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Allanore Y, Khanna D, Smith V, Aringer M, Hoffmann-Vold AM, Kuwana M, Merkel PA, Stock C, Sambevski S, Denton CP. Effects of nintedanib in patients with limited cutaneous systemic sclerosis and interstitial lung disease. Rheumatology (Oxford) 2024; 63:639-647. [PMID: 37294870 PMCID: PMC10907814 DOI: 10.1093/rheumatology/kead280] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/26/2023] [Accepted: 06/06/2023] [Indexed: 06/11/2023] Open
Abstract
OBJECTIVES To investigate the course of interstitial lung disease (ILD) and the effects of nintedanib in patients with limited cutaneous systemic sclerosis (lcSSc). METHODS In the SENSCIS trial, patients with SSc-ILD were randomized to receive nintedanib or placebo. Patients who completed the SENSCIS trial were eligible to enter SENSCIS-ON, in which all patients received open-label nintedanib. RESULTS Among 277 patients with lcSSc treated in the SENSCIS trial, the rate (s.e.) of decline in forced vital capacity (FVC; ml/year) over 52 weeks was -74.5 (19.2) in the placebo group and -49.1 (19.8) in the nintedanib group (difference: 25.3 [95% CI -28.9, 79.6]). Among 249 patients with data at week 52, mean (s.e.) change in FVC at week 52 was -86.4 (21.1) ml in the placebo group and -39.1 (22.2) ml in the nintedanib group. Among 183 patients with lcSSc who participated in SENSCIS-ON and had data at week 52, mean (s.e.) change in FVC from baseline to week 52 of SENSCIS-ON was -41.5 (24.0) ml in patients who took placebo in the SENSCIS trial and initiated nintedanib in SENSCIS-ON and -45.1 (19.1) ml in patients who took nintedanib in the SENSCIS trial and continued it in SENSCIS-ON. CONCLUSION Patients with lcSSc may develop progressive fibrosing ILD. By targeting pulmonary fibrosis, nintedanib slows decline in lung function in patients with lcSSc and ILD. TRIAL REGISTRATION ClinicalTrials.gov (https://clinicaltrials.gov), NCT02597933 and NCT03313180.
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Affiliation(s)
- Yannick Allanore
- Department of Rheumatology, Paris Cité University, APHP, Cochin Hospital, Paris, France
| | - Dinesh Khanna
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Vanessa Smith
- Department of Rheumatology and Internal Medicine, Ghent University Hospital and Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Martin Aringer
- Division of Rheumatology, Department of Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus, Dresden, Dresden, TU, Germany
| | | | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Christian Stock
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Steven Sambevski
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Christopher P Denton
- Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, University College London, London, UK
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2
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de Carvalho ESV, da Silva Santos G, de Siqueira GR, Duarte ALBP, Dantas AT. Ultrasound assessment of diaphragm and quadriceps muscles and its relationship with handgrip and respiratory muscle strength in patients with systemic sclerosis: a cross-sectional study. Clin Rheumatol 2024; 43:289-295. [PMID: 38015305 DOI: 10.1007/s10067-023-06812-4] [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] [Received: 09/13/2023] [Revised: 10/30/2023] [Accepted: 11/04/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Muscle dysfunction may cause disability and reduce the quality of life of patients with systemic sclerosis (SSc) when compared to healthy individuals. However, the literature on the topic is scarce and uses several criteria for assessing muscle dysfunction in this population. OBJECTIVES To compare diaphragm and quadriceps muscle thickness, diaphragm mobility, and handgrip strength between patients with SSc and healthy individuals. METHOD This cross-sectional study included 16 patients with SSc and 16 self-reported healthy individuals matched for age. We assessed quadriceps and diaphragm thickness and diaphragmatic mobility (ultrasound), handgrip strength (hand-held dynamometer), and respiratory muscle strength (manovacuometer). Patients also responded to the Health Assessment Questionnaire Disability Index and the International Physical Activity Questionnaire. RESULTS Patients with SSc presented lower quadriceps thickness (p < 0.0001), diaphragmatic mobility (p = 0.01), handgrip (p < 0.0001), and respiratory muscle strength (p < 0.0001) than healthy individuals. A moderate positive correlation was observed between handgrip strength and quadriceps thickness in patients with SSc (rho = 0.576; p = 0.02). CONCLUSIONS Patients with SSc presented reduced quadriceps thickness, diaphragmatic mobility, handgrip, and respiratory muscle strength when compared to healthy individuals Also, handgrip strength was correlated with quadriceps thickness in patients with SSc, suggesting that loss of muscle mass accompanies loss of peripheral muscle strength group of patients. Key Points • SSc patients presented reduced quadriceps thickness and diaphragmatic mobility • SSc patients have reduced handgrip and respiratory muscle strength • Lower handgrip muscle strength correlated with lower quadriceps thickness.
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Affiliation(s)
| | | | | | | | - Andréa Tavares Dantas
- Department of Clinical Medicine, Federal University of Pernambuco, Recife, Pernambuco, Brazil.
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3
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Maher TM, Assassi S, Azuma A, Cottin V, Hoffmann-Vold AM, Kreuter M, Oldham JM, Richeldi L, Valenzuela C, Wijsenbeek MS, Coeck C, Schlecker C, Voss F, Wachtlin D, Martinez FJ. Design of a phase III, double-blind, randomised, placebo-controlled trial of BI 1015550 in patients with progressive pulmonary fibrosis (FIBRONEER-ILD). BMJ Open Respir Res 2023; 10:e001580. [PMID: 37709661 PMCID: PMC10503394 DOI: 10.1136/bmjresp-2022-001580] [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: 12/06/2022] [Accepted: 08/22/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Progressive pulmonary fibrosis (PPF) includes any diagnosis of progressive fibrotic interstitial lung disease (ILD) other than idiopathic pulmonary fibrosis (IPF). However, disease progression appears comparable between PPF and IPF, suggesting a similar underlying pathology relating to pulmonary fibrosis. Following positive results in a phase II study in IPF, this phase III study will investigate the efficacy and safety of BI 1015550 in patients with PPF (FIBRONEER-ILD). METHODS AND ANALYSIS In this phase III, double-blind, placebo-controlled trial, patients are being randomised 1:1:1 to receive BI 1015550 (9 mg or 18 mg) or placebo twice daily over at least 52 weeks, stratified by background nintedanib use. Patients must be diagnosed with pulmonary fibrosis other than IPF that is progressive, based on predefined criteria. Patients must have forced vital capacity (FVC) ≥45% predicted and haemoglobin-corrected diffusing capacity of the lung for carbon monoxide ≥25% predicted. Patients must be receiving nintedanib for at least 12 weeks, or not receiving nintedanib for at least 8 weeks, prior to screening. Patients on stable treatment with permitted immunosuppressives (eg, methotrexate, azathioprine) may continue their treatment throughout the trial. Patients with clinically significant airway obstruction or other pulmonary abnormalities, and those using immunosuppressives that may confound FVC results (cyclophosphamide, tocilizumab, mycophenolate, rituximab) or high-dose steroids will be excluded. The primary endpoint is absolute change from baseline in FVC (mL) at week 52. The key secondary endpoint is time to the first occurrence of any acute ILD exacerbation, hospitalisation for respiratory cause or death, over the duration of the trial. ETHICS AND DISSEMINATION The trial is being carried out in accordance with the ethical principles of the Declaration of Helsinki, the International Council on Harmonisation Guideline for Good Clinical Practice and other local ethics committees. The study results will be disseminated at scientific congresses and in peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT05321082.
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Affiliation(s)
- Toby M Maher
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Section of Inflammation, Repair and Development, Imperial College London National Heart and Lung Institute, London, UK
| | - Shervin Assassi
- Division of Rheumatology, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Arata Azuma
- Pulmonary Medicine and Oncology, Nippon Medical School, Tokyo, Japan
- Respiratory Medicine and Clinical Research Centre, Meisei Hospital, Saitama, Japan
| | - Vincent Cottin
- Service de pneumologie, Hôpital Louis Pradel, Centre de Référence des Maladies Pulmonaires Rares, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, iNRAE, member of ERN-LUNG, Lyon, France
| | | | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Thoraxklinik, University of Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
| | - Justin M Oldham
- Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Luca Richeldi
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudia Valenzuela
- ILD Unit, Pulmonology Department, Hospital Universitario de la Princesa, University Autonomade Madrid, Madrid, Spain
| | - Marlies S Wijsenbeek
- Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Carl Coeck
- Boehringer Ingelheim SComm, Brussels, Belgium
| | | | - Florian Voss
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
| | - Daniel Wachtlin
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein, Germany
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Ghandour AM, Gamal RM, Eldein GS, Gamal AM, El-Hakeim E, Galal MAA, El-Nouby FH, Makarem YS, Awad AA, Hafez AA, Abozaid HSM. Study the Relationship of MDCT Staging in Disease Extent with the Systemic Sclerosis Disease Parameters. REUMATOLOGIA CLINICA 2022; 18:597-602. [PMID: 36435556 DOI: 10.1016/j.reumae.2021.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/08/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVES The highest incidence of death in systemic sclerosis due to pulmonary disease raises the need for early detection and treatment. The study aim is the assessment of interstitial pulmonary disease by Multi Detector High Resolution CT (MDCT) and finds its relationship with the other disease parameters and the Pulmonary Function tests (PFT). PATIENTS AND METHODS A prospective cross-sectional study was performed in Assiut University Hospitals from May 2018 to January 2020 and included 62 consecutive SSc female patients. Demographic, clinical, Laboratory, PFT and MDCT assessment were conducted for all participants. RESULTS The coarseness of fibrosis was 8.32 (range 0.0-17), the average proportion of ground-glass opacification was 28.3% (range, 0.0%-75%). Honey-comb pattern was seen in (52.5%). Mean Extent of disease was 46.25±3.7 (range 5-81). Restrictive deficit found in 42 patients. Significant relation was found between the extent of disease and the percentage predicted FVC (r=0.373, p 0.018) and FEV1/FVC (r=0.593, p 0.000) and coarseness of fibrosis and proportion of ground glass opacification correlated inversely with VC (r=-0.385, p=0.014, r=-0.376, p=0.017 respectively), Rayanud's phenomena, modified Rodnan Skin Score and Medsger's general are positively correlated with MDCT disease extent. CONCLUSION Scoring of systemic sclerosis (SSc) related interstitial lung disease (SSc-ILD) could be applicable as one of the important tools for disease assessment.
