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Piette Y, Van den Bossche F, Aerts J, Aerts N, Ajeganova S, Badot V, Berghen N, Blockmans D, Brusselle G, Caeyers N, De Decker M, De Haes P, De Cock C, De Keyser F, De Langhe E, Delcroix M, De Nutte H, De Pauw M, Depicker A, De Sutter A, De Sutter J, Du Four T, Frank C, Goubau J, Guiot J, Gutermuth J, Heeman L, Houssiau F, Hennes I, Lenaerts J, Lintermans A, Loeys B, Luyten H, Maeyaert B, Malfait F, Moeyersoons A, Mostmans Y, Nijs J, Poppe B, Polfliet K, Ruttens D, Sabato V, Schoeters E, Slabbynck H, Stuer A, Tamirou F, Thevissen K, Van Kersschaever G, Vanneuville B, Van Offel J, Vanthuyne M, Van Wabeke J, Verbist C, Vos I, Westhovens R, Wuyts W, Yserbyt J, Smith V. Flemish network on rare connective tissue diseases (CTD): patient pathways in systemic sclerosis. First steps taken. Acta Clin Belg 2024; 79:26-33. [PMID: 38108332 DOI: 10.1080/17843286.2023.2280737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/03/2023] [Indexed: 12/19/2023]
Abstract
Despite the low prevalence of each rare disease, the total burden is high. Patients with rare diseases encounter numerous barriers, including delayed diagnosis and limited access to high-quality treatments. In order to tackle these challenges, the European Commission launched the European Reference Networks (ERNs), cross-border networks of healthcare providers and patients representatives. In parallel, the aims and structure of these ERNs were translated at the federal and regional levels, resulting in the creation of the Flemish Network of Rare Diseases. In line with the mission of the ERNs and to ensure equal access to care, we describe as first patient pathways for systemic sclerosis (SSc), as a pilot model for other rare connective and musculoskeletal diseases. Consensus was reached on following key messages: 1. Patients with SSc should have multidisciplinary clinical and investigational evaluations in a tertiary reference expert centre at baseline, and subsequently every three to 5 years. Intermediately, a yearly clinical evaluation should be provided in the reference centre, whilst SSc technical evaluations are permissionably executed in a centre that follows SSc-specific clinical practice guidelines. In between, monitoring can take place in secondary care units, under the condition that qualitative examinations and care including interactive multidisciplinary consultations can be provided. 2. Patients with early diffuse cutaneous SSc, (progressive) interstitial lung disease and/or pulmonary arterial hypertension should undergo regular evaluations in specialised tertiary care reference institutions. 3. Monitoring of patients with progressive interstitial lung disease and/or pulmonary (arterial) hypertension will be done in agreement with experts of ERN LUNG.
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Affiliation(s)
- Y Piette
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine, Ghent University, Ghent, Belgium
- Department of Rheumatology, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | | | - J Aerts
- Flemish Association for Hereditary Connective Tissue Disorders (Bindweefsel.be), Koersel, Belgium
| | - N Aerts
- Department of Rheumatology, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - S Ajeganova
- Department of Clinical Sciences, Rheumatology Division, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - V Badot
- Department of Rheumatology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - N Berghen
- Department of Rheumatology, AZ Klina, Brasschaat, Belgium
| | - D Blockmans
- Department of general internal medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, Laboratory of clinical infectious and inflammatory disorders, KU Leuven, Leuven, Belgium
| | - G Brusselle
- Laboratory for Translational Research in Obstructive Pulmonary Diseases, Department of Respiratory Medicine, Ghent University Hospital, C. Heymanslaan, Ghent, Belgium
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Respiratory Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - N Caeyers
- Patiëntexpert ReumaNet, Zaventem, Belgium
| | - M De Decker
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - P De Haes
- Department of Dermatology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - C De Cock
- Department of Pneumology, Maria Middelares, Ghent, Belgium
| | | | - E De Langhe
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - M Delcroix
- Clinical Department of Respiratory Diseases, University Hospitals of Leuven and Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven - University of Leuven, Leuven, Belgium
| | | | - M De Pauw
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - A Depicker
- Department of Rheumatology, Maria Middelares, Ghent, Belgium
| | - A De Sutter
- Department of Family Practice and Primary Health Care, Ghent University, Ghent, Belgium
| | - J De Sutter
- Department of Cardiology, Hartcentrum, AZ Maria Middelares, Ghent, Belgium; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - T Du Four
- Department of Dermatology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - C Frank
- Department of Rheumatology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J Goubau
