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Fernández-Codina A, Nevskaya T, Baron M, Thomas Appleton C, Cecchini MJ, Philip A, El-Shimy M, Vanderhoek L, Pinal-Fernández I, Pope JE. Brentuximab vedotin for skin involvement in refractory diffuse cutaneous systemic sclerosis, an open-label trial. Rheumatology (Oxford) 2024:keae235. [PMID: 38652570 DOI: 10.1093/rheumatology/keae235] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/05/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE We explored the efficacy and safety of brentuximab vedotin, a chimeric anti-CD30 antibody drug conjugate, in patients with severe active diffuse cutaneous systemic sclerosis (dcSSc). METHODS This phase II proof-of-concept, single center, open-label, single arm, investigator-initiated trial included patients ≥18 years, with dcSSc, modified Rodnan skin score (mRSS) ≥15 with <5 years since the first non-Raynaud's symptom and/or skin worsening despite immunosuppression who were treated with intravenous brentuximab vedotin 0.6 mg/Kg q3 weeks for 45 weeks. The primary end point was a decrease in mRSS of ≥ 8 points at 48 weeks. RESULTS Eleven patients were treated with brentuximab vedotin, with 9 completing the study. The mean mRSS reduction at week 48 was 11.3 (95% CI 6.9, 15.8; p= 0.001), meeting the primary end point in the intention to treat analysis (7/11 had a decrease in mRSS ≥8). The % forced vital capacity increased by 7.8% (12.5). The Composite Response Index in dcSSc (CRISS) suggested a beneficial treatment effect (86% ≥0.6). Most adverse events were mild. No SAEs were attributed to brentuximab vedotin. CONCLUSION In dcSSc, brentuximab vedotin improved skin and FVC; without safety concerns. A placebo-controlled trial is warranted to corroborate these initial findings.
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Affiliation(s)
- Andreu Fernández-Codina
- Division of Rheumatology, Western University, London, Ontario, Canada
- Division of General Internal Medicine-Windsor Campus, Western University, London, Ontario, Canada
- Division of Systemic Autoimmune Diseases and Critical Care, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Tatiana Nevskaya
- Division of Rheumatology, Western University, London, Ontario, Canada
| | - Murray Baron
- Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - C Thomas Appleton
- Division of Rheumatology, Western University, London, Ontario, Canada
| | | | - Amanda Philip
- Division of Rheumatology, Western University, London, Ontario, Canada
| | - Maha El-Shimy
- Division of Rheumatology, Western University, London, Ontario, Canada
| | - Louise Vanderhoek
- Division of Rheumatology, Western University, London, Ontario, Canada
| | - Iago Pinal-Fernández
- Muscle Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland, USA
| | - Janet E Pope
- Division of Rheumatology, Western University, London, Ontario, Canada
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Baron M. The Duty to Accommodate. J Rheumatol 2024:jrheum.2024-0257. [PMID: 38561186 DOI: 10.3899/jrheum.2024-0257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
As the study by Jazayeri et al in this issue of The Journal of Rheumatology points out, the prevalence of unemployment in people with systemic sclerosis (SSc) is estimated at 40.5%, and SSc is associated with "presenteeism (ie, working while unwell), lack of participation in employment, and ultimately, absenteeism."1 This is of course true of patients with the many other musculoskeletal diseases that we as rheumatologists treat.
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Affiliation(s)
- Murray Baron
- M. Baron, MD, Department of Medicine, Division of Rheumatology, McGill University, Montreal, Quebec, Canada
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Muntyanu A, Milan R, Rahme E, Baron M, Netchiporouk E. Organic solvent exposure and systemic sclerosis: A retrospective cohort study based on the Canadian Scleroderma Research Group registry. J Am Acad Dermatol 2024; 90:605-607. [PMID: 37182702 DOI: 10.1016/j.jaad.2023.04.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/13/2023] [Accepted: 04/30/2023] [Indexed: 05/16/2023]
Affiliation(s)
- Anastasiya Muntyanu
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Raymond Milan
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Elham Rahme
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Murray Baron
- Division of Rheumatology, Department of Medicine, Jewish General Hospital, Montreal, Quebec, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada.
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Campochiaro C, Suliman YA, Hughes M, Schoones JW, Giuggioli D, Moinzadeh P, Baron M, Chung L, Ross L, Maltez N, Allanore Y, Denton CP, Distler O, Frech T, Furst DE, Khanna D, Krieg T, Kuwana M, Matucci-Cerinic M, Pope J, Alunno A. Non-surgical local treatments of digital ulcers in systemic sclerosis: a systematic literature review. Semin Arthritis Rheum 2023; 63:152267. [PMID: 37778090 DOI: 10.1016/j.semarthrit.2023.152267] [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: 04/29/2023] [Revised: 08/03/2023] [Accepted: 08/27/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Digital ulcers (DUs) are difficult to treat in patients with systemic sclerosis (SSc) and systemic (i.e., pharmacological) therapy is currently considered the 'standard of care'. Our aim was to examine the safety and efficacy of local, non-surgical treatment for SSc-DUs. METHODS A systematic literature review (SLR) of original research articles up to August, 29 2022 was performed according to the PICO framework. References were independently screened by two reviewers and risk of bias was assed using validated tools. Due to study heterogeneity narrative summaries are used to present data. RESULTS Among 899 retrieved references, 14 articles were included (2 randomised trials (RTs), and 12 observational (OBS) studies). The most frequently studied procedure (5 studies) was botulin A toxin (hand or single finger) injection with a reported healing rate (HR) of 71%-100%. Amniotic and hydrocolloid membranes were examined in one study each and associated with a good HR. Tadalafil 2% cream was studied in a single study with a reduction in the number of DUs. Vitamin E gel was associated with a reduction in ulcer healing time. Low-level light therapy, hydrodissection and corticosteroid injection, extracorporeal shock wave (ESW) and photobiomodulation were evaluated in a single study each and showed a positive trend. Dimethyl sulfoxide was associated with significant local toxicity. CONCLUSIONS A range of non-surgical, local treatments for SSc-DUs have been explored and showed efficacy to some extent. We have identified methodological flaws that should be avoided in the design of future studies to explore locally-acting treatments for SSc-DUs.
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Affiliation(s)
- Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University.
| | | | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
| | - Jan W Schoones
- Directorate of Research Policy (formerly Walaeus Library), Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Murray Baron
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Lorinda Chung
- Stanford University School of Medicine and Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Laura Ross
- The University of Melbourne, Melbourne, VIC, Australia; St Vincent's Hospital, Melbourne, Australia
| | | | | | | | | | - Tracy Frech
- University of Utah, Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | | | | | - Thomas Krieg
- Department of Dermatology and Venereology, University Hospital of Cologne, Cologne, Germany
| | | | | | - Janet Pope
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Alessia Alunno
- Department of Life, Health & Environmental Sciences, University of L'Aquila and Internal Medicine and Nephrology Unit and Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
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Ross L, Maltez N, Hughes M, Schoones JW, Baron M, Chung L, Giuggioli D, Moinzadeh P, Suliman YA, Campochiaro C, Allanore Y, Denton CP, Distler O, Frech T, Furst DE, Khanna D, Krieg T, Kuwana M, Matucci-Cerinic M, Pope J, Alunno A. Systemic pharmacological treatment of digital ulcers in systemic sclerosis: a systematic literature review. Rheumatology (Oxford) 2023; 62:3785-3800. [PMID: 37335850 PMCID: PMC10691932 DOI: 10.1093/rheumatology/kead289] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/19/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE To evaluate the evidence concerning systemic pharmacological treatments for SSc digital ulcers (DUs) to inform the development of evidence-based treatment guidelines. METHODS A systematic literature review of seven databases was performed to identify all original research studies of adult patients with SSc DUs. Randomized controlled trials (RCTs) and prospective longitudinal observational studies (OBSs) were eligible for inclusion. Data were extracted, applying the patient, intervention, comparison, outcome framework, and risk of bias (RoB) was assessed. Due to study heterogeneity, narrative summaries were used to present data. RESULTS Forty-seven studies that evaluated the treatment efficacy or safety of pharmacological therapies were identified among 4250 references. Data from 18 RCTs of 1927 patients and 29 OBSs of 661 patients, at various RoB (total 2588 patients) showed that i.v. iloprost, phosphodiesterase-5 inhibitors and atorvastatin are effective for the treatment of active DUs. Bosentan reduced the rate of future DUs in two RCTs (moderate RoB) and eight OBSs at low to high RoB. Two small studies (moderate RoB) indicate that Janus kinase inhibitors may be effective for the treatment of active DUs, otherwise there are no data to support the use of immunosuppression or anti-platelet agents in the management of DUs. CONCLUSION There are several systemic treatments, across four medication classes, that are effective therapies for the management of SSc DUs. However, a lack of robust data means it is not possible to define the optimal treatment regimen for SSc DUs. The relatively low quality of evidence available has highlighted further areas of research need.