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Affiliation(s)
- Abeer M Ghandour
- Department of Rheumatology& Rehabilitation, Assuit University, Egypt
| | - Rania M Gamal
- Department of Rheumatology& Rehabilitation, Assuit University, Egypt
| | | | - Aya M Gamal
- Department of Rheumatology& Rehabilitation, Assuit University, Egypt
| | - Eman El-Hakeim
- Department of Rheumatology& Rehabilitation, Assuit University, Egypt
| | - Marwa A A Galal
- Department of Rheumatology& Rehabilitation, Assuit University, Egypt
| | - Fatma H El-Nouby
- Department of Rheumatology& Rehabilitation, Assuit University, Egypt
| | - Yasmine S Makarem
- Department of Rheumatology& Rehabilitation, Assuit University, Egypt
| | - Ahmed Abdellatif Awad
- Department of Physical Medicine, Rheumatology & Rehabilitation, Ain Shams University, Egypt
| | - Ahmed A Hafez
- Department of Rheumatology& Rehabilitation, Assuit University, Egypt
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Hinchcliff M, Garcia-Milian R, Di Donato S, Dill K, Bundschuh E, Galdo FD. Cellular and Molecular Diversity in Scleroderma. Semin Immunol 2021; 58:101648. [PMID: 35940960 DOI: 10.1016/j.smim.2022.101648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
With the increasing armamentarium of high-throughput tools available at manageable cost, it is attractive and informative to determine the molecular underpinnings of patient heterogeneity in systemic sclerosis (SSc). Given the highly variable clinical outcomes of patients labelled with the same diagnosis, unravelling the cellular and molecular basis of disease heterogeneity will be crucial to predicting disease risk, stratifying management and ultimately informing a patient-centered precision medicine approach. Herein, we summarise the findings of the past several years in the fields of genomics, transcriptomics, and proteomics that contribute to unraveling the cellular and molecular heterogeneity of SSc. Expansion of these findings and their routine integration with quantitative analysis of histopathology and imaging studies into clinical care promise to inform a scientifically driven patient-centred personalized medicine approach to SSc in the near future.
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Affiliation(s)
- Monique Hinchcliff
- Yale School of Medicine, Department of Internal Medicine, Section of Rheumatology, Allergy & Immunology, USA.
| | | | - Stefano Di Donato
- Raynaud's and Scleroderma Programme, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Biomedical Research Centre, University of Leeds, UK
| | | | - Elizabeth Bundschuh
- Yale School of Medicine, Department of Internal Medicine, Section of Rheumatology, Allergy & Immunology, USA
| | - Francesco Del Galdo
- Raynaud's and Scleroderma Programme, Leeds Institute of Rheumatic and Musculoskeletal Medicine and NIHR Biomedical Research Centre, University of Leeds, UK.
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Ghandour AM, Gamal RM, Eldein GS, Gamal AM, El-Hakeim E, Galal MAA, El-Nouby FH, Makarem YS, Awad AA, Hafez AA, Abozaid HSM. Study the Relationship of MDCT Staging in Disease Extent with the Systemic Sclerosis Disease Parameters. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00120-0. [PMID: 34147353 DOI: 10.1016/j.reuma.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/09/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES The highest incidence of death in systemic sclerosis due to pulmonary disease raises the need for early detection and treatment. The study aim is the assessment of interstitial pulmonary disease by Multi Detector High Resolution CT (MDCT) and finds its relationship with the other disease parameters and the Pulmonary Function tests (PFT). PATIENTS AND METHODS A prospective cross-sectional study was performed in Assiut University Hospitals from May 2018 to January 2020 and included 62 consecutive SSc female patients. Demographic, clinical, Laboratory, PFT and MDCT assessment were conducted for all participants. RESULTS The coarseness of fibrosis was 8.32 (range 0.0-17), the average proportion of ground-glass opacification was 28.3% (range, 0.0%-75%). Honey-comb pattern was seen in (52.5%). Mean Extent of disease was 46.25±3.7 (range 5-81). Restrictive deficit found in 42 patients. Significant relation was found between the extent of disease and the percentage predicted FVC (r=0.373, p 0.018) and FEV1/FVC (r=0.593, p 0.000) and coarseness of fibrosis and proportion of ground glass opacification correlated inversely with VC (r=-0.385, p=0.014, r=-0.376, p=0.017 respectively), Rayanud's phenomena, modified Rodnan Skin Score and Medsger's general are positively correlated with MDCT disease extent. CONCLUSION Scoring of systemic sclerosis (SSc) related interstitial lung disease (SSc-ILD) could be applicable as one of the important tools for disease assessment.
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Affiliation(s)
- Abeer M Ghandour
- Department of Rheumatology& Rehabilitation, Assuit University, Egypt
| | - Rania M Gamal
- Department of Rheumatology& Rehabilitation, Assuit University, Egypt
| | | | - Aya M Gamal
- Department of Rheumatology& Rehabilitation, Assuit University, Egypt
| | - Eman El-Hakeim
- Department of Rheumatology& Rehabilitation, Assuit University, Egypt
| | - Marwa A A Galal
- Department of Rheumatology& Rehabilitation, Assuit University, Egypt
| | - Fatma H El-Nouby
- Department of Rheumatology& Rehabilitation, Assuit University, Egypt
| | - Yasmine S Makarem
- Department of Rheumatology& Rehabilitation, Assuit University, Egypt
| | - Ahmed Abdellatif Awad
- Department of Physical Medicine, Rheumatology & Rehabilitation, Ain Shams University, Egypt
| | - Ahmed A Hafez
- Department of Rheumatology& Rehabilitation, Assuit University, Egypt
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Yakut H, Özalevli S, Birlik AM. Fatigue and its relationship with disease-related factors in patients with systemic sclerosis: A cross-sectional study. Turk J Med Sci 2021; 51:530-539. [PMID: 32927933 PMCID: PMC8203131 DOI: 10.3906/sag-2005-314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/08/2020] [Indexed: 01/03/2023] Open
Abstract
Background/aim Fatigue is very common symptom in patients with systemic sclerosis (SSc) and adversely affects health-related quality of life and the ability to perform daily living activities. This study aimed to determine the severity of fatigue, and its related factors, in patients with SSc. Materials and methods A total of 35 patients with SSc (6 males and 29 females, mean age of 50.71 ± 10.09 years) and 35 healthy control subjects (8 males and 27 females, mean age of 54.14 ± 9.51 years) were included in this study. The Fatigue Impact Scale for fatigue, Modified Medical Research Council Scale for dyspnea severity, 6-Minute Walking Test for functional capacity, Health Assessment Questionnaire Disability Index, Scleroderma Health Assessment Questionnaire and Short Form-36 Quality of Life Questionnaire for health-related quality of life were used in the evaluation of the subjects. Furthermore, pulmonary functions, diffusion capacity, and respiratory and peripheral muscle strength were evaluated. Results Of the SSc patients, 80% experienced fatigue and presented with higher total and cognitive, physical, and psychosocial subscale fatigue scores than the healthy control subjects (P < 0.05). Moreover, the SSc patients exhibited significantly increased dyspnea severity, impaired pulmonary function-diffusion capacity, decreased respiratory-peripheral muscle strength, reduced functional capacity, and worsened health-related quality of life when compared to the control group (P < 0.05). Fatigue in the SSc group was significantly associated with age, dyspnea severity, diffusion capacity, respiratory and peripheral muscle strength, functional capacity, and health-related quality of life (P < 0.05). Conclusions Along with the decrease in diffusion capacity, increase dyspnea, a decrease in both peripheral and respiratory muscle strength, and worsening functional capacity may have an effect on increased fatigue in SSc patients. Increased fatigue can also affect the life quality and daily life activities of a patient. Therefore, multidisciplinary approaches are recommended to evaluate and improve these parameters in the treatment of fatigue from the early period in SSc patients.
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Affiliation(s)
- Hazal Yakut
- Department of Institute of Health Sciences, Dokuz Eylül University, İzmir, Turkey
| | - Sevgi Özalevli
- Department of School of Physical Therapy and Rehabilitation, Institute of Health Sciences, Dokuz Eylül University, İzmir, Turkey
| | - Ahmet Merih Birlik
- Department of Immunology and Rheumatology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
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Ruaro B, Confalonieri M, Salton F, Wade B, Baratella E, Geri P, Confalonieri P, Kodric M, Biolo M, Bruni C. The Relationship between Pulmonary Damage and Peripheral Vascular Manifestations in Systemic Sclerosis Patients. Pharmaceuticals (Basel) 2021; 14:403. [PMID: 33922710 PMCID: PMC8145021 DOI: 10.3390/ph14050403] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 12/18/2022] Open
Abstract
Systemic sclerosis (SSc) is an autoimmune disease, characterized by the presence of generalized vasculopathy and tissue fibrosis. Collagen vascular disorder in SSc is due to fibroblast and endothelial cell dysfunctions. This leads to collagen overproduction, vascular impairment and immune system abnormalities and, in the last stage, multi-organ damage. Thus, to avoid organ damage, which has a poor prognosis, all patients should be carefully evaluated and followed. This is particularly important in the initial disease phase, so as to facilitate early identification of any organ involvement and to allow for appropriate therapy. Pulmonary disease in SSc mainly involves interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH). High-resolution computed tomography (HRCT) and pulmonary function tests (PFT) have been proposed to monitor parenchymal damage. Although transthoracic echocardiography is the most commonly used screening tool for PAH in SSc patients, definitive diagnosis necessitates confirmation by right heart catheterization (RHC). Moreover, some studies have demonstrated that nailfold videocapillaroscopy (NVC) provides an accurate evaluation of the microvascular damage in SSc and is able to predict internal organ involvement, such as lung impairment. This review provides an overview of the correlation between lung damage and microvascular involvement in SSc patients.
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Affiliation(s)
- Barbara Ruaro
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (M.C.); (F.S.); (P.G.); (P.C.); (M.K.); (M.B.)
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (M.C.); (F.S.); (P.G.); (P.C.); (M.K.); (M.B.)
| | - Francesco Salton
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (M.C.); (F.S.); (P.G.); (P.C.); (M.K.); (M.B.)
| | - Barbara Wade
- AOU City of Health and Science of Turin, Department of Science of Public Health and Pediatrics, University of Torino, 10126 Torino, Italy;
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy;
| | - Pietro Geri
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (M.C.); (F.S.); (P.G.); (P.C.); (M.K.); (M.B.)
| | - Paola Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (M.C.); (F.S.); (P.G.); (P.C.); (M.K.); (M.B.)
| | - Metka Kodric
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (M.C.); (F.S.); (P.G.); (P.C.); (M.K.); (M.B.)
| | - Marco Biolo
- Department of Pulmonology, University Hospital of Cattinara, 34149 Trieste, Italy; (M.C.); (F.S.); (P.G.); (P.C.); (M.K.); (M.B.)
