients undergoing renal replacement therapy (RRT) due to other conditions. Patients with SRC who show no signs of renal functional recovery despite timely blood pressure control are candidates for kidney transplantation (KT). In this review, we reported the most recent advances in KT in patients with ESRD due to SSc, with a particular overview of the risk of disease recurrence after transplantation and the evolution of other disease manifestations.
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24
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Cavazzana I, Vojinovic T, Airo' P, Fredi M, Ceribelli A, Pedretti E, Lazzaroni MG, Garrafa E, Franceschini F. Systemic Sclerosis-Specific Antibodies: Novel and Classical Biomarkers. Clin Rev Allergy Immunol 2022; 64:412-430. [PMID: 35716254 PMCID: PMC10167150 DOI: 10.1007/s12016-022-08946-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/28/2022]
Abstract
Disease-specific autoantibodies are considered the most important biomarkers for systemic sclerosis (SSc), due to their ability to stratify patients with different severity and prognosis. Anti-nuclear antibodies (ANA), occurring in subjects with isolated Raynuad's phenomenon, are considered the strongest independent predictors of definite SSc and digital microvascular damage, as observed by nailfold videocapillaroscopy. ANA are present in more than 90% of SSc, but ANA negativity does not exclude SSc diagnosis: a little rate of SSc ANA negative exists and shows a distinct subtype of disease, with less vasculopathy, but more frequent lower gastrointestinal involvement and severe disease course. Anti-centromere, anti-Th/To, and anti-Topoisomerase I antibodies could be considered as classical biomarkers, covering about 60% of SSc and defining patients with well-described cardio-pulmonary complications. In particular, anti-Topoisomerase I represent a risk factor for development of diffuse cutaneous involvement and digital ulcers in the first 3 years of disease, as well as severe interstitial lung disease (ILD). Anti-RNA polymerase III is a biomarker with new clinical implications: very rapid skin thickness progression, gastric antral vascular ectasia, the occurrence of synchronous cancers, and possible association with silicone breast implants rupture. Moreover, novel SSc specific autoantibodies have been globally described in about 10% of "seronegative" SSc patients: anti-elF2B, anti-RuvBL1/2 complex, anti-U11/U12 RNP, and anti-BICD2 depict specific SSc subtypes with severe organ complications. Many autoantibodies could be considered markers of overlap syndromes, including SSc. Anti-Ku are found in 2-7% of SSc, strictly defining the PM/SSc overlap. They are associated with synovitis, joint contractures, myositis, and negatively associated with vascular manifestation of disease. Anti-U3RNP are associated with a well-defined clinical phenotype: Afro-Caribbean male patients, younger at diagnosis, and higher risk of pulmonary hypertension and gastrointestinal involvement. Anti-PM/Scl define SSc patients with high frequency of ILD, calcinosis, dermatomyositis skin changes, and severe myositis. The accurate detection of autoantibodies SSc specific and associated with overlap syndromes is crucial for patients' stratification. ANA should be correctly identified using indirect immunofluorescent assay and a standardized way of patterns' interpretation. The gold-standard technique for autoantibodies' identification in SSc is still considered immunoprecipitation, for its high sensitivity and specificity, but other assays have been widely used in routine practice. The identification of SSc autoantibodies with high diagnostic specificity and high predictive value is mandatory for early diagnosis, a specific follow-up and the possible definition of the best therapy for every SSc subsets. In addition, the validation of novel autoantibodies is mandatory in wider cohorts in order to restrict the gap of so-called seronegative SSc patients.
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Affiliation(s)
- Ilaria Cavazzana
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, piazzale Spedali Civili 1, Brescia, 25123, Italy.