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Affiliation(s)
- Laura Ross
- Department of Medicine and Rheumatology, University of Melbourne at St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Nancy Maltez
- Department of Medicine, Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael Hughes
- Department of Rheumatology, Northern Care Alliance NHS Foundation Trust, Salford Care Organisation, Salford, UK
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
| | - Jan W Schoones
- Directorate of Research Policy (formerly Walaeus Library), Leiden University Medical Center, Leiden, The Netherlands
| | - Murray Baron
- Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Lorinda Chung
- Department of Rheumatology, Stanford University School of Medicine and Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Dilia Giuggioli
- Department of Rheumatology, Division of Rheumatology, University of Modena and Reggio Emilia, Policlinico of Modena, Modena, Italy
| | - Pia Moinzadeh
- Department of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany
| | - Yossra A Suliman
- Department of Rheumatology and Rehabilitation, Assiut University Hospital, Assiut, Egypt
| | - Corrado Campochiaro
- Department of Immunology, Rheumatology, Allergy and Rare Diseases, Raffaele Hospital, Vita-Salute San Raffaele Università, Milan, Italy
| | - Yannick Allanore
- Department of Rheumatology, Cochin Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Christopher P Denton
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, London, UK
- UCL Division of Medicine, University College London, London, UK
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tracy Frech
- Department of Medicine, Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Veterans Affairs Medical Center, Nashville, TN, USA
| | - Daniel E Furst
- Department of Rheumatology and Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dinesh Khanna
- Department of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Thomas Krieg
- Department of Rheumatology, Division of Rheumatology, University of Modena and Reggio Emilia, Policlinico of Modena, Modena, Italy
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School, Tokyo, Japan
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, Careggi University Hospital, University of Florence, Florence, Italy
| | - Janet Pope
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Alessia Alunno
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
- Internal Medicine and Nephrology Division, ASL1 Avezzano-Sulmona-L'Aquila, L'Aquila, Italy
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Suliman YA, Campochiaro C, Hughes M, Schoones JW, Giuggioli D, Moinzadeh P, Baron M, Chung L, Ross L, Maltez N, Allanore Y, Denton CP, Distler O, Frech T, Furst DE, Khanna D, Krieg T, Kuwana M, Matucci-Cerinic M, Pope J, Alunno A. Surgical management of digital ulcers in systemic sclerosis: A systematic literature review. Semin Arthritis Rheum 2023; 63:152266. [PMID: 37826898 DOI: 10.1016/j.semarthrit.2023.152266] [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: 04/29/2023] [Revised: 09/02/2023] [Accepted: 09/23/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND There is a strong rationale to develop locally-acting surgical treatments for digital ulcers (DUs) in patients with systemic sclerosis (SSc). Our aim was to examine the safety and efficacy of local surgical management for SSc-DU. METHODS A systematic literature review was carried out until to August 2022 using 7 different databases. Original research studies concerning adult patients with SSc-DUs, and local surgical treatments were analysed using the PICO framework. We included randomized controlled trials, prospective/retrospective studies, and case series (minimum of 3 patients) References were independently screened by two reviewers including assessment of the risk of bias using validated tools. RESULTS Out of 899, 13eligible articles were included. Autologous fat (adipose tissue AT) grafting was the surgical modality most identified (7 studies, 1 randomized controlled double blinded trial and 6 prospective open-label single arm studies). The healing rate (HR) with autologous fat grafting (4 studies) was 66-100 %. Three studies reported autologous adipose-derived stromal vascular fraction grafting: HR of 32-60 %. Bone marrow derived cell transplantation in a single study showed 100 % healing rate over 4-24 weeks. Surgical sympathectomy was examined in 3 studies, prospective without comparator with a median healing rate of 81 %. Two surgical studies (of direct microsurgical revascularisation and microsurgical arteriolysis) showed 100 % healing of ulcers, with no complications. CONCLUSION Several surgical approaches for SSc-DUs have demonstrated some degree of safety and effectiveness for DU healing. However, there are significant methodological issues. Future studies are warranted to rigorously investigate surgical interventions for SSc-DUs.
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Affiliation(s)
- Yossra A Suliman
- Rheumatology and Rehabilitation Dept, Assiut University Hospital, Assiut, Egypt.
| | - Corrado Campochiaro
- IRCCS San Raffaele Hospital, Vita-Salute San Raffaele Università, Milan, Italy
| | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Northern Care Alliance NHS Foundation Trust, Salford Care alliance, Manchester Academic Health Science Centre, Manchester, UK
| | - Jan W Schoones
- Directorate of Research Policy (formerly Walaeus Library), Leiden University Medical Center, Leiden, the Netherlands
| | | | - Pia Moinzadeh
- Department of Dermatology and Venereology, University Hospital of Cologne, Germany
| | - Murray Baron
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Lorinda Chung
- Stanford University School of Medicine and Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Laura Ross
- The University of Melbourne, Melbourne, VIC, Australia; St Vincent's Hospital, Melbourne, Australia
| | | | | | | | | | - Tracy Frech
- University of Utah, Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Daniel E Furst
- University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Thomas Krieg
- Department of Dermatology and Venereology, University Hospital of Cologne, Cologne, Germany
| | | | | | - Janet Pope
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Alessia Alunno
- Department of Life, Health & Environmental Sciences, University of L'Aquila and Internal Medicine and Nephrology Unit and Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
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Kwakkenbos L, Thombs BD, Khanna D, Carrier ME, Baron M, Furst DE, Gottesman K, van den Hoogen F, Malcarne VL, Mayes MD, Mouthon L, Nielson WR, Poiraudeau S, Riggs R, Sauvé M, Wigley F, Hudson M, Bartlett SJ. Performance of the Patient-Reported Outcomes Measurement Information System-29 in scleroderma: a Scleroderma Patient-centered Intervention Network Cohort Study. Rheumatology (Oxford) 2023; 62:3771. [PMID: 31168593 PMCID: PMC11009684 DOI: 10.1093/rheumatology/kez234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Linda Kwakkenbos
- Lady Davis Institute for Medical Research, Jewish General Hospital
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
- Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
- Department of Medicine, McGill UniversityMontréal, Québec, Canada
- Department of Epidemiology, Biostatistics, and Occupational HealthMcGill University, Montréal, Québec, Canada
- Department of Educational and Counselling PsychologyMcGill University, Montréal, Québec, Canada
- Department of PsychologyMcGill University, Montréal, Québec, Canada
- School of Nursing, McGill University, Montréal, Québec, Canada
| | - Dinesh Khanna
- University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Murray Baron
- Lady Davis Institute for Medical Research, Jewish General Hospital
- Department of Medicine, McGill UniversityMontréal, Québec, Canada
| | - Daniel E Furst
- Division of Rheumatology, Geffen School of Medicine, University of California, Los Angeles
| | | | - Frank van den Hoogen
- Department of Rheumatology, Radboud University Medical Center
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Vanessa L Malcarne
- Department of Psychology, San Diego State University
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University and the University of California, San Diego, CA
| | - Maureen D Mayes
- Department of Internal Medicine, Division of Rheumatology, McGovern Medical School, University of Texas, Houston, TX, USA
| | - Luc Mouthon
- Université Paris Descartes, Assistance Publique-Hôpitaux de Paris
- Service de Médecine Interne, Hôpital Cochin, Paris, France
| | - Warren R Nielson
- Beryl & Richard Ivey Rheumatology Day Programs, St Joseph's Health Care
- Lawson Health Research Institute, London, Ontario, Canada
| | - Serge Poiraudeau
- Université Paris Descartes, Assistance Publique-Hôpitaux de Paris
- Service de Médecine Physique et Réadaptation, Hôpital Cochin
- IFR Handicap, INSERM, Paris, France
| | | | - Maureen Sauvé
- Scleroderma Society of Ontario, Hamilton
- Scleroderma Society of Canada, Ottawa, ON, Canada
| | - Fredrick Wigley
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marie Hudson
- Lady Davis Institute for Medical Research, Jewish General Hospital
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University and the University of California, San Diego, CA
| | - Susan J Bartlett
- Department of Medicine, McGill UniversityMontréal, Québec, Canada
- Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- McGill University Health Center, Montréal, Québec, Canada
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Baron M, Sassolas B, Pinard L, Ealet A. Numerical modelling for retrieval of the coating thickness variations from wavefront errors measurements. Opt Express 2023; 31:32968-32986. [PMID: 37859087 DOI: 10.1364/oe.494683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/08/2023] [Indexed: 10/21/2023]
Abstract
Multilayers coating are needed for large optical components performances, but the thickness non-uniformities over the useful aperture can generate spatial and chromatic variations of the reflectance, the transmittance and the wavefront errors. Although these dependences can be measured, they are difficult to anticipate if the underlying thickness variations are unknown. We present a model to retrieve these variations from wavefront error measurements that enables the computation of any optical properties over the useful aperture at any wavelength, angle of incidence or polarization.