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Firenze, 50121 Florence, Italy;
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Lescoat A, Roofeh D, Townsend W, Hughes M, Sandler RD, Zimmermann F, Pauling JD, Buch MH, Khanna D. Domains and outcome measures for the assessment of limited cutaneous systemic sclerosis: a scoping review protocol. BMJ Open 2021; 11:e044765. [PMID: 33707273 PMCID: PMC7957124 DOI: 10.1136/bmjopen-2020-044765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/21/2021] [Accepted: 01/28/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Limited cutaneous systemic sclerosis (lcSSc) is the most frequent subset of systemic sclerosis. Despite this, lcSSc is not the major focus of clinical studies. The lack of interventional studies in lcSSc is due, in part, to a paucity of relevant outcome measures to effectively evaluate this subset. A combined response index dedicated to lcSSc would facilitate development of well-designed trials and approval of new drugs. The objective of this scoping review is to perform a broad and comprehensive identification of the outcome measures (core set items) within relevant domains, which have been used so far to assess lcSSc. METHODS AND ANALYSIS The planned scoping review will be based on the approach proposed by Arksey et al and further developed by Levac et al. Development and reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews checklist and guidelines. The development of the search strategy was guided by the concepts of domains and outcomes based on the Outcome Measures in Rheumatology approach and by the different names and definitions of SSc, with a specific emphasis on their occurrence in clinical trial studies. Two databases will be searched: MEDLINE and Embase. Studies in English, published from the year 1988 onwards, will be included, since 1988 corresponds to the publication of LeRoy's first consensus definition of lcSSc. Data will be extracted and analysed using a standardised charting tool. ETHICS AND DISSEMINATION No ethical approval is required for this study. The results will be submitted to an international peer-reviewed journal and scientific conferences, informing the discussion on which items should be included in a combined response index dedicated to lcSSc (the CRISTAL project: Combined Response Index for Scleroderma Trial Assessing lcSSc).
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Affiliation(s)
- Alain Lescoat
- Internal Medicine & Clinical Immunology, CHU Rennes, Rennes, France
- Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - David Roofeh
- Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Whitney Townsend
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Hughes
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robert D Sandler
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - John D Pauling
- Department of Rheumatology, Royal National Hospital For Rheumatic Diseases (at Royal United Hospitals), University of Bath, Bath, UK
| | - Maya H Buch
- Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University Foundation Trust, Manchester, UK
| | - Dinesh Khanna
- Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
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10
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Imaging in Diagnosis of Systemic Sclerosis. J Clin Med 2021; 10:jcm10020248. [PMID: 33445449 PMCID: PMC7827740 DOI: 10.3390/jcm10020248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/28/2020] [Accepted: 01/08/2021] [Indexed: 12/27/2022] Open
Abstract
Systemic sclerosis (SSc) is a connective tissue disease characterized by fibrosis in skin and internal organs, progressive vascular obliteration, and the production of autoantibodies. Diagnostic imaging is irreplaceable in both diagnosing and monitoring patients suffering from systemic sclerosis. In addition to routinely used methods, such as comparative X-ray of the hands or a contrast-enhanced examination of the upper gastrointestinal tract or chest, there is an array of less widespread examinations, with an emphasis on magnetic resonance imaging (MRI) and ultrasonography, not only in the evaluation of the musculoskeletal system. This article will review the various imaging modalities available for SSc imaging and assessment, focusing on their utility as tissue-specific diagnosis and treatment monitoring.
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Mulkoju R, Saka VK, Rajaram M, Kumari R, Negi VS, Mohanty Mohapatra M, Govindaraj V, Dwivedi DP, Mahesh Babu V. Pulmonary Manifestations in Systemic Sclerosis: Hospital-Based Descriptive Study. Cureus 2020; 12:e8649. [PMID: 32685316 PMCID: PMC7366045 DOI: 10.7759/cureus.8649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Prevalence of systemic sclerosis (SSc)-related organ injury is difficult to estimate as it occurs early in SSc, even though patients are often asymptomatic. As the patients with organ damage have a poor prognosis, all the patients should be carefully evaluated and followed‑up in the initial periods. This facilitates the early identification and initiation of appropriate therapy. This study emphasizes on different clinical manifestations and early predictors of lung involvement by using clinical, radiological, and pulmonary function tests in a tertiary care centre. Materials and methods A total of 53 SSc cases, who satisfied American College of Rheumatology (ACR) 2013 criteria, without any overlap syndromes were included in the study. All patients underwent thorough clinical examination along with Modified Rodnan Scoring (MRS) assessment, nailfold capillaroscopy (NFC), chest X-ray (CXR), HRCT thorax, 2D-echocardiography, spirometry and diffusion lung study by carbon monoxide (DLco). Results Out of 53 patients, four were male and 49 were female. Twenty-one patients had limited SSc (lcSSc) and 32 had diffuse SSc (dcSSc). Eighty-three per cent of subjects presented with skin manifestations and 34% with respiratory complaints. Reticulonodular opacities and ground glassing were the predominant radiological abnormalities suggestive of non-specific interstitial pneumonia (NSIP) followed by usual interstitial pneumonia (UIP). Pulmonary hypertension was predominant in patients with lcSSc. Thirty-eight patients had a restrictive pattern of spirometry. Forty-four patients showed deranged DLco, among which two patients showed an isolated decrease in DLco. Thirty-seven patients had abnormal NFC among which dropout pattern was predominant. MRS was significantly correlated with pulmonary involvement by DLco and HRCT. Conclusions SSc can affect the lungs even before developing obvious clinical pulmonary manifestations. DLco and HRCT play a critical role in detecting early lung involvement and predicting the outcomes in SSc. Higher modified Rodnan’s score, which has a significant correlation with DLco and HRCT can be used to predict early visceral involvement in resource-limited settings.
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Affiliation(s)
- Ravindrachari Mulkoju
- Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Vinod Kumar Saka
- Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Manju Rajaram
- Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Rashmi Kumari
- Dermatology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, IND
| | - Vir S Negi
- Internal Medicine: Rheumatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | | | - Vishnukanth Govindaraj
- Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Dharm Prakash Dwivedi
- Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Vemuri Mahesh Babu
- Internal Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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Volkmann ER. Natural History of Systemic Sclerosis-Related Interstitial Lung Disease: How to Identify a Progressive Fibrosing Phenotype. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2019; 5:31-40. [PMID: 33693056 DOI: 10.1177/2397198319889549] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The natural history of interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) is highly variable. Historical observational studies have demonstrated that the greatest decline in lung function in SSc occurs early in the course of the disease; however, not all patients experience a decline in lung function even in the absence of treatment. Furthermore, among patients who do experience a decline in lung function, the rate of decline can be either rapid or slow. The most common clinical phenotypes of SSc-ILD therefore: (i) Rapid Progressors, (ii) Gradual Progressors, (iii) Stabilizers and (iv) Improvers. This review summarizes the features of SSc-ILD patients who are more likely to experience rapid progression of ILD, as well as those who are more likely not to experience ILD progression. Understanding the clinical, biological and radiographic factors that consistently predict ILD-related outcomes in SSc is central to our ability to recognize those patients who are at heightened risk for ILD progression. With new options available for treating patients with SSc-ILD, it is more important than ever to accurately identify patients who may derive the most benefit from aggressive SSc-ILD therapy. Early therapeutic intervention in patients with this progressive fibrosing phenotype may ultimately improve morbidity and mortality outcomes in patients with SSc-ILD.
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Affiliation(s)
- Elizabeth R Volkmann
- University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, USA
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The Chinese herb Tripterygium wilfordii Hook F for the treatment of systemic sclerosis-associated interstitial lung disease: data from a Chinese EUSTAR Center. Clin Rheumatol 2019; 39:813-821. [PMID: 31713733 DOI: 10.1007/s10067-019-04784-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/29/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of the Chinese herb Tripterygium wilfordii Hook F (TwHF) for the treatment of systemic sclerosis-associated interstitial lung disease (SSc-ILD). METHODS SSc-ILD patients who were regularly treated for more than 1 year and were currently taking a stable dose of TwHF (40-60 mg/day) or CYC (100 mg/day) were selected from the EUSTAR database of Peking Union Medical College Hospital. The efficacy of treatments was assessed by the change in pulmonary function, including the forced vital capacity (FVC) and the percentage of predicted FVC (FVC pred%). RESULTS Among the 431 patients diagnosed with SSc-ILD, 76 fulfilled the inclusion and exclusion criteria. Twenty eight patients received TwHF monotherapy, while 48 received oral CYC monotherapy. Baseline data prior to treatment did not differ significantly between the two groups. After 1 year of treatment, significant improvements in the FVC and FVC pred% were seen in both groups (P < 0.05) and the magnitude of improvement was comparable (P = 0.93). However, TwHF was only found to be effective in improving FVC and FVC pred% when administered as a maintenance therapy, but not as an induction therapy. No severe adverse events were seen in either group. Leucopenia occurred more often in the CYC group compared to the TwHF group (P = 0.034). CONCLUSION TwHF may be considered as a potential alternative drug for SSc-ILD patients, especially as a maintenance therapy. A prospective randomized controlled trial is necessary to further confirm these results.Key Points• This is the first clinical study of Tripterygium wilfordii Hook F (TwHF) in the treatment of SSc-ILD, providing a novel therapeutic option for SSc-ILD.• TwHF shows a comparable therapeutic efficacy to CYC when treating SSc-ILD.• TwHF has unique therapeutic advantages considering the balance of economy and safety and may be a good potential choice for maintenance therapy.
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Waibel S, Matthé E. Erstdiagnosestellung einer systemischen Sklerose anhand okulärer Komplikationen. Ophthalmologe 2019; 116:661-664. [DOI: 10.1007/s00347-018-0789-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Caron M, Hoa S, Hudson M, Schwartzman K, Steele R. Pulmonary function tests as outcomes for systemic sclerosis interstitial lung disease. Eur Respir Rev 2018; 27:170102. [PMID: 29769294 PMCID: PMC9488607 DOI: 10.1183/16000617.0102-2017] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/24/2018] [Indexed: 01/17/2023] Open
Abstract
Interstitial lung disease (ILD) is the leading cause of morbidity and mortality in systemic sclerosis (SSc). We performed a systematic review to characterise the use and validation of pulmonary function tests (PFTs) as surrogate markers for systemic sclerosis-associated interstitial lung disease (SSc-ILD) progression.Five electronic databases were searched to identify all relevant studies. Included studies either used at least one PFT measure as a longitudinal outcome for SSc-ILD progression (i.e. outcome studies) and/or reported at least one classical measure of validity for the PFTs in SSc-ILD (i.e. validation studies).This systematic review included 169 outcome studies and 50 validation studies. Diffusing capacity of the lung for carbon monoxide (DLCO) was cumulatively the most commonly used outcome until 2010 when it was surpassed by forced vital capacity (FVC). FVC (% predicted) was the primary endpoint in 70.4% of studies, compared to 11.3% for % predicted DLCO Only five studies specifically aimed to validate the PFTs: two concluded that DLCO was the best measure of SSc-ILD extent, while the others did not favour any PFT. These studies also showed respectable validity measures for total lung capacity (TLC).Despite the current preference for FVC, available evidence suggests that DLCO and TLC should not yet be discounted as potential surrogate markers for SSc-ILD progression.