| | - Tamara Vojinovic
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, piazzale Spedali Civili 1, Brescia, 25123, Italy
| | - Paolo Airo'
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, piazzale Spedali Civili 1, Brescia, 25123, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, piazzale Spedali Civili 1, Brescia, 25123, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Angela Ceribelli
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Eleonora Pedretti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maria Grazia Lazzaroni
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, piazzale Spedali Civili 1, Brescia, 25123, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Emirena Garrafa
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Department of Laboratory Diagnostics, ASST Spedali Civili, Brescia, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, piazzale Spedali Civili 1, Brescia, 25123, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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25
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Valenzuela A, Chung L. Subcutaneous calcinosis: Is it different between systemic sclerosis and dermatomyositis? JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2022; 7:7-23. [PMID: 35386947 PMCID: PMC8922676 DOI: 10.1177/23971983211053245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/27/2021] [Indexed: 02/03/2023]
Abstract
Calcinosis cutis is the deposition of insoluble calcium in the skin and subcutaneous tissues. It is a manifestation of several autoimmune connective tissue diseases, most frequently with systemic sclerosis and juvenile dermatomyositis, followed by adult dermatomyositis. Autoimmune connective tissue disease-associated calcinosis is of the dystrophic subtype, which occurs at sites of damaged tissue in the setting of normal serum calcium and phosphate levels. In juvenile dermatomyositis, calcinosis is considered a marker of ongoing disease activity and possibly inadequate treatment, while in adult dermatomyositis, it is a hallmark of skin damage due to chronic rather than active disease. Calcinosis is associated with long disease duration in systemic sclerosis and dermatomyositis, anti-polymyositis/sclerosis autoantibodies in systemic sclerosis and NXP-2 and melanoma differentiation-associated gene 5 in dermatomyositis. Calcinosis in systemic sclerosis occurs most frequently in the hands, particularly the fingers, whereas in dermatomyositis, it affects mainly the trunk and extremities. The primary mineral component of calcinosis is hydroxyapatite in systemic sclerosis and carbonate apatite in dermatomyositis. Calcinosis in dermatomyositis and systemic sclerosis share some pathogenic mechanisms, but vascular hypoxia seems to play a more important role in systemic sclerosis, whereas the release of calcium from mitochondria in muscle cells damaged by myopathy may be a primary mechanism contributing to dermatomyositis-related calcinosis. Multiple treatment strategies for dermatomyositis and systemic sclerosis-related calcinosis have been used with variable results. Early aggressive treatment of underlying myositis in patients with dermatomyositis may improve long-term outcomes of calcinosis. A better understanding of the pathogenesis of calcinosis is needed to improve treatment options.
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Affiliation(s)
- Antonia Valenzuela
- Division of Clinical Immunology and Rheumatology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA,Division of Immunology and Rheumatology, VA Palo Alto Health Care System, Palo Alto, CA, USA,Lorinda Chung, Division of Immunology and Rheumatology, Stanford University School of Medicine, 1000 Welch Rd Ste 203, MC 5755, Palo Alto, CA 94304, USA.
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26
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Ge Y, Shu X, He L, Li C, Lu X, Wang G. Interstitial Lung Disease Is a Major Characteristic of Patients Who Test Positive for Anti-PM/Scl Antibody. Front Med (Lausanne) 2022; 8:778211. [PMID: 35118087 PMCID: PMC8804089 DOI: 10.3389/fmed.2021.778211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Objective This study aimed to analyze the clinical features of anti-PM/Scl antibodies in Chinese patients. Method We reviewed the clinical data of anti-PM/Scl antibody-positive patients, including their long-term follow-up. Results A total of 30 patients carried anti-PM/Scl antibodies, 21 (70%) were females, and the mean age was 55.4 years, 15 (50%) and 10 (33.3%) patients were positive for anti-PM/Scl-75 and anti-PM/Scl-100, respectively. Fifteen cases (50%) were diagnosed as inflammatory myopathy, namely, 11 dermatomyositis (DM) and 4 polymyositis (PM). Five (16.7%) patients were diagnosed with overlap syndrome, and only one (3.3%) was diagnosed as systemic sclerosis. The other 9 (30%) patients were classified as undifferentiated connective tissue disease. Twenty-six (86.7%) had interstitial lung disease (ILD) and was the sole manifestation in 8 (26.7%) patients, 15 (58.0%) showed non-specific interstitial pneumonia based on high-resolution CT or lung biopsy. The majority of patients (95%) with mild and moderate groups on basis of pulmonary function tests. Compared to the anti-PM/Scl-100 group, the occurrence of clinical characteristics was not significantly different from the anti-PM/Scl-75 group, except the levels of C-reactive protein and erythrocyte sedimentation rate in the anti-PM/Scl-75 antibody-positive group were higher (p < 0.05). All patients with positive Ro-52 antibodies had ILD and were more likely to develop skin rash in the group with Ro-52 (p = 0.024). With a follow-up of the present cohort, 70.8% improved with treatment, but 16.7% of patients are easy to relapse. Conclusion The anti-PM/Scl antibody occurred frequently in DM/PM patients, ILD was the major clinical feature, especially in patients combined with Ro-52. Some patients may complicate with ILD alone without extrapulmonary manifestations. Anti-PM/Scl antibodies positive patients were responsive to treatment.