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Baron M, Barbacki A, Man A, de Vries-Bouwstra JK, Johnson D, Stevens W, Osman M, Wang M, Zhang Y, Sahhar J, Ngian GS, Proudman S, Nikpour M. Prediction of damage trajectories in systemic sclerosis using group-based trajectory modelling. Rheumatology (Oxford) 2023; 62:3059-3066. [PMID: 36625513 PMCID: PMC10473274 DOI: 10.1093/rheumatology/kead002] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/07/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES Damage accrual in SSc can be tracked using the Scleroderma Clinical Trials Consortium Damage Index (DI). Our goal was to develop a prediction model for damage accrual in SSc patients with early disease. METHODS Using patients with <2 years disease duration from Canada and Australia as a derivation cohort, and from the Netherlands as a validation cohort, we used group-based trajectory modelling (GBTM) to determine 'good' and 'bad' latent damage trajectories. We developed a prediction model from this analysis and applied it to patients from derivation and validation cohorts. We plotted the actual DI trajectories of the patients predicted to be in 'good' or 'bad' groups. RESULTS We found that the actual trajectories of damage accumulation for lcSSc and dcSSc were very different, so we studied each subset separately. GBTM found two distinct trajectories in lcSSc and three in dcSSc. We collapsed the two worse trajectories in the dcSSc into one group and developed a prediction model for inclusion in either 'good' or 'bad' trajectories. The performance of models using only baseline DI and sex was excellent with ROC AUC of 0.9313 for lcSSc and 0.9027 for dcSSc. Using this model, we determined whether patients would fall into 'good' or 'bad' trajectory groups and then plotted their actual trajectories which showed clear differences between the predicted 'good' and 'bad' cases in both derivation and validation cohorts. CONCLUSIONS A simple model using only cutaneous subset, baseline DI and sex can predict damage accumulation in early SSc.
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Affiliation(s)
- Murray Baron
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Ariane Barbacki
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Ada Man
- Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Dylan Johnson
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Wendy Stevens
- Division of Rheumatology, St. Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Mohammed Osman
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mianbo Wang
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Susanna Proudman
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Mandana Nikpour
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- University of Melbourne at St-Vincent Hospital, Melbourne, Fitzroy, Victoria, Australia
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Ruaro B, Baron M, Rosato E, Martini R, Confalonieri M. Special Issue "Rheumatic Diseases: Pathophysiology, Targeted Therapy, Focus on Vascular and Pulmonary Manifestations 2022". Pharmaceuticals (Basel) 2023; 16:ph16050652. [PMID: 37242435 DOI: 10.3390/ph16050652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
This Special Issue, titled "Rheumatic Diseases: Pathophysiology, Targeted Therapy, Focus on Vascular and Pulmonary Manifestations", aims to demonstrate recent and new advances and future trends in the field of rheumatic diseases [...].
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Affiliation(s)
- Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Murray Baron
- Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, QC 3755, Canada
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Romeo Martini
- Unit of Angiology, AULSS 1 Dolomiti, Ospedale San Martino, 32100 Belluno, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
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Ouchene L, Muntyanu A, Assayag D, Veilleux È, Abril A, Ferrara G, Yacyshyn E, Pineau CA, O'Brien E, Baron M, Osman M, Gniadecki R, Netchiporouk E. Skin disorders and interstitial lung disease: Part II-The spectrum of cutaneous diseases with lung disease association. J Am Acad Dermatol 2023; 88:767-782. [PMID: 36228940 DOI: 10.1016/j.jaad.2022.09.051] [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: 06/30/2022] [Revised: 08/30/2022] [Accepted: 09/07/2022] [Indexed: 11/06/2022]
Abstract
Part 2 of this 2-part CME introduces dermatologists to noninfectious inflammatory skin diseases associated with pulmonary involvement. In many cases, dermatologists may be the first physicians recognizing respiratory complications associated with these diagnoses. Because pulmonary involvement is often the leading cause of morbidity and mortality, dermatologists should be comfortable screening and monitoring for lung disease in high-risk patients, recognizing cutaneous stigmata of lung disease in these patients and referring to pulmonary specialists, when appropriate, for prompt treatment initiation. Some treatments used for skin disease may not be appropriate in the context of lung disease and hence, choosing a holistic approach is important. Interstitial lung disease and pulmonary hypertension are the most common pulmonary complications and a significant cause of mortality in autoimmune connective tissue diseases, especially systemic sclerosis, dermatomyositis, and mixed connective tissue disease. Pulmonary complications, notably interstitial lung disease, are also common and life-threatening in sarcoidosis and vasculitis, while they are variable in neutrophilic and autoimmune blistering diseases.
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Affiliation(s)
- Lydia Ouchene
- Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Anastasiya Muntyanu
- Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Deborah Assayag
- Division of Pulmonary Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Èvicka Veilleux
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Andy Abril
- Division of Rheumatology, Mayo Clinic, Jacksonville, Florida
| | - Giovanni Ferrara
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Elaine Yacyshyn
- Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
| | - Christian A Pineau
- Division of Rheumatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Elizabeth O'Brien
- Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Murray Baron
- Division of Rheumatology, McGill University Health Centre, Montréal, Québec, Canada
| | - Mohammed Osman
- Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Gniadecki
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
| | - Elena Netchiporouk
- Division of Dermatology, McGill University Health Centre, Montréal, Québec, Canada.
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Barbacki A, Baron M, Wang M, Zhang Y, Stevens W, Sahhar J, Proudman S, Nikpour M, Man A. Damage Trajectories in Systemic Sclerosis Using Group-Based Trajectory Modeling. Arthritis Care Res (Hoboken) 2023; 75:640-647. [PMID: 35226416 DOI: 10.1002/acr.24873] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 02/11/2022] [Accepted: 02/24/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is an autoimmune disease characterized by progressive organ damage, which can be measured using the Scleroderma Clinical Trials Consortium Damage Index (SCTC-DI). We aimed to identify whether distinct trajectories of damage accrual exist and to determine which variables are associated with different trajectory groups. METHODS Incident cases of SSc (<2 years) were identified in the Australian Scleroderma Interest Group and Canadian Scleroderma Research Group prospective registries. Group-based trajectory modeling was used to identify SCTC-DI trajectories over the cohort's first 5 annual visits. Baseline variables associated with trajectory membership in a univariate analysis were examined in multivariable models. RESULTS A total of 410 patients were included. Three trajectory groups were identified: low (54.6%), medium (36.2%), and high (10.3%) damage. Patients with faster damage accrual had higher baseline SCTC-DI scores. Older age (odds ratio [OR] 1.57 [95% confidence interval (95% CI) 1.18-2.10]), male sex (OR 2.55 [95% CI 1.10-5.88]), diffuse disease (OR 6.7 [95% CI 2.57-17.48]), tendon friction rubs (OR 5.4 [95% CI 1.86-15.66]), and elevated C-reactive protein level (OR 1.98 [95% CI 1.49-2.63]) increased the odds of being in the high-damage group versus the reference (low damage), whereas White ethnicity (OR 0.31 [95% CI 0.12-0.75]) and anticentromere antibodies (OR 0.24 [95% CI 0.07-0.77]) decreased the odds. CONCLUSION We identified 3 trajectories of damage accrual in a combined incident SSc cohort. Several characteristics increased the odds of belonging to worse trajectories. These findings may be helpful in recognizing patients in whom early aggressive treatment is necessary.
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Affiliation(s)
- Ariane Barbacki
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Murray Baron
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Mianbo Wang
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Yuqing Zhang
- Massachusetts General Hospital, Harvard Medical School, Boston
| | - Wendy Stevens
- St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | | | - Susanna Proudman
- Royal Adelaide Hospital, North Terrace, Adelaide, South Australia
| | - Mandana Nikpour
- University of Melbourne at St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Ada Man
- University of Manitoba, Winnipeg, Manitoba, Canada
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Chapelle C, Broudeur L, Bessard A, Durand T, Le Berre - Scoul C, Rigaud J, Baron M, Neunlist M, Perrouin-Verbe MA. Urothelial remodeling after spinal cord injury. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00884-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Deshauer S, Junek M, Baron M, Beattie KA, Larché MJ. Effect of pregnancy on scleroderma progression. J Scleroderma Relat Disord 2023; 8:27-30. [PMID: 36743807 PMCID: PMC9896202 DOI: 10.1177/23971983221101311] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/07/2022] [Indexed: 11/15/2022]
Abstract
Objective To explore the trajectory of scleroderma disease activity in women who experienced a pregnancy after systemic sclerosis diagnosis compared to nulliparous women. Methods We analyzed data from the Canadian Scleroderma Research Group registry by identifying nulliparous women and women with ⩾1 pregnancy after systemic sclerosis diagnosis. Patient characteristics were compared between groups at registry entry. Controlling for age, smoking, and time since systemic sclerosis diagnosis, generalized estimating equations tested the effect of pregnancy on force vital capacity, diffusing capacity of the lungs for carbon monoxide, right ventricular systolic pressure, glomerular filtration rate, antibody status, active digital ulcers, physician global assessment of activity, and severity over 9 years. Results At registry entry, numbers of women in the nulliparous and pregnancy after systemic sclerosis diagnosis groups were 153 and 45, respectively. Corresponding numbers at 6 and 9 years were 48 and 21, and 18 and 9, respectively. The prevalence of anti-topoisomerase positivity was 18.3% in nulliparous and 12.5% in pregnancy after systemic sclerosis diagnosis. Baseline differences included mean (Standard deviation) age of diagnosis (nulliparous: 38.8 (14.0), pregnancy after systemic sclerosis diagnosis: 22.6 (6.8) years, p < 0.001), disease duration (nulliparous: 9.6 (8.9), pregnancy after systemic sclerosis diagnosis: 21.9 (9.6) years; p < 0.001), and inflammatory arthritis (nulliparous: 41 (28%), pregnancy after systemic sclerosis diagnosis: 22 (49%), p = 0.009). There were no significant differences between groups in the change of any outcomes over time. Conclusion Results demonstrated that having ⩾1 pregnancy after systemic sclerosis diagnosis did not appear to significantly impact long-term renal, respiratory, or global function outcomes. While this offers a hopeful message to systemic sclerosis patients planning a pregnancy, physicians and patients should remain vigilant for potential post-partum complications.