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Affiliation(s)
- Melissa Caron
- Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Sabrina Hoa
- Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Division of Rheumatology, Jewish General Hospital, Montreal, QC, Canada
| | - Marie Hudson
- Division of Rheumatology, Jewish General Hospital, Montreal, QC, Canada
| | - Kevin Schwartzman
- Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Russell Steele
- Dept of Mathematics and Statistics, McGill University, Montreal, QC, Canada
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16
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Xiao H, Zhang GF, Liao XP, Li XJ, Zhang J, Lin H, Chen Z, Zhang X. Anti-fibrotic effects of pirfenidone by interference with the hedgehog signalling pathway in patients with systemic sclerosis-associated interstitial lung disease. Int J Rheum Dis 2018; 21:477-486. [PMID: 29316328 DOI: 10.1111/1756-185x.13247] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To determine whether pirfenidone attenuates lung fibrosis by interfering with the hedgehog (Hh) signalling pathway in patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD). METHODS Twenty-five SSc-ILD patients (20 first visit, five who underwent pirfenidone treatment for 6 months) and 10 healthy controls were recruited. Lung tissues were obtained by open-chest surgery, and primary lung fibroblasts were isolated, cultured and stimulated with pirfenidone. The levels of the proteins glioma-associated oncogene 1 (GLI1), suppressor of fused (Sufu), α-smooth muscle actin, and fibronectin in lung tissues or fibroblasts were determined by Western blotting. The messenger RNA levels of GLI1, glioma-associated oncogene 2, protein patched homolog 1, and Sufu in lung tissues or fibroblasts were determined by quantitative reverse-transcription polymerase chain reaction. Meanwhile, the levels of phosphorylation glycogen synthase kinasep-3β (pGSK-3β), phosphorylation SMAD2 (pSMAD2), and phosphorylation c-Jun N-terminal kinase (pJNK) in fibroblasts were determined by Western blotting. RESULTS Hh pathway activation was increased in the lung tissue of SSc-ILD patients and was decreased by pirfenidone, Sufu was upregulated in lung fibroblasts isolated from SSc-ILD patients after pirfenidone challenge, and pirfenidone inhibited the phosphorylation of GSK-3β signalling. CONCLUSION Pirfenidone has anti-fibrotic effects in SSc-ILD patients by interfering with both the Hh signalling pathway and the GSK-3β signalling pathway via the regulation of Sufu expression. These results might promote its use in other Hh driven lung diseases such as idiopathic pulmonary fibrosis and especially the interstitial lung disease associated with connective tissue diseases.
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Affiliation(s)
- Hua Xiao
- Southern Medical University, Guangzhou, China.,Department of Rheumatology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Rheumatology, The First Peoples' Hospital of Chenzhou, Hunan, China
| | - Guang-Feng Zhang
- Southern Medical University, Guangzhou, China.,Department of Rheumatology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiang-Ping Liao
- Department of Rheumatology, The First Peoples' Hospital of Chenzhou, Hunan, China
| | - Xiao-Jie Li
- Department of Pathology, The First Peoples' Hospital of Chenzhou, Hunan, China
| | - Jian Zhang
- Statistics of Translational Medicine Institute, National and Local Joint Engineering Laboratory for High-Through Molecular Diagnosis Technology, The First Peoples' Hospital of Chenzhou, Hunan, China
| | - Haobo Lin
- Southern Medical University, Guangzhou, China.,Department of Rheumatology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhe Chen
- Department of Rheumatology, The First Peoples' Hospital of Chenzhou, Hunan, China
| | - Xiao Zhang
- Southern Medical University, Guangzhou, China.,Department of Rheumatology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Le Gouellec N, Duhamel A, Perez T, Hachulla AL, Sobanski V, Faivre JB, Morell-Dubois S, Lambert M, Hatron PY, Hachulla E, Béhal H, Matran R, Launay D, Remy-Jardin M. Predictors of lung function test severity and outcome in systemic sclerosis-associated interstitial lung disease. PLoS One 2017; 12:e0181692. [PMID: 28763468 PMCID: PMC5538660 DOI: 10.1371/journal.pone.0181692] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 07/04/2017] [Indexed: 11/19/2022] Open
Abstract
Systemic sclerosis-related interstitial lung disease (SSc-ILD) is the leading cause of death in SSc. In this study, we aimed to describe the baseline severity and evolution of forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO) in patients with SSc-ILD and to assess the baseline clinical, biological and high-resolution CT scan (HRCT) predictors of this evolution. Baseline and serial FVC and DLCO were collected in 75 SSc-ILD patients followed during 6.4±4.2 years (n = 557 individual data). FVC and DLCO evolution was modelled using a linear mixed model with random effect. During follow-up, FVC was stable while DLCO significantly decreased (-1.5±0.3%/year (p<0.0001). Baseline NYHA functional class III/IV, extensive SSc-ILD on HRCT and DLCO<80% were associated with a lower baseline FVC. Absence of digital ulcers extensive SSc-ILD, and FVC<80% and were associated with a lower baseline DLCO. Presence or history of digital ulcers and presence of pulmonary hypertension at baseline or during follow-up were associated with a faster decline of DLCO overtime. Neither age, gender, subtype of SSc nor specificity of autoantibodies were associated with baseline severity or outcome of lung function tests. In this SSc-ILD population, FVC was therefore stable while DLCO significantly declined over time. ILD extension was associated with baseline FVC and DLCO but not with their evolution. Presence or history of digital ulcers and pulmonary hypertension were predictors of a faster decline of DLCO over time.
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Affiliation(s)
- Noémie Le Gouellec
- Univ. Lille, U995, Lille Inflammation Research International Center (LIRIC), Lille, France
- Inserm, U995, Lille, France
- CHU Lille, département de médecine interne et immunologie clinique, Lille, France
- Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), Lille, France
| | | | - Thierry Perez
- CHRU Lille, Service d’Explorations Fonctionnelles Respiratoires, Lille, France
| | | | - Vincent Sobanski
- Univ. Lille, U995, Lille Inflammation Research International Center (LIRIC), Lille, France
- Inserm, U995, Lille, France
- CHU Lille, département de médecine interne et immunologie clinique, Lille, France
- Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), Lille, France
| | | | - Sandrine Morell-Dubois
- Univ. Lille, U995, Lille Inflammation Research International Center (LIRIC), Lille, France
- Inserm, U995, Lille, France
- CHU Lille, département de médecine interne et immunologie clinique, Lille, France
- Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), Lille, France
| | - Marc Lambert
- Univ. Lille, U995, Lille Inflammation Research International Center (LIRIC), Lille, France
- Inserm, U995, Lille, France
- CHU Lille, département de médecine interne et immunologie clinique, Lille, France
- Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), Lille, France
| | - Pierre-Yves Hatron
- Univ. Lille, U995, Lille Inflammation Research International Center (LIRIC), Lille, France
- Inserm, U995, Lille, France
- CHU Lille, département de médecine interne et immunologie clinique, Lille, France
- Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), Lille, France
| | - Eric Hachulla
- Univ. Lille, U995, Lille Inflammation Research International Center (LIRIC), Lille, France
- Inserm, U995, Lille, France
- CHU Lille, département de médecine interne et immunologie clinique, Lille, France
- Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), Lille, France
| | | | - Regis Matran
- CHRU Lille, Service d’Explorations Fonctionnelles Respiratoires, Lille, France
| | - David Launay
- Univ. Lille, U995, Lille Inflammation Research International Center (LIRIC), Lille, France
- Inserm, U995, Lille, France
- CHU Lille, département de médecine interne et immunologie clinique, Lille, France
- Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), Lille, France
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Boulos D, Ngian GS, Rajadurai A, Elford K, Stevens W, Proudman S, Owen C, Roddy J, Nikpour M, Youssef P, Hill C, Sahhar J. Long-term efficacy and tolerability of mycophenolate mofetil therapy in diffuse scleroderma skin disease. Int J Rheum Dis 2017; 20:481-488. [DOI: 10.1111/1756-185x.13035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Daniel Boulos
- Department of Rheumatology; Monash Health; Melbourne Victoria Australia
| | - Gene-Siew Ngian
- Department of Rheumatology; Monash Health; Melbourne Victoria Australia
| | - Anton Rajadurai
- Department of Rheumatology; Monash Health; Melbourne Victoria Australia
| | - Kathleen Elford
- Department of Rheumatology; Monash Health; Melbourne Victoria Australia
| | - Wendy Stevens
- Department of Rheumatology; St Vincent's Health; Melbourne Victoria Australia
| | - Susanna Proudman
- Department of Rheumatology; Royal Adelaide Hospital; Adelaide South Australia Australia
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Claire Owen
- Department of Rheumatology; Austin Health; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
| | - Janet Roddy
- Department of Rheumatology; Royal Perth Hospital; Perth Western Australia Australia
| | - Mandana Nikpour
- Department of Rheumatology; St Vincent's Health; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
| | - Peter Youssef
- Department of Rheumatology; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| | - Catherine Hill
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
- Department of Rheumatology; Queen Elizabeth Hospital; Adelaide South Australia Australia
| | - Joanne Sahhar
- Department of Rheumatology; Monash Health; Melbourne Victoria Australia
- Department of Medicine; Monash University; Melbourne Victoria Australia
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Fallahi P, Ruffilli I, Giuggioli D, Colaci M, Ferrari SM, Antonelli A, Ferri C. Associations between Systemic Sclerosis and Thyroid Diseases. Front Endocrinol (Lausanne) 2017; 8:266. [PMID: 29042859 PMCID: PMC5632355 DOI: 10.3389/fendo.2017.00266] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 09/21/2017] [Indexed: 12/31/2022] Open
Abstract
We have reviewed scientific literature about the association of systemic sclerosis (SSc) and thyroid disorders. A high incidence, and prevalence, of new cases of autoimmune thyroiditis (AT) and/or hypothyroidism have been shown in sclerodermic patients (overall in the female gender). An association among a Th1 immune-predominance, low vitamin D levels, and AT have been also shown in SSc patients. Cases of Graves' disease (GD) have been described in SSc patients, too, according with the higher prevalence of thyroid autoimmunity. It has been also shown a higher prevalence of papillary thyroid cancer (PTC), in association with AT, in SSc patients. However, in order to confirm results about GD and thyroid cancer, studies in larger number of patients with SSc are needed. During the follow-up of SSc patients it would be appropriate to monitor carefully their thyroid status. The abovementioned data strongly suggest a periodic thyroid function follow-up in female SSc patients [showing a borderline high (although in the normal range) thyroid-stimulating hormone level, antithyroid peroxidase antibody positivity, and a small thyroid with a hypoechoic pattern], and, when necessary, appropriate treatments. In conclusion, most of the studies show an association among SSc, AT, and hypothyroidism, such as an increased prevalence of TC overall in SSc patients with AT. Only few cases of GD have been also described in SSc.