- Department of Orthopaedics and Traumatology, AZ Maria Middelares, Ghent, Belgium; Department of Orthopedics and Traumatology, UZ Brussel, Brussels, Belgium
| | - J Guiot
- Department of Respiratory Medicine, Universitary hospital of Liège, Liège, Belgium
| | - J Gutermuth
- Department of Dermatology, University Hospital Brussels, Brussels, Belgium
| | - L Heeman
- Huisartspraktijk De Zwaene, Bruges, Belgium
| | - F Houssiau
- Pôle de Pathologies Rhumatismales Inflammatoires et Systémiques, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain; Service de Rhumatologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - I Hennes
- CIB-Liga; Patiëntexpert ReumaNet, Zaventem, Belgium
| | - J Lenaerts
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium; Reumainstituut and Jessa Hospital, Hasselt, Belgium; Department of Rheumatology, AZ Vesalius, Tongeren, Belgium
| | | | - B Loeys
- Department of Clinical Genetics, Radboud University Medical Center, Nijmegen, The Netherlands; Center for Medical Genetics, Antwerp University Hospital & University of Antwerp, Antwerp, Belgium
| | - H Luyten
- Department of Rheumatology, AZ Sint-Lucas, Ghent, Belgium
| | - B Maeyaert
- Department of Rheumatology, AZ Sint-Lucas, Bruges, Belgium
| | - F Malfait
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium; Department for Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - A Moeyersoons
- Department of Rheumatology, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Y Mostmans
- Department of Immunology-Allergology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium; Department of Dermatology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J Nijs
- Department of Cardiac Surgery, UZ Brussels, Brussels, Belgium
| | - B Poppe
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium; Department for Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - K Polfliet
- Sclero'ken VZW; Patiëntexpert ReumaNet, Zaventem, Belgium
| | - D Ruttens
- Department of Respiratory Medicine, Ziekenhuis Oost Limburg, Genk, Belgium; Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium
| | - V Sabato
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium; Department of Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium; Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
| | | | - H Slabbynck
- Department of Pneumology, ZNA Middelheim, Antwerpen, Belgium
| | - A Stuer
- Department of Rheumatology, AZ Delta, Roeselare, Belgium
| | - F Tamirou
- Huisartspraktijk De Zwaene, Bruges, Belgium
| | - Kristof Thevissen
- Department of Rheumatology, ZOL Genk, Genk, Belgium; Reumacentrum Genk, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | | | - B Vanneuville
- Department of Rheumatology, Sint-Andries Hospital, Tielt, Belgium; Department of Rheumatology, AZ Groeninge, Kortrijk, Belgium
| | - J Van Offel
- Department of Rheumatology, University Hospital of Antwerp, Antwerp, Belgium
| | - M Vanthuyne
- Pôle de Pathologies Rhumatismales Inflammatoires et Systémiques, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain; Service de Rhumatologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - J Van Wabeke
- Department of Rheumatology, AZ Sint-Lucas, Ghent, Belgium
| | - C Verbist
- Department of Rheumatology, AZ Delta, Roeselare, Belgium
| | - I Vos
- Department of Rheumatology, GZA Hospitals, Antwerp, Belgium
| | - R Westhovens
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - W Wuyts
- Department of Pneumology, UZ Leuven, Leuven, Belgium
| | - J Yserbyt
- Department of Pneumology, UZ Leuven, Leuven, Belgium
| | - V Smith
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre (IRC), Ghent, Belgium
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Liakouli V, Ciancio A, Del Galdo F, Giacomelli R, Ciccia F. Systemic sclerosis interstitial lung disease: unmet needs and potential solutions. Nat Rev Rheumatol 2024; 20:21-32. [PMID: 37923862 DOI: 10.1038/s41584-023-01044-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 11/06/2023]
Abstract
Systemic sclerosis (SSc), or scleroderma, is a rare, complex, systemic autoimmune disease of unknown aetiology, characterized by high morbidity and mortality often resulting from cardiopulmonary complications such as interstitial lung disease and pulmonary arterial hypertension. Despite substantial progress in unravelling the pathways involved in the pathogenesis of SSc and the increasing number of therapeutic targets tested in clinical trials, there is still no cure for this disease, although several proposed treatments might limit the involvement of specific organs, thereby slowing the natural history of the disease. A specific focus of recent research has been to address the plethora of unmet needs regarding the global management of SSc-related interstitial lung disease, including its pathogenesis, early diagnosis, risk stratification of patients, appropriate treatment regimens and monitoring of treatment response, as well as the definition of progression and predictors of progression and mortality. More refined stratification of patients on the basis of clinical features, molecular signatures, identification of subpopulations with distinct clinical trajectories and implementation of outcome measures for future clinical trials could also improve therapeutic management strategies, helping to avoid poor outcomes related to lung involvement.