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Affiliation(s)
- Siobhan Deshauer
- Division of Rheumatology, Department of
Medicine, McMaster University, Hamilton, ON, Canada
- Siobhan Deshauer, Division of Rheumatology,
Department of Medicine, McMaster University, 702-25 Charlton Avenue East,
Hamilton, ON L8N 1Y2, Canada.
| | - Mats Junek
- Division of Rheumatology, Department of
Medicine, McMaster University, Hamilton, ON, Canada
| | - Murray Baron
- Division of Rheumatology, Jewish
General Hospital, Department of Medicine, McGill University, Québec, QC,
Canada
| | - Karen A Beattie
- Division of Rheumatology, Department of
Medicine, McMaster University, Hamilton, ON, Canada
| | - Margaret J Larché
- Division of Rheumatology, Department of
Medicine, McMaster University, Hamilton, ON, Canada
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Ross L, Proudman S, Walker J, Stevens W, Ferdowsi N, Quinlivan A, Morrisroe K, Baron M, Nikpour M. Evaluation of patient and physician assessments of gastrointestinal disease activity in systemic sclerosis. J Rheumatol 2022; 50:519-525. [PMID: 36379565 DOI: 10.3899/jrheum.220832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
ObjectiveTo assess whether patient and physician global assessment of gastrointestinal disease in systemic sclerosis (SSc) are associated with a meaningful change in disease status.MethodsOne hundred and forty-three participants from the Australian Scleroderma Cohort Study were recruited to this study. Using logistic regression analysis, we evaluated the relationship between patient and physician assessed gastrointestinal disease status and symptoms, measures of health-related quality of life (Medical Short Form 36 (SF-36)) and gastrointestinal disease severity, measured by the Scleroderma Clinical Trials Consortium (SCTC) UCLA Gastrointestinal Tract 2.0 Score (GIT 2.0).ResultsPatient-reported worsening of gastrointestinal symptoms in the month preceding assessment was significantly associated with more severe gastrointestinal disease (OR 6.14, p<0.01) and progressive worsening gastrointestinal disease severity as measured by the GIT 2.0 score (OR 45.98, p<0.01). The new onset of reflux was the only specific symptom associated with patient reported gastrointestinal disease activity (OR 2.98, p=0.04). Physician assessed gastrointestinal disease activity was not significantly associated with higher GIT 2.0 scores or increasing severity of disease. Patient and physician assessed gastrointestinal activity was not associated with SF-36 scores.ConclusionIn the absence of objective measures of gastrointestinal disease activity in SSc, patient-reported symptoms of gastrointestinal disease could be used to indicate disease activity and merit consideration for inclusion in a multi-system disease activity index.
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Ross L, Nikpour M, D'Aoust J, Khanna D, Merkel PA, Pauling JD, Baron M. Patient and Physician Global Assessments of Disease Status in Systemic Sclerosis. Arthritis Care Res (Hoboken) 2022. [PMID: 36342397 DOI: 10.1002/acr.25056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/11/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
Global assessments of disease by both patients and physicians are widely used in clinical studies of systemic sclerosis (SSc). They are commonly secondary end points in randomized controlled trials (RCTs) and are considered important items in composite measures of treatment response. A comprehensive literature review was conducted of the formats, wording, and clinimetric properties of the patient global assessment of disease status (PtGA) and physician global assessment of disease status (PhGA) used in RCTs of SSc. Marked heterogeneity was found in the wording and measurement scales of the global assessments applied in RCTs. These instruments were not developed using rigorous methodology and have not been fully validated. There is a pressing need for standardization and validation of patient and physician global assessment tools in SSc to enable universal application of these measures across RCTs in SSc.
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Affiliation(s)
- Laura Ross
- The University of Melbourne at St Vincent's Hospital and St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Mandana Nikpour
- The University of Melbourne at St Vincent's Hospital and St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Julie D'Aoust
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | | | - Murray Baron
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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17
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Hughes M, Allanore Y, Baron M, Del Galdo F, Denton CP, Frech T, Furst DE, Galetti I, Dagna L, Herrick AL, Kuwana M, Matucci-Cerinic P, McMahan ZH, Murray CD, Proudman S, Matucci-Cerinic M. Proton pump inhibitors in systemic sclerosis: a reappraisal to optimise treatment of gastro-oesophageal reflux disease. Lancet Rheumatol 2022; 4:e795-e803. [PMID: 37936680 PMCID: PMC10628971 DOI: 10.1016/s2665-9913(22)00183-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Gastroesophageal reflux disease (GERD) is associated with significant morbidity in patients with systemic sclerosis (SSc). Although the introduction of proton pump inhibitors (PPIs) into clinical care have represented a major achievement in the management of oesophago-gastric problems in SSc, PPIs are seldom fully effective in SSc patients, and the utilization of maximum PPI dosages is a very frequent clinical practice. However, currently there is little evidence currently to support the empiric use of PPIs in SSc which is especially relevant in regard to safety concerns of long-term exposure with have been raised in the general population. The purpose of this viewpoint is to highlight the significant beneficial impact of PPIs on GERD in SSc, while considering the potential adverse effects in this patient population. Furthermore, we highlight the unmet needs of SSc patients with GERD, and also propose an agenda for future research to optimise the safe and effective use of PPIs in SSc.
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Affiliation(s)
- Michael Hughes
- Tameside Hospital, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, United Kingdom
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Yannick Allanore
- Service de Rhumatologie, Hôpital Cochin, APHP, Université de Paris, Paris, France
| | - Murray Baron
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Francesco Del Galdo
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Christopher P Denton
- Centre for Rheumatology, Royal Free Campus, University College London, United Kingdom
| | - Tracy Frech
- Vanderbilt University Medical Center, Department of Medicine, Division of Rheumatology and Immunology, Nashville, TN, USA
| | - Daniel E Furst
- Department of Experimental and Clinical Medicine, University of Florence & Department of Geriatric Medicine, Division of Rheumatology AOUC, Florence, Italy
- Division of Rheumatology, Department of Medicine, University of California in Los Angeles, Los Angeles, California, USA
| | - Ilaria Galetti
- FESCA, Federation of European Scleroderma Associations, Belgium
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital & Vita-Salute San Raffaele University, Milan, Italy
| | - Ariane L Herrick
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom
- Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Pietro Matucci-Cerinic
- University Hospital, Santa Maria della Misericordia, Department of Surgery and Transplantation, University of Udine, Italy
| | - Zsuzsanna H McMahan
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Rheumatology, Baltimore, MD
| | - Charles D Murray
- Jewish General Hospital, Division of Rheumatology, McGill University, Montreal, Canada
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital and Discipline of Medicine, University of Adelaide, Adelaide, South Australia, 5000
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare diseases (UnIRAR), IRCCS San Raffaele Hospital & Vita-Salute San Raffaele University, Milan, Italy
- Dept. Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy
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18
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Muntyanu A, Milan R, Rahme E, LaChance A, Ouchene L, Cormier M, Litvinov IV, Hudson M, Baron M, Netchiporouk E. Exposure to silica and systemic sclerosis: A retrospective cohort study based on the Canadian Scleroderma Research Group. Front Med (Lausanne) 2022; 9:984907. [PMID: 36250083 PMCID: PMC9556811 DOI: 10.3389/fmed.2022.984907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionSystemic sclerosis (SSc) is thought to be induced by an environmental trigger in genetically predisposed individuals. This study assessed the demographic and clinical characteristics and disease severity of silica exposed SSc patients.MethodsData was obtained from the Canadian Scleroderma Research Group (CSRG) cohort, containing 1,439 patients (2004–2019). Univariate and multivariate logistic regression analyses were performed, to determine the phenotype and severity of silica-exposed SSc patients. Mortality was assessed using Cox Survival Regression and Kaplan-Meier analyses.ResultsAmong 1,439 patients (86.7% females), 95 patients reported exposure to silica. Those exposed were younger, of male sex and with more severe disease. Sex differences were observed where male patients exposed to silica were more likely to be Caucasian and smokers whereas female patients were younger at SSc diagnosis compared to unexposed. Multivariate regression, controlled for multiple confounders, showed that silica exposure was associated with a younger age at diagnosis and worse disease severity and mortality.ConclusionExposure to silica was reported in ∼7% of CSRG cohort and ∼20% of male patients and was associated with a worse prognosis in terms of age of diagnosis, organ involvement and mortality. Hence, screening for silica exposure among higher risk individuals may be beneficial and these patients may require closer monitoring for systemic disease.