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Affiliation(s)
- Poupak Fallahi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- *Correspondence: Poupak Fallahi,
| | - Ilaria Ruffilli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Dilia Giuggioli
- Department of Medical, Surgical, Maternal, Pediatric and Adult Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Michele Colaci
- Department of Medical, Surgical, Maternal, Pediatric and Adult Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Clodoveo Ferri
- Department of Medical, Surgical, Maternal, Pediatric and Adult Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Çetinçakmak MG, Göya C, Hamidi C, Tekbaş G, Abakay Ö, Batmaz İ, Hattapoğlu S, Yavuz A, Bilici A. Quantitative volumetric assessment of pulmonary involvement in patients with systemic sclerosis. Quant Imaging Med Surg 2016; 6:50-6. [PMID: 26981455 DOI: 10.3978/j.issn.2223-4292.2016.02.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Computed tomography (CT) is the gold standard for assessing interstitial lung disease (ILD) in patients with systemic sclerosis (SSc). In this study, we performed a quantitative calculation of ILD severity by examining the lung volume of SSc patients. METHODS The present study was performed retrospectively on 38 patients with SSc who were referred to our clinic. Patients were divided into two groups based on high-resolution computed tomography (HRCT): patients with ILD and patients without ILD.The percentage of lower lobe volume (PLLV) was calculated using HRCT. In addition, we evaluated the PLLV in all patients according to age, diffusing capacity of the lung for carbon monoxide (DLCO) and spirometric findings, and assessed the relationships among these factors. RESULTS PLLV of the right lung in patients with ILD was reduced when compared with patients without ILD (P=0.041). The PLLV of the right lung in patients with ILD was negatively correlated with age and forced vital capacity (FVC; P=0.01 and P=0.012, respectively). CONCLUSIONS The PLLV of the right lung may decrease in SSc patients with ILD. In these patients, the PLLV may be a quantitative parameter indicating damage in the lung.
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Affiliation(s)
- Mehmet Güli Çetinçakmak
- 1 Department of Radiology, 2 Department of Chest Disease, Medical School, Dicle University, Diyarbakir, Turkey ; 3 Department of Physical Medicine and Rehabilitation, Dicle University, Diyarbakir, Turkey ; 4 Department of Radiology, Medical School, Yüzüncüyıl University, Van, Turkey
| | - Cemil Göya
- 1 Department of Radiology, 2 Department of Chest Disease, Medical School, Dicle University, Diyarbakir, Turkey ; 3 Department of Physical Medicine and Rehabilitation, Dicle University, Diyarbakir, Turkey ; 4 Department of Radiology, Medical School, Yüzüncüyıl University, Van, Turkey
| | - Cihad Hamidi
- 1 Department of Radiology, 2 Department of Chest Disease, Medical School, Dicle University, Diyarbakir, Turkey ; 3 Department of Physical Medicine and Rehabilitation, Dicle University, Diyarbakir, Turkey ; 4 Department of Radiology, Medical School, Yüzüncüyıl University, Van, Turkey
| | - Güven Tekbaş
- 1 Department of Radiology, 2 Department of Chest Disease, Medical School, Dicle University, Diyarbakir, Turkey ; 3 Department of Physical Medicine and Rehabilitation, Dicle University, Diyarbakir, Turkey ; 4 Department of Radiology, Medical School, Yüzüncüyıl University, Van, Turkey
| | - Özlem Abakay
- 1 Department of Radiology, 2 Department of Chest Disease, Medical School, Dicle University, Diyarbakir, Turkey ; 3 Department of Physical Medicine and Rehabilitation, Dicle University, Diyarbakir, Turkey ; 4 Department of Radiology, Medical School, Yüzüncüyıl University, Van, Turkey
| | - İbrahim Batmaz
- 1 Department of Radiology, 2 Department of Chest Disease, Medical School, Dicle University, Diyarbakir, Turkey ; 3 Department of Physical Medicine and Rehabilitation, Dicle University, Diyarbakir, Turkey ; 4 Department of Radiology, Medical School, Yüzüncüyıl University, Van, Turkey
| | - Salih Hattapoğlu
- 1 Department of Radiology, 2 Department of Chest Disease, Medical School, Dicle University, Diyarbakir, Turkey ; 3 Department of Physical Medicine and Rehabilitation, Dicle University, Diyarbakir, Turkey ; 4 Department of Radiology, Medical School, Yüzüncüyıl University, Van, Turkey
| | - Alpaslan Yavuz
- 1 Department of Radiology, 2 Department of Chest Disease, Medical School, Dicle University, Diyarbakir, Turkey ; 3 Department of Physical Medicine and Rehabilitation, Dicle University, Diyarbakir, Turkey ; 4 Department of Radiology, Medical School, Yüzüncüyıl University, Van, Turkey
| | - Aslan Bilici
- 1 Department of Radiology, 2 Department of Chest Disease, Medical School, Dicle University, Diyarbakir, Turkey ; 3 Department of Physical Medicine and Rehabilitation, Dicle University, Diyarbakir, Turkey ; 4 Department of Radiology, Medical School, Yüzüncüyıl University, Van, Turkey
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Salaffi F, Carotti M, Di Donato E, Di Carlo M, Ceccarelli L, Giuseppetti G. Computer-Aided Tomographic Analysis of Interstitial Lung Disease (ILD) in Patients with Systemic Sclerosis (SSc). Correlation with Pulmonary Physiologic Tests and Patient-Centred Measures of Perceived Dyspnea and Functional Disability. PLoS One 2016; 11:e0149240. [PMID: 26930658 PMCID: PMC4773230 DOI: 10.1371/journal.pone.0149240] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/28/2016] [Indexed: 01/17/2023] Open
Abstract
Objectives This study was designed (a) to evaluate an improved quantitative lung fibrosis score based on a computer-aided diagnosis (CaM) system in patients with systemic sclerosis (SSc),—related interstitial lung disease (SSc-ILD), (b) to investigate the relationship between physiologic parameters (forced vital capacity [FVC] and single-breath diffusing capacity for carbon monoxide [DLCO]), patient-centred measures of dyspnea and functional disability and CaM and visual reader-based (CoVR) methods, and (c) to identify potential surrogate measures from quantitative and visual HRCT measurement. Methods 126 patients with SSc underwent chest radiography, HRCT and PFTs. The following patient-centred measures were obtained: modified Borg Dyspnea Index (Borg score), VAS for breathing, and Health Assessment Questionnaire-Disability Index (HAQ-DI). HRCT abnormalities were scored according to the conventional visual reader-based score (CoVR) and by a CaM. The relationships among the HRCT scores, physiologic parameters (FVC and DLCO, % predicted) results and patient-centred measures, were calculated using linear regression analysis and Pearson’s correlation. Multivariate regression models were performed to identify the predictor variables on severity of pulmonary fibrosis. Results Subjects with limited cutaneous SSc had lower HAQ-DI scores than subjects with diffuse cutaneous SSc (p <0.001). CaM and CoVR scores were similar in the 2 groups. In univariate analysis, a strong correlation between CaM and CoVR was observed (p <0.0001). In multivariate analysis the CaM and CoVR scores were predicted by DLco, FVC, Borg score and HAQ-DI. Age, sex, disease duration, anti-topoisomerase antibodies and mRSS were not significantly associated with severity of pulmonary fibrosis on CaM- and CoVR methods. Conclusions Although a close correlation between CaM score results and CoVR total score was found, CaM analysis showed a more significant correlation with DLco (more so than the FVC), patient-centred measures of perceived dyspnea and functional disability. Computer-aided tomographic analysis is computationally efficient, and in combination with physiologic and patient-centred measures, it could allow a means for accurately assessing and monitoring the disease progression or response to therapy.
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Affiliation(s)
- Fausto Salaffi
- Department of Reumatology, Polythecnic University of Marche, Jesi (Ancona), Italy
- * E-mail:
| | - Marina Carotti
- Department of Radiology, Polythecnic University of Marche, Ancona, Italy
| | - Eleonora Di Donato
- Department of Reumatology, Polythecnic University of Marche, Jesi (Ancona), Italy
| | - Marco Di Carlo
- Department of Reumatology, Polythecnic University of Marche, Jesi (Ancona), Italy
| | - Luca Ceccarelli
- Department of Radiology, Polythecnic University of Marche, Ancona, Italy
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Yasuoka H. Recent Treatments of Interstitial Lung Disease with Systemic Sclerosis. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2016; 9:97-110. [PMID: 26819563 PMCID: PMC4720185 DOI: 10.4137/ccrpm.s23315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/15/2015] [Accepted: 09/23/2015] [Indexed: 02/06/2023]
Abstract
Systemic sclerosis (SSc) is a disorder characterized by immune dysfunction, microvascular injury, and fibrosis. Organ involvement in patients with SSc is variable; however, pulmonary involvement occurs in up to 90% of patients with SSc. Interstitial lung disease (ILD) is a major cause of mortality and, thus, a major determinant in the prognosis of patients with SSc. This review summarizes current findings about the characteristics of ILD in patients with SSc, selection of patients with SSc-ILD who are candidates for the treatment, and current treatment options.
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Affiliation(s)
- Hidekata Yasuoka
- Assistant Professor, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku, Tokyo, Japan
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Tseng CC, Yen JH, Tsai WC, Ou TT, Wu CC, Sung WY, Hsieh MC, Chang SJ. Reduced incidence of Crohn's disease in systemic sclerosis: a nationwide population study. BMC Musculoskelet Disord 2015; 16:251. [PMID: 26370572 PMCID: PMC4570507 DOI: 10.1186/s12891-015-0693-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 08/21/2015] [Indexed: 12/28/2022] Open
Abstract
Background To date, there has been no studies to evaluate the incidence of Crohn’s disease in systemic sclerosis patients. The goals of this study were to evaluate the incidence of Crohn’s disease and its relationship with sex and age in patients with systemic sclerosis. Methods We enrolled patients with systemic sclerosis and controls from Taiwan’s Registry of Catastrophic Illness Database and National Health Insurance Research Database. Every systemic sclerosis patient was matched to at most three controls by sex, age, month and year of initial diagnosis of systemic sclerosis. The standardized incidence ratio (SIR) of Crohn’s disease in systemic sclerosis patients, and 95 % confidence interval (95 % CI) were calculated. Cox hazard regression was used to calculate the hazard ratio (HR). Results The study enrolled 2,829 patients with systemic sclerosis and 8,257 controls. Male and female patients with systemic sclerosis both had lower rates of incident Crohn’s disease (SIR: 0.18, 95 % CI = 0.05–0.62; SIR: 0.10, 95 % CI = 0.05–0.21, respectively). The risk of incident Crohn’s disease in systemic sclerosis was still lower than in controls when we stratified the patients according to their ages. In Cox hazard regression, the hazard rates of Crohn’s disease were lower in systemic sclerosis patients after adjusting for genders and ages (HR: 0.12, 95 % CI = 0.06–0.21, p < 0.001). Conclusions Systemic sclerosis is associated with decreased incidence of, irrespective of sex and age of the patients.