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Affiliation(s)
- Vasiliki Liakouli
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Antonio Ciancio
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
- Scleroderma Programme, NIHR Biomedical Research Centre, Leeds Teaching Hospital Trusts, Leeds, UK
| | - Roberto Giacomelli
- Rheumatology and Immunology Unit, Department of Medicine, University of Rome Campus Biomedico, Rome, Italy
| | - Francesco Ciccia
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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Pope JE, Denton CP, Johnson SR, Fernandez-Codina A, Hudson M, Nevskaya T. State-of-the-art evidence in the treatment of systemic sclerosis. Nat Rev Rheumatol 2023; 19:212-226. [PMID: 36849541 PMCID: PMC9970138 DOI: 10.1038/s41584-023-00909-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 03/01/2023]
Abstract
Systemic sclerosis (SSc) is a rare autoimmune connective tissue disease with multi-organ involvement, fibrosis and vasculopathy. Treatment in SSc, including early diffuse cutaneous SSc (dcSSc) and the use of organ-specific therapies, has improved, as evident from randomized clinical trials. Treatments for early dcSSc include immunosuppressive agents such as mycophenolate mofetil, methotrexate, cyclophosphamide, rituximab and tocilizumab. Patients with rapidly progressive early dcSSc might be eligible for autologous haematopoietic stem cell transplantation, which can improve survival. Morbidity from interstitial lung disease and pulmonary arterial hypertension is improving with the use of proven therapies. Mycophenolate mofetil has surpassed cyclophosphamide as the initial treatment for SSc-interstitial lung disease. Nintedanib and possibly perfinidone can be considered in SSc pulmonary fibrosis. Pulmonary arterial hypertension is frequently treated with initial combination therapy (for example, with phosphodiesterase 5 inhibitors and endothelin receptor antagonists) and, if necessary, the addition of a prostacyclin analogue. Raynaud phenomenon and digital ulcers are treated with dihydropyridine calcium channel blockers (especially nifedipine), then phosphodiesterase 5 inhibitors or intravenous iloprost. Bosentan can reduce the development of new digital ulcers. Trial data for other manifestations are mostly lacking. Research is needed to develop targeted and highly effective treatments, best practices for organ-specific screening and early intervention, and sensitive outcome measurements.
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Affiliation(s)
- Janet E Pope
- Division of Rheumatology, St Joseph's Health Care, London, ON, Canada.
- Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.
| | | | - Sindhu R Johnson
- Toronto Scleroderma Program, Toronto Western Hospital, Mount Sinai Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Andreu Fernandez-Codina
- Division of Rheumatology, St Joseph's Health Care, London, ON, Canada
- General Internal Medicine, Windsor Regional Hospital, Windsor, ON, Canada
- Critical Care, Emergency and Systemic Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
| | - Marie Hudson
- Department of Medicine, McGill University, Montreal, QC, Canada
- Division of Rheumatology and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Tatiana Nevskaya
- Division of Rheumatology, St Joseph's Health Care, London, ON, Canada
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