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Affiliation(s)
- Anastasiya Muntyanu
- Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Raymond Milan
- Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Elham Rahme
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Avery LaChance
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Lydia Ouchene
- Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Maxime Cormier
- Division of Respiratory Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Ivan V. Litvinov
- Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Division of Dermatology, University of Ottawa, Ottawa, ON, Canada
- *Correspondence: Ivan V. Litvinov,
| | - Marie Hudson
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, QC, Canada
- Division of Rheumatology, Department of Medicine, Jewish General Hospital, Montreal, QC, Canada
| | - Murray Baron
- Division of Rheumatology, Department of Medicine, Jewish General Hospital, Montreal, QC, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - the Canadian Scleroderma Research GroupBaronM.HudsonM.GygerG.PopeJ.LarcheM.KhalidiN.MasettoA.SuttonE.Rodriguez ReynaT. S.MaltezN.ThorneC.FortinP. R.IkicA.RobinsonD.JonesN.LeClercqS.DochertyP.SmithD.FritzlerM. J.Montreal, Quebec; Montreal, Quebec; Montreal, Quebec; London, Ontario; Hamilton, Ontario; Hamilton, Ontario; Sherbrooke, Quebec; Halifax, Nova Scotia; Mexico City, Mexico; Ottawa, Ontario; Newmarket, Ontario; Quebec, Quebec; Quebec, Quebec; Winnipeg, Manitoba; Edmonton, Alberta; Calgary, Alberta; Moncton, New Brunswick; Ottawa, Ontario; Department of Medicine, Cumming School of Medicine, Calgary, Alberta.
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Lafont C, Paillaud E, Bertolus C, Baron M, Caillet P, Bouvard E, Laurent M, Salvan D, Chaumette L, De Decker Lemarcis L, Piot B, Barry B, Raynaud-Simon A, Sauvaget E, Minard A, Anota A, Panjo H, Brugel L, Canouï-Poitrine F. 657MO Effectiveness of geriatric assessment-driven interventions on quality of life for 2 years in older patients with head and neck cancer: Results from the EGeSOR trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Cornu JN, Auble A, Degremont S, Baron M, Roman H, Pfister C, Grise P. Sacral neuromodulation for management of severe bladder dysfunction due to endometriosis: experience from a tertiary reference center. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00779-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Zheng B, Wang M, McKenna K, Shapiro L, Silver R, Csuka ME, van den Hoogen F, Robinson D, Pauling JD, Hummers L, Krieg T, Del Galdo F, Spiera R, Jones N, Khalidi N, Vacca A, de Vries‐Bouwstra JK, Gordon J, Baron M, Pope JE, Hudson M, Gyger G, Larché MJ, Masetto A, Sutton E, Rodriguez‐Reyna TS, Maltez N, Smith D, Thorne C, Ikic A, Fortin PR, Fritzler MJ. Agreement Between Physician Evaluation and the Composite Response Index in Diffuse Cutaneous Systemic Sclerosis. Arthritis Care Res (Hoboken) 2022. [DOI: 10.1002/acr.24638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Boyang Zheng
- McGill University, Jewish General Hospital Montreal Quebec Canada
| | - Mianbo Wang
- Lady Davis Institute for Medical Research Jewish General Hospital Montreal Quebec Canada
| | - Kerry McKenna
- Lady Davis Institute for Medical Research Jewish General Hospital Montreal Quebec Canada
| | - Lee Shapiro
- Albany Medical College, The Center for Rheumatology Albany New York
| | | | | | | | | | | | | | | | | | | | - Niall Jones
- University of Alberta Edmonton Alberta Canada
| | | | | | | | | | - Murray Baron
- McGill University, Jewish General Hospital Montreal Quebec Canada
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22
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Nevskaya T, Martin Calderon L, Baron M, Pope J. POS0913 INCREASED HEALTH CARE UTILIZATION IN SYSTEMIC SCLEROSIS PATIENTS WHO HAVE DIGITAL ULCERS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSystemic sclerosis is a multi-system autoimmune disease characterized by fibrosis of the skin and internal organs, and vasculopathy which manifests as pulmonary arterial hypertension and digital ulcers. Digital ulcers are debilitating and painful lesions most commonly present in the digit tips or extensor surfaces of the hands leading to significant morbidity and decreased quality of life. SSc patients with digital ulcers may require increased support and therefore may have greater healthcare resource utilization compared to those patients without digital ulcers.ObjectivesWe assessed the impact of DUs on resource utilization including hospitalizations, outpatient visits and procedures within a large SSc Canadian registry.MethodsA cohort of patients with SSc and digitals ulcers was derived from the Canadian Scleroderma Research Group registry and matched to controls individually based on sex, age (±3 years), SSc subtype, and disease duration (±2 years). Eligible patients met the 2013 ACR/EULAR criteria (confirmed by an experienced rheumatologist), were 18 years of age, had completed the Resource Utilization Questionnaire (RUQ), and had active digital ulcers at two consecutive annual visits (baseline study visit and at 1st year). The Medgser Disease Severity Scale was used to assess ulcer disease severity. Unadjusted and adjusted regression analyses compared the association between DUs and resource utilization.ResultsRUQs in 104 SSc patients with active DUs at two consecutive annual visits were compared with 104 patients without DUs matched 1:1 for age, sex, disease subtype and duration. Over one year, DUs were associated with a higher number of tests (p˂0.05) and visits to health professionals, especially to a rheumatologist (p˂0.0001) and internist (p=0.003), a greater need for an accompanying person (p˂0.05) and aids purchased/received (p˂0.05). Having DUs was associated with more severe disease, even after excluding the peripheral vascular domain from a total DSS (9.7±4.5 vs 5.6±2.7, p˂0.0001). After adjustment for disease severity in other organs, the presence of DUs remained a significant predictor of more frequent physician visits and more tests (all˂0.05) by linear regression analysis.ConclusionSSc patients with DUs utilized significantly more healthcare resources per annum even after adjustment for disease severity in other organ systems.References[1]Khimdas S, Harding S, Bonner A, Zummer B, Baron M, Pope J, Canadian Scleroderma Research Group. Associations with digital ulcers in a large cohort of systemic sclerosis: results from the Canadian Scleroderma Research Group registry. Arthritis care & research. 2011 Jan;63(1):142-9.[2]Nihtyanova SI, Brough GM, Black CM, Denton CP. Clinical burden of digital vasculopathy in limited and diffuse cutaneous systemic sclerosis. Annals of the rheumatic diseases. 2008 Jan 1;67(1):120-3.Disclosure of InterestsNone declared
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Campochiaro C, Suliman YA, Hughes M, Schoones J, Giuggioli D, Moinzadeh P, Maltez N, Ross L, Baron M, Chung L, Allanore Y, Denton CP, Distler O, Frech T, Furst D, Khanna D, Krieg T, Kuwana M, Matucci-Cerinic M, Pope J, Alunno A. POS0888 NON-SURGICAL LOCAL TREATMENTS FOR DIGITAL ULCERS IN SYSTEMIC SCLEROSIS: A SYSTEMATIC LITERATURE REVIEW. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundDigital ulcers(DUs) in systemic sclerosis(SSc) represent a major clinical challenge. There are no recommendations for the local management of SSc-DUs. Systemic therapy is considered the standard of care. However, there is a strong rationale for local approaches to DU by avoiding side effects from systemic therapies. The World Scleroderma Foundation DU Working Group intends to develop evidence-based recommendations for DU management including local, non-surgical treatment(ln-sT).ObjectivesTo summarise the literature on the safety and efficacy of ln-sT for SSc-DUs.MethodsA systematic literature review(SLR) of papers describing the use of ln-sT for DU in SSc was performed up to May 2021 according to the PICO framework. References were independently screened by two reviewers who independently assessed the full text of eligible articles and extracted data.ResultsAmong 790 retrieved references, 12 were included. Median(range) number of patients per study was 9(7–84), mean age ranging from 37 to 62.5 years. In 5(41%) studies a control group was included. Background systemic therapies are summarized in Table 1. The most studied treatment was botulin toxin A(BTA). It was used as hand injection in 3 studies (median dose ranging from 90 to 150 U) and as 50 U single finger injection in 1 study. Healing rate after a median time of 8-49 weeks ranged from 71% to 100%. In 2 studies a reduction in VAS pain was observed from 20% to 100%. Transient muscle weakness was the most common side effect in 10% of patients. Amniotic(Am) and hydrocolloid membranes(HyM) were used in 1 study each. They were associated with a good healing rate, statistically significant for the HyM. Tadalafil 2% cream was studied in 1 study and was associated with a reduction in the median DU number from 1.6 to 1 per patient after a median time of 4 weeks and a reduction by 1.4 point in the 10-mm VAS scale. Vitamin