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Affiliation(s)
- Chia-Chun Tseng
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Jeng-Hsien Yen
- Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan. .,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Wen-Chan Tsai
- Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Tsan-Teng Ou
- Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Cheng-Chin Wu
- Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Wan-Yu Sung
- Division of Rheumatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Ming-Chia Hsieh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan. .,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
| | - Shun-Jen Chang
- Department of Kinesiology, Health and Leisure Studies, National University of Kaohsiung, Kaohsiung, Taiwan.
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Interstitial lung disease: NHLBI Workshop on the Primary Prevention of Chronic Lung Diseases. Ann Am Thorac Soc 2015; 11 Suppl 3:S169-77. [PMID: 24754826 DOI: 10.1513/annalsats.201312-429ld] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Population-based, longitudinal studies spanning decades linking risk factors in childhood, adolescence and early adulthood to incident clinical interstitial lung disease (ILD) events in late adulthood have not been performed. In addition, no observational or randomized clinical trials have been conducted; therefore, there is presently no evidence to support the notion that reduction of risk factor levels in early life prevents ILD events in adult life. Primary prevention strategies are host-directed interventions designed to modify adverse risk factors (i.e., smoking) with the goal of preventing the development of ILD, whereas primordial prevention for ILD can be defined as the elimination of external risk factors (i.e., environmental pollutants). As no ILD primary prevention studies have been previously conducted, we propose that research studies that promote implementation of primary prevention strategies could, over time, make a subset of ILD preventable. Herein, we provide a number of initial steps required for the future implementation of prevention strategies; this statement discusses the rationale and available evidence that support potential opportunities for primordial and primary prevention, as well as fertile areas for future research of preventive intervention in ILD.
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Demir N, Şahin A, Küçükşahin O, Kayacan O, Dinçer İ, Sayın T, Karnak D, Turgay M. Pulmonary Arterial Hypertension and Systemic Sclerosis Relation: A Single Centre Experience. Heart Lung Circ 2014; 23:667-73. [DOI: 10.1016/j.hlc.2014.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/25/2014] [Accepted: 02/01/2014] [Indexed: 11/25/2022]
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Waszczykowska A, Goś R, Waszczykowska E, Dziankowska-Bartkowiak B, Jurowski P. Prevalence of ocular manifestations in systemic sclerosis patients. Arch Med Sci 2013; 9:1107-13. [PMID: 24482658 PMCID: PMC3902710 DOI: 10.5114/aoms.2013.39217] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 02/22/2012] [Accepted: 03/31/2012] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Systemic sclerosis (scleroderma, SSc) is a severe chronic connective tissue disease caused by immune system disorders and changes in the structure and functions of blood vessels, which consequently leads to enhanced tissue fibrosis. The aim of the study was to evaluate changes in the organ of vision in systemic sclerosis patients. MATERIAL AND METHODS Overall the study involved 27 patients with systemic sclerosis. The control group comprised 27 age- and gender-matched healthy individuals. All the study subjects underwent complete ophthalmological examination that in systemic sclerosis patients additionally involved fluorescein angiography. RESULTS OPHTHALMOLOGICAL EXAMINATION REVEALED HIGHER INCIDENCE OF THE FOLLOWING ABNORMALITIES IN THE STUDY GROUP, COMPARED TO THE CONTROL: symptoms of dry eye syndrome (19 eyes, p < 0.02), astigmatism(in 30 eyes, p < 0.01), posterior subcapsular cataract (10 eyes, p < 0.05), increased intraocular pressure (> 21 mm Hg were observed in 11 eyes, p < 0.002) and vascular abnormalities within fundus in fluorescein angiography (20 eyes). CONCLUSIONS In patients with systemic sclerosis numerous abnormalities within the vision of organ may be found. Regular ophthalmological examinations are essential among the mentioned group. The examination should be particularly focused on the presence of retinal vascular abnormalities.
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Affiliation(s)
- Arleta Waszczykowska
- Institute of Eye Disease Diagnostics, 2 Department of Eye Diseases, Medical University of Lodz, Poland
| | - Roman Goś
- Institute of Ophthalmology and Vision Rehabilitation, 2 Department of Eye Diseases, Medical University of Lodz, Poland
| | | | | | - Piotr Jurowski
- Institute of Eye Disease Diagnostics, 2 Department of Eye Diseases, Medical University of Lodz, Poland
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Vij R, Strek ME. Diagnosis and treatment of connective tissue disease-associated interstitial lung disease. Chest 2013; 143:814-824. [PMID: 23460159 DOI: 10.1378/chest.12-0741] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Interstitial lung disease (ILD) is one of the most serious pulmonary complications associated with connective tissue diseases (CTDs), resulting in significant morbidity and mortality. Although the various CTDs associated with ILD often are considered together because of their shared autoimmune nature, there are substantial differences in the clinical presentations and management of ILD in each specific CTD. This heterogeneity and the cross-disciplinary nature of care have complicated the conduct of prospective multicenter treatment trials and hindered our understanding of the development of ILD in patients with CTD. In this update, we present new information regarding the diagnosis and treatment of patients with ILD secondary to systemic sclerosis, rheumatoid arthritis, dermatomyositis and polymyositis, and Sjögren syndrome. We review information on risk factors for the development of ILD in the setting of CTD. Diagnostic criteria for CTD are presented as well as elements of the clinical evaluation that increase suspicion for CTD-ILD. We review the use of medications in the treatment of CTD-ILD. Although a large, randomized study has examined the impact of immunosuppressive therapy for ILD secondary to systemic sclerosis, additional studies are needed to determine optimal treatment strategies for each distinct form of CTD-ILD. Finally, we review new information regarding the subgroup of patients with ILD who meet some, but not all, diagnostic criteria for a CTD. A careful and systematic approach to diagnosis in patients with ILD may reveal an unrecognized CTD or evidence of autoimmunity in those previously believed to have idiopathic ILD.
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Affiliation(s)
- Rekha Vij
- Section of Pulmonary and Critical Care, Department of Medicine, The University of Chicago, Chicago, IL.
| | - Mary E Strek
- Section of Pulmonary and Critical Care, Department of Medicine, The University of Chicago, Chicago, IL
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Sampaio-Barros PD, Zimmermann AF, Souza Müller CD, Lobato Borges CT, Medeiros Freire EA, Maretti GB, Marques Neto JF, Fonseca Salgado MC, da Cunha Sauma MDFL, de Azevedo MNL, Fontenelle S, Kayser C. Recomendações sobre diagnóstico e tratamento da esclerose sistêmica. REVISTA BRASILEIRA DE REUMATOLOGIA 2013. [DOI: 10.1590/s0482-50042013000300004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kesarwani P, Murali AK, Al-Khami AA, Mehrotra S. Redox regulation of T-cell function: from molecular mechanisms to significance in human health and disease. Antioxid Redox Signal 2013; 18:1497-534. [PMID: 22938635 PMCID: PMC3603502 DOI: 10.1089/ars.2011.4073] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Reactive oxygen species (ROS) are thought to have effects on T-cell function and proliferation. Low concentrations of ROS in T cells are a prerequisite for cell survival, and increased ROS accumulation can lead to apoptosis/necrosis. The cellular redox state of a T cell can also affect T-cell receptor signaling, skewing the immune response. Various T-cell subsets have different redox statuses, and this differential ROS susceptibility could modulate the outcome of an immune response in various disease states. Recent advances in T-cell redox signaling reveal that ROS modulate signaling cascades such as the mitogen-activated protein kinase, phosphoinositide 3-kinase (PI3K)/AKT, and JAK/STAT pathways. Also, tumor microenvironments, chronic T-cell stimulation leading to replicative senescence, gender, and age affect T-cell susceptibility to ROS, thereby contributing to diverse immune outcomes. Antioxidants such as glutathione, thioredoxin, superoxide dismutase, and catalase balance cellular oxidative stress. T-cell redox states are also regulated by expression of various vitamins and dietary compounds. Changes in T-cell redox regulation may affect the pathogenesis of various human diseases. Many strategies to control oxidative stress have been employed for various diseases, including the use of active antioxidants from dietary products and pharmacologic or genetic engineering of antioxidant genes in T cells. Here, we discuss the existence of a complex web of molecules/factors that exogenously or endogenously affect oxidants, and we relate these molecules to potential therapeutics.
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Affiliation(s)
- Pravin Kesarwani
- Department of Surgery, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA
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Cottrell TR, Wise RA, Wigley FM, Boin F. The degree of skin involvement identifies distinct lung disease outcomes and survival in systemic sclerosis. Ann Rheum Dis 2013; 73:1060-6. [PMID: 23606705 DOI: 10.1136/annrheumdis-2012-202849] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine whether the pattern of skin involvement can predict clinical features, risk of restrictive lung disease (RLD) and survival in a large scleroderma (SSc) cohort. METHODS Demographic and clinical data collected over 30 years from 2205 patients with SSc were retrospectively analysed after subdividing subjects into four subtypes based on pattern of skin fibrosis: type 0 (no skin involvement), type 1 (limited to metacarpophalangeal joints), type 2 (distal to elbows/knees) and type 3 (proximal to elbows/knees). Clinical features associated with skin subsets were identified by regression analyses. Kaplan-Meier and Cox proportional hazards models were used to compare time to RLD and survival across subtypes. RESULTS The presence and severity of RLD were positively associated with skin subtype (p<0.001). RLD prevalence incrementally ranged from 51.9% in type 0 to 76.7% in type 3 (p<0.001). Type 2 SSc exhibited a distinct phenotype with intermediate risk for RLD relative to type 1 (higher, p<0.001) and type 3 (lower, p<0.001) and a unique autoantibody profile, with a prevalence of anticentromere antibodies lower than type 1 (28.9% vs 44.1%, p=0.001) and of anti-topoisomerase I antibodies similar to type 3 (32.8% vs 28.7%, p=0.38). These autoantibodies were also found to be significant negative (OR=0.33, p<0.001) and positive (OR=1.6, p=0.01) predictors of RLD risk, respectively. Mortality was also intermediate in type 2 patients relative to type 3 (p=0.0003) and type 1 (p=0.066). CONCLUSIONS These data suggest that the current classification subdividing SSc into limited and diffuse cutaneous subtypes misclassifies an intermediate group of patients exhibiting unique autoantibody profile, disease course and clinical outcomes.