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27
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Saito S, Endo Y, Nishio M, Uchiyama A, Uehara A, Toki S, Yasuda M, Ishikawa O, Muro Y, Motegi SI. Anti-polymyositis/Scl antibody-positive overlap syndrome of diffuse cutaneous systemic sclerosis, dermatomyositis, systemic lupus erythematosus, and antiphospholipid syndrome. J Dermatol 2021; 49:294-298. [PMID: 34730249 DOI: 10.1111/1346-8138.16219] [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: 06/19/2021] [Revised: 10/04/2021] [Accepted: 10/20/2021] [Indexed: 11/28/2022]
Abstract
A 37-year-old Japanese man with a 3-year history of diffuse cutaneous systemic sclerosis was admitted to our hospital with high fever, arthralgia, myalgia, and muscle weakness. A physical examination revealed facial erythema, Gottron's sign, and mechanic's hands in addition to skin sclerosis. Laboratory data revealed significantly elevated levels of creatine kinase and decreased complement. Anti-RNP, anti-Smith, anti-DNA, anti-β2 -glycoprotein 1, anti-polymyositis (PM)/Scl75, and anti-PM/Scl100 antibodies were detected. He also had urinary protein, interstitial lung disease, pericarditis, multifocal cerebral infarctions, and leukoencephalopathy. Thus, a diagnosis of overlap syndrome of diffuse cutaneous systemic sclerosis, dermatomyositis, and systemic lupus erythematosus with antiphospholipid syndrome was made. Because of the intractable course, he was treated with multiple immunosuppressive and immunomodulatory drugs, including three rounds of 1000 mg methylprednisolone pulse therapy. This is the first case report of anti-PM/Scl antibody-positive overlap syndrome of three major connective tissue diseases.
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Affiliation(s)
- Shintaro Saito
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yukie Endo
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Mayu Nishio
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akihiko Uchiyama
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akihito Uehara
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Sayaka Toki
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masahito Yasuda
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Osamu Ishikawa
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshinao Muro
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sei-Ichiro Motegi
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
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28
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Selva-O'Callaghan A, Simeon-Aznar CP. The scleromyositis phenotype. Lessons from a multicentre international cohort of anti-PM/Scl-positive patients. Rheumatology (Oxford) 2021; 60:4956-4957. [PMID: 33983413 DOI: 10.1093/rheumatology/keab433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Albert Selva-O'Callaghan
- Systemic Autoimmune Diseases Unit, Vall d'Hebron General Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Carmen Pilar Simeon-Aznar
- Systemic Autoimmune Diseases Unit, Vall d'Hebron General Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
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29
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Biomarker und Histologie bei idiopathischen inflammatorischen Myopathien. AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1548-8934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungDie idiopathischen inflammatorischen Myopathien (IIM) sind eine Gruppe entzündlicher Muskelerkrankungen für deren Diagnosestellung, Verlaufsbeurteilung, Prognoseabschätzung und Risikostratifizierung Biomarker eine jeweils essentielle Rolle spielen. Biomarker in diesem Kontext können sowohl „herkömmliche“ serologische Marker wie Muskelenzyme oder Autoantikörper, histologische Marker wie entitätsspezifische inflammatorische Muster, aber auch genomische und genetische Marker sein. Der vorliegende Artikel gibt einen Überblick über bewährte und innovative Marker.
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30
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Kuwana M, Gil-Vila A, Selva-O’Callaghan A. Role of autoantibodies in the diagnosis and prognosis of interstitial lung disease in autoimmune rheumatic disorders. Ther Adv Musculoskelet Dis 2021; 13:1759720X211032457. [PMID: 34377160 PMCID: PMC8320553 DOI: 10.1177/1759720x211032457] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/25/2021] [Indexed: 12/17/2022] Open
Abstract
Interstitial lung disease (ILD) has been recognized as a frequent manifestation associated with a substantial morbidity and mortality burden in patients with autoimmune rheumatic disorders. Serum autoantibodies are considered good biomarkers for identifying several subsets or specific phenotypes of ILD involvement in these patients. This review features the role of several autoantibodies as a diagnostic and prognostic biomarker linked to the presence ILD and specific ILD phenotypes in autoimmune rheumatic disorders. The case of the diverse antisynthetase antibodies in the antisynthease syndrome or the anti-melanoma differentiation-associated 5 protein (MDA5) antibodies as a marker of a severe condition such as rapidly progressive ILD in patients with clinically amyopathic dermatomyositis are some of the associations herein reported in the group of myositis spectrum disorders. Specific autoantibodies such as the well-known anti-topoisomerase I (anti-Scl70) or the anti-Th/To, anti-U11/U12 ribonucleoprotein, and anti-eukaryotic initiation factor 2B (eIF2B) antibodies seems to be specifically linked to ILD in patients with systemic sclerosis. Overlap syndromes between systemic sclerosis and myositis, also have good ILD biomarkers, which are the anti-PM/Scl and anti-Ku autoantibodies. Lastly, other not so often reported disorders as being associated with ILD but recently most recognized as is the case of rheumatoid arthritis associated ILD or entities herein included in the miscellaneous disorders section, which include anti-neutrophil cytoplasmic antibody-associated interstitial lung disease, Sjögren's syndrome or the mixed connective tissue disease, are also discussed.
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Affiliation(s)
- Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine; Scleroderma/Myositis Center of Excellence (SMCE) Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan
| | - Albert Gil-Vila
- Systemic Autoimmune Diseases Unit, Vall d’Hebron General Hospital, Medicine Dept, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Albert Selva-O’Callaghan
- Systemic Autoimmune Diseases Unit, Vall d’Hebron General Hospital, Medicine Dept, Universitat Autónoma de Barcelona, Barcelona, Spain
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