E gel was shown to be associated with a statistically significant reduction in the healing time compared to SoC alone in 1 RCT(13.2 ± 2.7 versus 20.9 ± 3.6 weeks, P=<0.001). Low-level light therapy, hydrodissection and corticosteroid injection and extracorporeal shock wave(ESW) were evaluated in 1 study each. They were all associated with positive outcomes which was statistically significant only for the ESW. The only negative trial examined dimethyl sulfoxide and was associated with local toxicity.Table 1.Characteristics of the studies.TreatmentType of studyPatientsBaseline DUBackground therapy (%) ETA CCB APA PG ARB ACE-I PDE-5i ISFollow-up (weeks)Healing rate(%)*Pain Reduction (VAS/10)ComparatorHydrodissection and corticosteroid injectionP1202334.4Rheumatoid ArthritisTadalafil 2% Vitamin E gelRRCT15131.6(1)3.5±2.30462700130704 241(1)Reduced time to heal**1.4SoCAmHyMRP67310001002800002817033143810090**SoCBTAMedian 90 U per handHigh-concentration hand100 U non-dominant handSingle finger 50 URRPP772010314571140718558551008514201001414718 4981277717510020%100%Untreated CHLow-level light therapyP8102537025378100ESWP9493355661144441**1.31Dimethyl sulfoxideDBRCT84No change, skin toxicity with 70% formulation*Unless otherwise stated. **Statistically significant. ARB= angiotensin receptor antagonist. ACEi= ACE inhibitors. APA= anti-platelet agents. CCB= calcium channel blockers. CH= contralateral hand. DBRCT= double blind randomized-controlled trial. ETA = endothelin antagonist. IS= immunosuppression. PG= prostaglandins. PDE-5i= Phosphodiesterase type-5 inhibitors. P = prospective. R = retrospective. SoC= standard of care (as per local protocol).ConclusionOur SLR supports interest to develop ln-sTs for SSc-DUs. The number of studies is limited and mainly case reports and small single studies are present. Treatments were well tolerated and there was evidence of efficacy for BTA, vitamin E, ESW and HyM in refractory DUs. The evidence is not robust and confounding factors (vasodilators background therapies) could impact on the findings. Future research is indicated to conduct larger, well-designed studies.Disclosure of InterestsCorrado Campochiaro: None declared, Yossra A. Suliman: None declared, Michael Hughes Speakers bureau: Actelion pharmaceuticals, Eli Lilly, and Pfizer, outside of the submitted work., Jan Schoones: None declared, Dilia Giuggioli: None declared, Pia Moinzadeh Speakers bureau: speaking fees from Actelion pharmaceuticals and Boehringer Ingelheim, Nancy Maltez: None declared, Laura Ross: None declared, Murray Baron: None declared, Lorinda Chung: None declared, Yannick Allanore: None declared, Christopher P Denton: None declared, Oliver Distler Speakers bureau: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur, Tracy Frech: None declared, Daniel Furst: None declared, Dinesh Khanna Speakers bureau: Janssen and Eicos Sciences, Inc., Thomas Krieg: None declared, Masataka Kuwana Speakers bureau: Speakers fees from AbbVie, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai, Eisai, GlaxoSmithKline, Janssen, Nippon Shinyaku, Ono Pharmaceuticals, Tanabe-Mitsubishi, and Consultant fees from AstraZeneca, Boehringer Ingelheim, Corbus, Kissei, Mochida, outside of the submitted work., Marco Matucci-Cerinic: None declared, Janet Pope: None declared, Alessia Alunno: None declared
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Suliman YA, Campochiaro C, Hughes M, Schoones J, Giuggioli D, Maltez N, Moinzadeh P, Ross L, Chung L, Allanore Y, Baron M, Denton CP, Distler O, Frech T, Furst D, Khanna D, Krieg T, Kuwana M, Matucci-Cerinic M, Pope J, Alunno A. POS0898 SURGICAL MANAGEMENT OF DIGITAL ULCERS IN SYSTEMIC SCLEROSIS: A SYSTEMATIC LITERATURE REVIEW. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundManagement of digital ulcers (DUs) in systemic sclerosis (SSc) is a major clinical challenge. To date, systemic therapy is generally considered as the ‘standard of care’ for significant SSc-DUs. However, there is a strong rationale to develop local approaches to DUs, to avoid side effects from systemic therapies. World Scleroderma Foundation DU Working Group intends to develop practical, evidence-based recommendations for DU management including local, Surgical Treatment (L-ST).ObjectivesTo summarize the literature on the safety and efficacy of L-ST for SSc-DUs.MethodsA systematic literature review (SLR) was conducted up to May 2021. According to the PICO framework, eligibility criteria were defined and original research articles about surgical treatment of SSc DUs in adult patients were included. References were independently screened by 2 reviewers who assessed the full text of eligible articles and extracted data.ResultsThirteen eligible articles out of 790 total publications were identified (Table 1). Due to the paucity of randomized controlled trials of surgical treatments for SSc-DU, we included retrospective studies and case series with at least 4 patients. Autologous fat (adipose tissue AT) grafting was the surgical modality mostly identified (7 studies of which 1 RCT and 6 prospective open label single arm). The healing rate (HR) with autologous fat grafting (4 studies) ranged from 66-100 %. In the RCT, two age and sex matched groups were included, adipose tissue (AT)group (n=25 pts) and sham procedure (SP) group (n=13), DU healing was reported in 23/25 in AT group versus 1/13 in the SP group in 8 wks, (p<0.0001), 12 pts in the SP group, received rescue AT injection, all of them healed after 8 wks. Three studies reported autologous adipose-derived stromal vascular fraction(SVF) grafting and the HR ranged from 32-60%, followed up to 12 months. Transient edema and paresthesia were reported in 2 studies, and amputation in 2 ulcers in 1 study, and no complications were reported in other studies. Surgical sympathectomy was reported in 3 studies, with a median healing rate of 81%. Bone marrow derived cell transplantation in a single study showed 87% healing rate over (4-24 wks). Two surgical studies (of direct microsurgical revascularization N=4, and microsurgical arteriolysis, N=6), showed 100% healing of ulcers, no complications reported.Table 1.Characteristics of the extracted studies.StudydesignPatients (n)Baseline DU (n)Background therapy (%)Follow-upOutcomeHealed ulcers(%) Adipose tissue graftAutologous fat graftp9.15PG, CCB—100ETA 26PDE-5i 138-12 wks66Adipose tissue graftingRCT25 case13- Ctr25-case13- CtrPG- 100CCB 1008 wks92-case7-CtrAdipose tissue implantp1515no therapy7 wks100Adipose tissue graftp129PG,CCB-100ETA6 month88adipose derived SVFp1215PDE-5i, ccb, PG allowed22m6Adipose derived SVFp1215CCB 50ETA166 m63 Adipose derived SVFp1819CCB 50PG 27ETA 5IS 7124 wks32SympathectomySympathectomyR611CCB-10020 m81SympathectomyR1335PGCCBAPA35Sympathectomy, vascular bypass (+vein graftR1726Ccb 35APA 47PDE-i5 589 m100Bone marrow derived cells transplantation)p88PG-6236 m87Direct microsurgical revascularizationR44m100Limited microsurgical arteriolysisR61712 m100SVF =stromal vascular fraction P = prospective. R = retrospective. RCT= double blind randomized-controlled trial. ETA = endothelin antagonist. CCB= calcium channel blockers. APA= anti-platelet agents. PG= prostaglandins. ARB= angiotensin receptor antagonist. ACEi= ACE inhibitors. PDE-5i= PDE-5 inhibitors. IS= immunosuppression. M=median. SoC= standard of care. HR= healing rateConclusionOur SLR has identified several surgical modalities for SSc-DUs. L-STseemed generally effective and safe for DU healing, thus Significant methodological issues emerged including small numbers of pts, lack of comparator, failure to report confounders such as background therapies and variable follow up. Future research is warranted to rigorously investigate surgical interventions for Dus.Disclosure of InterestsYossra A. Suliman: None declared, Corrado Campochiaro: None declared, Michael Hughes Speakers bureau: speaking fees from Actelion pharmaceuticals, Eli Lilly, and Pfizer, outside of the submitted work, Jan Schoones: None declared, Dilia Giuggioli: None declared, Nancy Maltez: None declared, Pia Moinzadeh Speakers bureau:: speaking fees from Actelion pharmaceuticals and Boehringer Ingelheim, Laura Ross: None declared, Lorinda Chung: None declared, Yannick Allanore: None declared, Murray Baron: None declared, Christopher P Denton: None declared, Oliver Distler Shareholder of: Consultancy relationship with and/or has received research funding from and/or has served as a speaker for the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Speakers bureau: Consultancy relationship with and/or has received research funding from and/or has served as a speaker for the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Consultant of: Consultancy relationship with and/or has received research funding from and/or has served as a speaker for the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Grant/research support from: Consultancy relationship with and/or has received research funding from and/or has served as a speaker for the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Tracy Frech: None declared, Daniel Furst: None declared, Dinesh Khanna Speakers bureau: Janssen and Eicos Sciences, Inc., Paid instructor for: Janssen and Eicos Sciences, Inc., Consultant of: Janssen and Eicos Sciences, Inc., Thomas Krieg: None declared, Masataka KUWANA Speakers bureau: Speakers fees from AbbVie, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai, Eisai, GlaxoSmithKline, Janssen, Nippon Shinyaku, Ono Pharmaceuticals, Tanabe-Mitsubishi, and Consultant fees from AstraZeneca, Boehringer Ingelheim, Corbus, Kissei, Mochida, outside of the submitted work., Paid instructor for: Speakers fees from AbbVie, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai, Eisai, GlaxoSmithKline, Janssen, Nippon Shinyaku, Ono Pharmaceuticals, Tanabe-Mitsubishi, and Consultant fees from AstraZeneca, Boehringer Ingelheim, Corbus, Kissei, Mochida, outside of the submitted work., Consultant of: Speakers fees from AbbVie, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai, Eisai, GlaxoSmithKline, Janssen, Nippon Shinyaku, Ono Pharmaceuticals, Tanabe-Mitsubishi, and Consultant fees from AstraZeneca, Boehringer Ingelheim, Corbus, Kissei, Mochida, outside of the submitted work., Marco Matucci-Cerinic: None declared, Janet Pope: None declared, Alessia Alunno: None declared