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Affiliation(s)
- Tricia R Cottrell
- Johns Hopkins University School of Medicine, , Baltimore, Maryland, USA
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Ando K, Motojima S, Doi T, Nagaoka T, Kaneko N, Aoshima M, Takahashi K. Effect of glucocorticoid monotherapy on pulmonary function and survival in Japanese patients with scleroderma-related interstitial lung disease. Respir Investig 2013; 51:69-75. [PMID: 23790734 DOI: 10.1016/j.resinv.2012.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 10/24/2012] [Accepted: 12/05/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Scleroderma-related interstitial lung disease (SSc-ILD) is a chronic, progressive condition that is characterized by a restrictive ventilator defect. Cyclophosphamide (CYC), with or without glucocorticoid, effectively alters the course of SSc-ILD. However, the effect of glucocorticoid monotherapy remains unclear. METHODS Seventy-one patients with SSc-ILD were classified into 2 groups: 21 in the treatment group (glucocorticoid monotherapy [n=14] or immunosuppressive agents [n=7]) and 50 in the non-treatment group. Their backgrounds and prognoses were analyzed retrospectively. We also classified these patients into survival (n=55) and non-survival (n=16) groups to assess prognostic factors. RESULTS The median follow-up period was 9.8 years. The treatment group had a greater proportion of patients with diffuse systemic sclerosis or respiratory symptoms than the non-treatment group. The treatment group's annual change in forced vital capacity (FVC) compared to baseline, which was 170.4mL (157.8mL for the glucocorticoid monotherapy subgroup and 191.3mL for the immunosuppressive agent subgroup), was better than that of the non-treatment group, -60.8mL (p<0.01). Still, in terms of 5- and 10-year survival, there was no statistically significant difference between these groups. No incidence of SSc renal crisis was reported in the treatment group. The non-survival group included more patients with pulmonary hypertension than the survival group, but multivariate analysis showed no other statistically significantly difference between these groups. CONCLUSIONS Similar to CYC, glucocorticoid alone improved pulmonary function of Japanese SSc-ILD patients, suggesting that this monotherapy is a good alternative when CYC is contraindicated.
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Affiliation(s)
- Katsutoshi Ando
- Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan.
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Theodore AC, Tseng CH, Li N, Elashoff RM, Tashkin DP. Correlation of cough with disease activity and treatment with cyclophosphamide in scleroderma interstitial lung disease: findings from the Scleroderma Lung Study. Chest 2013; 142:614-621. [PMID: 22156609 DOI: 10.1378/chest.11-0801] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Cough is a significant symptom in patients with scleroderma interstitial lung disease (SSc-ILD), affecting 73% of the 158 patients enrolled in the Scleroderma Lung Study (SLS), a multicenter randomized trial of oral cyclophosphamide (CYC) vs placebo (PLA) in patients with active interstitial lung disease. METHODS We examined the correlation of cough frequency and severity and phlegm production at baseline in 156 SLS participants with other baseline variables representing SSc-ILD disease activity and the cough response to 1 year of treatment with CYC vs PLA. RESULTS Patients with cough at baseline had significantly lower diffusing capacity of the lung for carbon monoxide, dyspnea, the quality-of-life physical component summary, and the maximal fibrosis score on high-resolution CT imaging compared with those without cough at baseline. Cough severity and frequency correlated with FVC % predicted. After 12 months of treatment, cough frequency decreased in the CYC group compared with the PLA group and was significantly different from the PLA group at 18 months (6 months after discontinuation of CYC). However, the decreases in cough frequency did not correlate with the changes in FVC or diffusing capacity of the lung for carbon monoxide observed in the CYC group. Treatment-related improvements in cough frequency, as well as in FVC, were no longer apparent 12 months after discontinuation of CYC. CONCLUSIONS Cough is a common symptom in SSc-ILD and correlates with the extent of fibrosis. Cough frequency decreases significantly in response to treatment with CYC but returns to baseline 1 year after withdrawal of treatment. Cough may be a symptom of ongoing fibrosis and an independent variable in assessing therapeutic response to CYC. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT000004563; URL: www.clinicaltrials.gov
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Affiliation(s)
- Arthur C Theodore
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Boston University School of Medicine, Boston, MA.
| | - Chi-Hong Tseng
- Department of Biomathematics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Ning Li
- Biostatistics Core, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Robert M Elashoff
- Department of Biomathematics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Donald P Tashkin
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
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Circulating biomarkers of interstitial lung disease in systemic sclerosis. Int J Rheumatol 2012; 2012:121439. [PMID: 22988462 PMCID: PMC3439977 DOI: 10.1155/2012/121439] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 07/23/2012] [Accepted: 07/28/2012] [Indexed: 12/16/2022] Open
Abstract
Interstitial lung disease (ILD) is a major cause of morbidity and mortality in patients with systemic sclerosis (SSc). Although a large proportion of SSc patients have only limited interstitial involvement with an indolent course, in a significant minority ILD is progressive, requiring prompt treatment and careful monitoring. One of the main challenges for the clinician treating this highly variable disease is the early identification of patients at risk of progressive ILD, while avoiding potentially toxic treatments in those whose disease is inherently stable. Easily available and repeatable biomarkers that allow estimation of the risk of ILD progression and early response to treatment are highly desirable. In this paper, we review the evidence for circulating biomarkers with potential roles in diagnosis, monitoring of disease activity, or determining prognosis. Peripheral blood biomarkers offer the advantages of being readily obtained, non-invasive, and serially monitored. Several possible candidates have emerged from studies performed so far, including SP-D, KL-6, and CCL18. Presently however, there are few prospective studies evaluating the predictive ability of prospective biomarkers after adjustment for disease severity. Future carefully designed, prospective studies of well characterised patients with ILD, with optimal definition of disease severity and outcome measures are needed.
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Sticherling M. Systemic sclerosis-dermatological aspects. Part 1: Pathogenesis, epidemiology, clinical findings. J Dtsch Dermatol Ges 2012; 10:705-18; quiz 716. [PMID: 22913330 DOI: 10.1111/j.1610-0387.2012.07999.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Systemic sclerosis is a chronic inflammatory multiorgan disease belonging to the group of collagen-vascular disorders. With a prevalence of 10/100,000 inhabitants it may be regarded a rather rare disease. Its etiology and pathogenesis have still not been elucidated in detail, especially with regard to the differential involvement of skin and the cause of the clinically heterogeneous disease courses. Various components of the vasculature, connective tissue as well as the immune system are involved in a yet unknown sequence and significance. Patients need to be cared for in an interdisciplinary fashion depending on the individual organ involvement. Apart from the skin, the heart, kidneys and lungs are mainly affected in addition to frequent gastrointestinal and musculoskeletal symptoms. Clinically two distinct subsets may be separated, acral (also termed limited) and diffuse scleroderma, which are characterized by anti-centromere and anti-Scl-70/topoisomerase-1 antibodies, respectively. Recent data demonstrate a poor prognosis even in limited disease when pulmonary arterial hypertension develops at an early stage. In diffuse disease sudden and rapid onset will result in a sclerosis of major internal organs and early death in many cases.
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Affiliation(s)
- Michael Sticherling
- Department of Dermatology, University of Erlangen, Ulmenweg 18, Erlangen, Germany.
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High-Resolution Computed Tomographic Findings in Systemic Sclerosis–Associated Interstitial Lung Disease. J Clin Rheumatol 2012; 18:229-33. [DOI: 10.1097/rhu.0b013e318261176f] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pérez Campos D, Estévez Del Toro M, Peña Casanovas A, González Rojas PP, Morales Sánchez L, Gutiérrez Rojas AR. Are high doses of prednisone necessary for treatment of interstitial lung disease in systemic sclerosis? ACTA ACUST UNITED AC 2012; 8:58-62. [PMID: 22317852 DOI: 10.1016/j.reuma.2011.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 11/05/2011] [Accepted: 11/12/2011] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Interstitial lung disease (ILD) as part of systemic sclerosis (SS) is a leading cause of morbidity and mortality. OBJECTIVES To evaluate the use of intravenous pulse cyclophosphamide combined with low and high doses of prednisone in the treatment of ILD in SS is equally effective. METHOD An experimental, exploratory and randomized single-blind clinical trial was conducted at Hermanos Ameijeiras Clinical Surgical Hospital from September 2006 to December 2009, including 23 patients with SS and ILD. Two treatment schedules were evaluated and randomly assigned. Group A was composed of 13 patients with a monthly dose of cyclophosphamide (ev) for 6 months and a twice-monthly dose for the remaining 6 months, prednisone (1 mg × kg × day) 4 weeks and then the dose was lowered to 5mg every 2 weeks up to 10mg. Group B: 10 patients with cyclophosphamide (ev), oral prednisone 10mg daily. RESULTS There are significant differences at onset of CVF and the honeycomb pattern between both groups, where the high dose group was at a disadvantage. At the end of treatment the low dose group achieved improvement of radiologic lesions and the Warrick index, unlike the high dose group. The remaining variables experienced improvement in both groups without marked inequality. Similarly, slight adverse reactions were present in both groups. Two patients dropped out of the study. CONCLUSIONS A combination of low dose steroids with cyclophosphamide is effective in interstitial lung disease treatment especially in active disease, and results did not showe differences regarding the high dose group but the sample size and the evolutionary severity of high dose patients oblige other studies to verify this data.
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Ibn Yacoub Y, Amine B, Bensabbah R, Hajjaj-Hassouni N. Assessment of fatigue and its relationships with disease-related parameters in patients with Systemic sclerosis. Clin Rheumatol 2011; 31:655-60. [PMID: 22187224 DOI: 10.1007/s10067-011-1906-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 11/27/2011] [Accepted: 12/05/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Yousra Ibn Yacoub
- Department of Rheumatology (Pr N Hajjaj-Hassouni), El Ayachi Hospital, University Hospital of Rabat-Sale, 11000, Sale, Morocco.
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Roth MD, Tseng CH, Clements PJ, Furst DE, Tashkin DP, Goldin JG, Khanna D, Kleerup EC, Li N, Elashoff D, Elashoff RM. Predicting treatment outcomes and responder subsets in scleroderma-related interstitial lung disease. ACTA ACUST UNITED AC 2011; 63:2797-808. [PMID: 21547897 DOI: 10.1002/art.30438] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To identify baseline characteristics of patients with scleroderma-related interstitial lung disease (SSc-ILD) that could serve as predictors of the most favorable response to 12-month treatment with oral cyclophosphamide (CYC). METHODS Regression analyses were retrospectively applied to the Scleroderma Lung Study data in order to identify baseline characteristics that correlated with the absolute change in forced vital capacity (FVC) (% predicted values) and the placebo-adjusted change in % predicted FVC over time (the CYC treatment effect). RESULTS Completion of the CYC arm of the Scleroderma Lung Study was associated with a placebo-adjusted improvement in the % predicted FVC of 2.11% at 12 months, which increased to 4.16% when patients were followed up for another 6 months (P=0.014). Multivariate regression analyses identified the maximal severity of reticular infiltrates (assessed as maximum fibrosis scores) on high-resolution computed tomography (HRCT) at baseline, the modified Rodnan skin thickness score (MRSS) at baseline, and the Mahler baseline dyspnea index as independent correlates of treatment response. When patients were stratified on the basis of whether 50% or more of any lung zone was involved by reticular infiltrates on HRCT and/or whether patients exhibited an MRSS of at least 23, a subgroup of patients emerged in whom there was an average CYC treatment effect of 9.81% at 18 months (P<0.001). Conversely, there was no treatment effect (a -0.58% difference) in patients with less severe HRCT findings and a lower MRSS at baseline. CONCLUSION A retrospective analysis of the Scleroderma Lung Study data identified the severity of reticular infiltrates on baseline HRCT and the baseline MRSS as patient features that might be predictive of responsiveness to CYC therapy.
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Affiliation(s)
- Michael D Roth
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90095-1690, USA.
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Hant FN, Herpel LB, Silver RM. Pulmonary manifestations of scleroderma and mixed connective tissue disease. Clin Chest Med 2011; 31:433-49. [PMID: 20692538 DOI: 10.1016/j.ccm.2010.05.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Pulmonary manifestations are common in connective tissue diseases, and are associated with significant morbidity and mortality in this patient population. Systemic sclerosis (SSc) and mixed connective tissue disease (MCTD) are clinical entities for which the detection of lung involvement is essential to improve patient care and outcomes. This article discusses the pathogenesis, clinical presentation, and evaluation of the patient with pulmonary disease related to SSc and MCTD, with an emphasis on interstitial lung disease and pulmonary hypertension.
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Affiliation(s)
- Faye N Hant
- Medical University of South Carolina, Charleston, SC 29425-6370, USA.
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Abstract
Interstitial lung disease and pulmonary hypertension (PH) are the most common cardiopulmonary findings in patients with systemic sclerosis (SSc). About two thirds of patients suffering from SSc develop scleroderma interstitial lung disease. PH is present in about 20% of SSc patients and is typically associated with severe lung disease, although it may be an isolated manifestation of SSc. High-resolution CT scanning is a key method for evaluating chest involvement. There are four roles of imaging in scleroderma interstitial lung disease: 1) detection of lung involvement, 2) identification of patients likely to respond to treatment, 3) assessment of treatment efficacy, and 4) exclusion of other significant diseases to include PH and cardiac and esophageal abnormalities.
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Affiliation(s)
- Diane Strollo
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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Khanna D, Seibold JR, Wells A, Distler O, Allanore Y, Denton C, Furst DE. Systemic Sclerosis-Associated Interstitial Lung Disease: Lessons from Clinical Trials, Outcome Measures, and Future Study Design. Curr Rheumatol Rev 2010; 6:138-144. [PMID: 20676227 PMCID: PMC2911794 DOI: 10.2174/157339710791330768] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pulmonary involvement including interstitial lung disease (ILD) is the leading cause of mortality in patients with systemic sclerosis (scleroderma; SSc). This article reviews the current evidence based medicine regarding available therapies for SSc-ILD ; discusses the lessons learned from recent SSc-ILD randomized controlled trials (RCTs); and proposes outcome measures and recommendations for design of future RCTs for SSc-ILD.
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Affiliation(s)
- Dinesh Khanna
- Division of Rheumatology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Athol Wells
- Royal Brompton Hospital and National Heart and Lung Institute, London, UK
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Switzerland
| | - Yannick Allanore
- Paris Descartes University, Rheumatology A Department, Cochin Hospital, APHP, 75014 Paris, France
| | - Chris Denton
- Centre for Rheumatology, Royal Free Hospital, London, UK
| | - Daniel E. Furst
- Division of Rheumatology, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Zhao L, Xiao K, Wang H, Wang Z, Sun L, Zhang F, Zhang X, Tang F, He W. Thalidomide has a therapeutic effect on interstitial lung fibrosis: evidence from in vitro and in vivo studies. Clin Exp Immunol 2009; 157:310-5. [PMID: 19604271 DOI: 10.1111/j.1365-2249.2009.03962.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The objective of this study was to investigate the effects of thalidomide (THD) on interstitial lung fibrosis (ILF). In vitro, human fetal lung fibroblast (HFL-F) to myofibroblast (MF) trans-differentiation was induced by transforming growth factor (TGF)-beta1. The effects of THD on trans-differentiation process or differentiated MF were evaluated by measuring hydroxyproline (HYP) content by alkaline hydrolysis colorimetry, alpha-smooth muscle actin (alpha-SMA) protein by Western blot and alpha-SMA and pro-collagen III mRNA expressions by semi-quantitative reverse transcription-polymerase chain reaction; in vivo, a mouse model of ILF was generated by daily subcutaneous injection of bleomycin (BLM) in female C3H mice. Gastric perfusion of THD began 1 week prior to injection and lasted for 8 weeks. Lung specimens were harvested at different time-points (1, 4, 6 and 8 weeks) for pathology and immunohistochemistry examination. The HYP content, alpha-SMA and pro-collagen III mRNA expressions were also assessed. THD inhibited the up-regulation of HYP protein, pro-collagen III mRNA and alpha-SMA protein induced by TGF-beta1 in HFL-F cells, and additionally inhibited pro-collagen III mRNA expression on trans-differentiated MF. THD reduced HYP synthesis in the lung tissues of BLM-treated mice at week 4, and slightly reduced the numbers of alpha-SMA-positive cells. THD had an effect on ILF models both in vitro and in vivo.
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Affiliation(s)
- L Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Early aggressive intra-venous pulse cyclophosphamide therapy for interstitial lung disease in a patient with systemic sclerosis. A case report. Clin Rheumatol 2009; 28 Suppl 1:S31-4. [DOI: 10.1007/s10067-009-1098-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 01/14/2009] [Indexed: 10/21/2022]
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Hanitsch LG, Burmester GR, Witt C, Hunzelmann N, Genth E, Krieg T, Lehmacher W, Melchers I, Meurer M, Müller-Ladner U, Schulze-Lohoff E, Becker M, Sunderkoetter C, Riemekasten G. Skin sclerosis is only of limited value to identify SSc patients with severe manifestations--an analysis of a distinct patient subgroup of the German Systemic Sclerosis Network (DNSS) Register. Rheumatology (Oxford) 2009; 48:70-3. [PMID: 19056798 DOI: 10.1093/rheumatology/ken408] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES In SSc, diagnosis and classification is based mainly on skin sclerosis. Herein, we investigated in a large multicentre cohort, to what extent skin sclerosis reflects organ involvement and additional clinical symptoms. METHODS A total of 1200 SSc patients from the register of the German Systemic Sclerosis Network (DNSS), classified as either lcSSc or dcSSc, were analysed for their serological characteristics, clinical symptoms and organ manifestations in relation to skin involvement measured by the modified Rodnan skin score (mRSS). RESULTS SSc patients with different mRSS did not differ significantly in their disease duration and in most of the clinical symptoms. They showed a similar distribution of most organ manifestations such as pulmonary arterial hypertension as well as cardiac, renal and nervous system involvement. More severe skin thickening was found to be associated with pulmonary fibrosis and gastrointestinal symptoms, as well as with digital ulcers and musculoskeletal involvement. CONCLUSIONS In patients with SSc, potentially life-threatening complications and clinical symptoms with high impact on the quality of life occur independently from the extent of skin sclerosis. The diagnosis in SSc patients with a low mRSS could be missed or they could be insufficiently treated.
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Affiliation(s)
- L G Hanitsch
- Clinic of Rheumatology and Clinical Immunology, Charité Universitätsmedizin, Charité, Berlin, Germany
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Current world literature. Curr Opin Rheumatol 2008; 20:729-35. [PMID: 18946335 DOI: 10.1097/bor.0b013e328317a234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Overbeek MJ, Groepenhoff H, Voskuyl AE, Smit EF, Peeters JWL, Vonk-Noordegraaf A, Spreeuwenberg MD, Dijkmans BC, Boonstra A. Membrane diffusion- and capillary blood volume measurements are not useful as screening tools for pulmonary arterial hypertension in systemic sclerosis: a case control study. Respir Res 2008; 9:68. [PMID: 18828919 PMCID: PMC2576177 DOI: 10.1186/1465-9921-9-68] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Accepted: 10/01/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is no optimal screening tool for the assessment of pulmonary arterial hypertension (PAH) in patients with systemic sclerosis (SSc). A decreasing transfer factor of the lung for CO (TLCO) is associated with the development of PAH in SSc. TLCO can be partitioned into the diffusion of the alveolar capillary membrane (Dm) and the capillary blood volume (Vc). The use of the partitioned diffusion to detect PAH in SSc is not well established yet. This study evaluates whether Dm and Vc could be candidates for further study of the use for screening for PAH in SSc. METHODS Eleven SSc patients with PAH (SScPAH+), 13 SSc patients without PAH (SScPAH-) and 10 healthy control subjects were included. Pulmonary function testing took place at diagnosis of PAH. TLCO was partitioned according to Roughton and Forster. As pulmonary fibrosis in SSc influences values of the (partitioned) TLCO, these were adjusted for fibrosis score as assessed on HRCT. RESULTS TLCO as percentage of predicted (%) was lower in SScPAH+ than in SScPAH- (41 +/- 7% vs. 63 +/- 12%, p < 0.0001, respectively). Dm% in SScPAH+ was decreased as compared with SScPAH- (22 +/- 6% vs. 39 +/- 12%, p < 0.0001, respectively), also after adjustment for total fibrosis score (before adjustment: B = 17.5, 95% CI 9.0-25.9, p = < 0.0001; after adjustment: B = 14.3, 95% CI 6.0-21.7, p = 0.008). No difference was found in Vc%. There were no correlations between pulmonary hemodynamic parameters and Dm% in the PAH groups. CONCLUSION SScPAH+ patients have lower Dm% than SScPAH- patients. There are no correlations between Dm% and hemodynamic parameters of PAH in SScPAH+. These findings do not support further study of the role of partitioning TLCO in the diagnostic work- up for PAH in SSc.
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Affiliation(s)
- Maria J Overbeek
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands.
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Wells AU, Hogaboam CM. Update in Diffuse Parenchymal Lung Disease 2007. Am J Respir Crit Care Med 2008; 177:580-4. [DOI: 10.1164/rccm.200801-056up] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Nunes H. Pneumopathies interstitielles diffuses. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)92793-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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