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Maltez N, Ross L, Hughes M, Schoones J, Baron M, Chung L, Campochiaro C, Suliman YA, Giuggioli D, Moinzadeh P, Allanore Y, Denton CP, Distler O, Frech T, Furst D, Khanna D, Krieg T, Kuwana M, Matucci-Cerinic M, Pope J, Alunno A. POS0900 SYSTEMIC PHARMACOLOGICAL TREATMENT OF DIGITAL ULCERS IN SYSTEMIC SCLEROSIS: A SYSTEMATIC LITERATURE REVIEW. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundDigital ulcers (DU) are common in systemic sclerosis (SSc) and associated with reduced survival, high morbidity and poor quality of life. Recommendations have previously been proposed for DU management yet there remains significant unmet patient need. Therefore the World Scleroderma Foundation DU Working Group intends to develop practical evidence based recommendations for DU management.ObjectivesTo summarise data on efficacy and safety of systemic treatments for SSc DU.MethodsA systematic literature review to May 2021 was performed. PubMed, MEDLINE, Embase, Web of Science, Cochrane Library, Emcare (OVID) and Academic Search Premier databases were searched for original studies on adult patients with SSc DU treated with systemic pharmacological treatment. Based on the PICO framework, eligibility criteria were defined and references were independently screened by two reviewers. Reviewers independently assessed the full text of eligible articles. Owing to interstudy heterogeneity narrative summaries were used to present data.ResultsThe search strategy identified 1271 references of which 45 eligible articles were included. Seventeen studies were randomised placebo controlled trials (RCT) pertaining to PDE5 antagonists (PDE5i) (n=3), endothelin receptor antagonists (ERA) (n=3), prostanoids (n=7), antiplatelet agents (n=1) and other (n=3) (Table 1). No head to head RCT was retrieved. All other studies were observational studies (OBS). Studies were highly heterogeneous with application of differing definition of DU, variable study eligibility criteria, clinical endpoints and follow up periods. This limited the calculation of effect size and comparison across studies.Table 1.Characteristics of placebo controlled randomised controlled trialsAuthor YearInterventionnFollow upOutcomeFavours interventionHachulla 2016Sildenafil8312 weeksTime to DU healing-Andrigueti 2017Sildenafil4112 weeksDU healing+Shenoy 2010Tadalafil246 weeksNew DU+Khanna 2016Macitentan55416 weeksNew DU-Matucci-Cerinic 2011Bosentan18832 weeksNew DU Time to healing of DU+-Korn 2004Bosentan12212 weeksNew DU+Kawald 2008IV iloprost5012 monthsDU healing-Wigley 1992IV iloprost3510 weeksDU healing+Wigley 1994IV iloprost739 weeks50% reduction in DU score-Seibold 2017Treprostinil14820 weeksNet DU burden-Vayssairat 1999Beraprost10725 weeks% patients with new DU-Denton 2017Selexipag7412 weeksNumber of new DU DU healing-Lau 1993Cicaprost334 weeksNumber of DU-Abou-Raya 2008Atorvastatin844 monthsNumber of DU+Au 2010Cyclophosphamide15812 monthsNumber of patients with DU-Beckett 1984Dipyridamole / aspirin412 yearsChange in general SSc-Nagaraja 2019Riociguat1732 weeksNet DU burden-+ significantly superior to comparator- non significantly different from comparatorDU: digital ulcers IV: intravenous SSc: systemic sclerosisSeveral RCT found improved DU healing with treatment: two with PDE5i, one with iloprost and one showed improved DU healing and prevention with atorvastatin. Two RCT demonstrated effective prevention of new DU with bosentan. OBS studies with a total of 621 patients showed variable improvements in the healing of DU with CCB, PDE5i, ERA, statins, N-acetylcysteine, prostanoids and ketanserin and prevention of new DU with ERA.Regarding safety, all treatments were generally tolerated with few serious adverse events. Treatment was ceased in 6.25-17.5% of patients in RCT due to treatment related side effects.ConclusionDespite several studies assessing the efficacy and safety of systemic pharmacological treatment of SSc DU, it is not possible to draw solid conclusions due to study heterogeneity. Small RCT have shown treatment benefit with PDE5i, iloprost and atorvastatin. Large studies demonstrated effective prevention of new DU with bosentan. Our results highlight the urgent need for improved clinical trial design to generate more robust evidence and novel therapies to guide the management SSc DU.AcknowledgementsThis work was supported by the World Scleroderma Foundation.Disclosure of InterestsNancy Maltez: None declared, Laura Ross: None declared, Michael Hughes Speakers bureau: Actelion Pharmaceuticals, Eli Lilly and Pfizer outside of the submitted work., Jan Schoones: None declared, Murray Baron: None declared, Lorinda Chung Consultant of: Eicos, Corrado Campochiaro: None declared, Yossra A. Suliman: None declared, Dilia Giuggioli: None declared, Pia Moinzadeh Speakers bureau: Actelion Pharmaceuticals, Boehringer Ingelheim, Yannick Allanore: None declared, Christopher P Denton: None declared, Oliver Distler Speakers bureau: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur., Consultant of: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur., Grant/research support from: Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143), Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur., Tracy Frech: None declared, Daniel Furst: None declared, Dinesh Khanna Consultant of: Eicos Sciences Inc, Janssen, Thomas Krieg: None declared, Masataka Kuwana Speakers bureau: Speaker fees from AbbVie, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai, Eisai, GlaxoSmithKline, Janssen, Nippon Shinyaku, Ono Pharmaceuticals, Tanabe-Mitsubishi, and consultancy fees from AstraZeneca, Boehringer Ingelheim, Corbus, Kissei, Mochida outside of the submitted work., Marco Matucci-Cerinic: None declared, Janet Pope: None declared, Alessia Alunno: None declared
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Nevskaya T, Martin Calderon L, Baron M, Pope JE. Health Care Utilization Is Increased In Systemic Sclerosis Patients Who Have Digital Ulcers. Arthritis Care Res (Hoboken) 2022; 75:1071-1078. [PMID: 35439364 DOI: 10.1002/acr.24902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/15/2022] [Accepted: 04/14/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Digital ulcers (DUs) occur in half of the patients with systemic sclerosis (SSc) and require healthcare interventions for treatment and monitoring for complications including infection and gangrene. OBJECTIVE We assessed the impact of DUs on resource utilization including hospitalizations, outpatient visits and procedures within a large SSc Canadian registry in a matched cohort study. METHODS 1698 SSc patients who completed one or more 84-item Resource Utilization Questionnaire (RUQ) for a 12-month recall period between September 2005 and February 2020 were included (9077 questionnaires). Organ involvement was assessed by disease severity scores (DSS) on the Medsger scale. Unadjusted and adjusted regression analyses compared the association between DUs and resource utilization. RESULTS RUQs in 104 SSc patients with active DUs at two consecutive annual visits were compared with 104 patients without DUs matched 1:1 for age, sex, disease subtype and duration. Over one year, DUs were associated with a higher number of tests (p˂0.05) and visits to health professionals, especially to a rheumatologist (p˂0.0001) and internist (p=0.003), a greater need for an accompanying person (p˂0.05) and aids purchased/received (p˂0.05). Having DUs was associated with more severe disease, even after excluding the peripheral vascular domain from a total DSS (9.7±4.5 vs 5.6±2.7, p˂0.0001). After adjustment for disease severity in other organs, the presence of DUs remained a significant predictor of more frequent physician visits and more tests (all˂0.05) by linear regression analysis. CONCLUSION SSc patients with DUs utilized significantly more healthcare resources per annum even after adjustment for disease severity in other organ systems.
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Affiliation(s)
- Tatiana Nevskaya
- Schulich School of Medicine and Dentistry, University of Western Ontario, Division of Rheumatology, St. Joseph's Health Care, London, Ontario, Canada
| | - Leonardo Martin Calderon
- Schulich School of Medicine and Dentistry, University of Western Ontario, Division of Rheumatology, St. Joseph's Health Care, London, Ontario, Canada
| | - Murray Baron
- McGill University, Division of Rheumatology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Janet E Pope
- Schulich School of Medicine and Dentistry, University of Western Ontario, Division of Rheumatology, St. Joseph's Health Care, London, Ontario, Canada
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Jha M, Wang M, Steele R, Baron M, Fritzler MJ, Hudson M. NT-proBNP, hs-cTnT, and CRP predict the risk of cardiopulmonary outcomes in systemic sclerosis: Findings from the Canadian Scleroderma Research Group. J Scleroderma Relat Disord 2022; 7:62-70. [PMID: 35386945 PMCID: PMC8922674 DOI: 10.1177/23971983211040608] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/31/2021] [Indexed: 02/03/2023]
Abstract
Objective The aim of this study was to determine the independent value of N-terminal pro b-type natriuretic peptide, high-sensitivity cardiac troponin T, and C-reactive protein to predict onset of cardiopulmonary disease in a large, multi-center systemic sclerosis cohort followed prospectively. Methods Subjects from the Canadian Scleroderma Research Group registry with data on N-terminal pro b-type natriuretic peptide, high-sensitivity cardiac troponin T, and C-reactive protein were identified. Outcomes of interest were death, systolic dysfunction (left ventricular ejection fraction < 50% or medications for heart failure), pulmonary arterial hypertension by right heart catheterization, pulmonary hypertension by cardiac echocardiography (systolic pulmonary artery pressures ⩾ 45 mmHg), arrhythmias (pacemaker/implantable cardiac defibrillator or anti-arrhythmic medications), and interstitial lung disease. Multivariate Cox proportional hazard models were generated for each outcome. Results A total of 675 subjects were included with a mean follow-up of 3.0 ± 1.8 years. Subjects were predominantly women (88.4%) with mean age of 58.2 ± 11.3 years and mean disease duration of 13.7 ± 9.1 years. One hundred and one (101, 15%) subjects died during follow-up, 37 (6.4 %) developed systolic dysfunction, 18 (2.9%) arrhythmias, 34 (5.1%) pulmonary arterial hypertension, 43 (7.3%) pulmonary hypertension, and 48 (12.3%) interstitial lung disease. In multivariate analyses, elevated levels of N-terminal pro b-type natriuretic peptide, high-sensitivity cardiac troponin T, and C-reactive protein were associated with increased risk of death, while elevated levels of N-terminal pro b-type natriuretic peptide and C-reactive protein were associated with increased risk of developing pulmonary hypertension. Conclusion In systemic sclerosis, N-terminal pro b-type natriuretic peptide, high-sensitivity cardiac troponin T, and C-reactive protein have independent predictive value for death and pulmonary hypertension. A larger study would be required to determine the predictive value of these biomarkers for less common systemic sclerosis outcomes.
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Affiliation(s)
| | | | | | - Murray Baron
- McGill University, Montreal, QC, Canada,Lady Davis Institute, Montreal, QC, Canada,Jewish General Hospital, Montréal, QC, Canada
| | | | | | - Marie Hudson
- McGill University, Montreal, QC, Canada,Lady Davis Institute, Montreal, QC, Canada,Jewish General Hospital, Montréal, QC, Canada,Marie Hudson, Jewish General Hospital, Room A-725, 3755 Côte Sainte-Catherine Road, Montreal, QC H3T 1E2, Canada.
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Park R, Nevskaya T, Baron M, Pope JE. Immunosuppression use in early systemic sclerosis may be increasing over time. J Scleroderma Relat Disord 2022; 7:33-41. [PMID: 35386940 PMCID: PMC8922673 DOI: 10.1177/23971983211000971] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/06/2021] [Indexed: 02/03/2023]
Abstract
Background Immunosuppression remains the main treatment for progressing skin involvement, interstitial lung disease and inflammatory joint or muscle disease in systemic sclerosis. This study investigated the pattern and trends in immunosuppressive agents used in early systemic sclerosis (diagnosed before and after 2007) to determine whether the changes in the preferred type, timing and combination of immunosuppression took place over the past decade. Methods In total, 397 Canadian Scleroderma Research Group database patients (183 diffuse cutaneous systemic sclerosis and 214 limited cutaneous systemic sclerosis) who had baseline and follow-up visits within 3 years (mean: 1.8 ± 0.8) after disease onset were included: 82% females, age at diagnosis 53 ± 13 years. Bivariate, chi-square, analysis of variance and adjusted regression analyses were used. Results In total, 115 diffuse cutaneous systemic sclerosis patients (63%) and 62 limited cutaneous systemic sclerosis (29%) received immunosuppressive drugs, most commonly methotrexate, followed by mycophenolate mofetil and cyclophosphamide. In diffuse cutaneous systemic sclerosis, immunosuppressants were prescribed after 2007 more often (74% vs 50%, p = 0.001), especially methotrexate (p = 0.02) and mycophenolate mofetil (p = 0.04), and earlier (peak at 2 years after onset). Immunosuppressive therapy was associated with male gender, interstitial lung disease, anti-Scl70 positivity, ACA negativity and inflammatory joint disease in limited cutaneous systemic sclerosis and with ACA negativity and a higher modified Rodnan skin score in diffuse cutaneous systemic sclerosis. Multivariate regression analysis showed that the use of immunosuppressants after 2007 was predicted only by ACA negativity in limited cutaneous systemic sclerosis and by younger age in diffuse cutaneous systemic sclerosis. Conclusion Over the past decade, there has been a trend to prescribe immunosuppressants more often and earlier in diffuse cutaneous systemic sclerosis patients, regardless of modified Rodnan skin score. Methotrexate is being more frequently used, and mycophenolate mofetil has gained favour over cyclophosphamide. Autoantibody status was the most consistent predictor of immunosuppressive therapy.
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Affiliation(s)
- Ryan Park
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Tatiana Nevskaya
- Division of Rheumatology, Department of Medicine, St. Joseph’s Health Care, London, ON, Canada
| | - Murray Baron
- Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Janet E Pope
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada,Division of Rheumatology, Department of Medicine, St. Joseph’s Health Care, London, ON, Canada,Janet Pope, Division of Rheumatology, Department of Medicine, St. Joseph’s Health Care, 268 Grosvenor Street, London, ON N6A 4V2, Canada.
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Valenzuela A, Stevens K, Chung MP, Rodriguez-Reyna TS, Proudman S, Baron M, Castelino FV, Hsu V, Green L, Galdo FD, Li S, Fiorentino D, Chung L. Change in calcinosis over 1 year using the Scleroderma Clinical Trials Consortium Radiologic Scoring System for Calcinosis of the hands in patients with Systemic Sclerosis. Semin Arthritis Rheum 2022; 53:151980. [DOI: 10.1016/j.semarthrit.2022.151980] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
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Muntyanu A, Ouchene L, Zhou S, Hudson M, Rezaeian M, LaChance A, Litvinov IV, Baron M, Netchiporouk E. Geographical Distribution of Systemic Sclerosis in Canada: An Ecological Study based on the Canadian Scleroderma Research Group. J Am Acad Dermatol 2022; 87:1095-1097. [PMID: 35031410 DOI: 10.1016/j.jaad.2021.12.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 12/08/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Anastasiya Muntyanu
- Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Lydia Ouchene
- Faculty of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Siriu Zhou
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Marie Hudson
- Lady Davis Institute, Jewish General Hospital, McGill University, Montréal, QC, Canada; Division of Rheumatology, Department of Medicine, Jewish General Hospital, Montreal, QC, Canada
| | - Mohsen Rezaeian
- Department of Epidemiology and Biostatistics, Occupational Environment Research Center, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Avery LaChance
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ivan V Litvinov
- Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Murray Baron
- Division of Rheumatology, Department of Medicine, Jewish General Hospital, Montreal, QC, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.
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Hoa S, Baron M, Hudson M. Screening and management of subclinical interstitial lung disease in systemic sclerosis: an international survey. Rheumatology (Oxford) 2021; 61:3401-3407. [PMID: 34918033 DOI: 10.1093/rheumatology/keab929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Interstitial lung disease (ILD) is the leading cause of mortality in systemic sclerosis (SSc). Experts now recommend HRCT screening in all SSc patients and treatment of subclinical ILD in SSc patients with high-risk phenotypes. We undertook an international survey to understand current screening and treatment practices in subclinical SSc-ILD. METHODS An electronic REDCap survey was distributed to 611 general rheumatologists, 348 national and international SSc experts, 285 general respirologists and 57 ILD experts. RESULTS 198 participants responded to the survey, including 135 (68%) rheumatologists and 54 (27%) respirologists. Over half (59%) of respondents routinely ordered HRCTs in all newly diagnosed SSc patients, although this practice was more common in Europe (83%), the United States (68%), Asia (73%) and Latin America (100%) compared to Canada (40%) and Australia (40%). Nearly half (48%) of respondents would not treat subclinical SSc-ILD, whereas 52% would treat or consider treatment. At least 70% would likely treat subclinical ILD in the setting of diffuse SSc, anti-topoisomerase-I autoantibodies, disease duration below 18 months, ground-glass opacities, oxygen desaturation, or significant ILD progression on imaging or pulmonary function tests. The majority (67%) of respirologists would not treat subclinical ILD. Mycophenolate mofetil was the preferred first-line drug for the treatment of subclinical SSc-ILD. CONCLUSION This international survey highlights important regional variations in SSc-ILD screening and significant heterogeneity among rheumatologists and respirologists in the treatment of subclinical SSc-ILD. High-quality research addressing these questions is needed to produce evidence-based guidelines and harmonize the approach to identification and treatment of subclinical SSc-ILD.
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Affiliation(s)
- Sabrina Hoa
- Division of Rheumatology, Department of Medicine, Centre hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Murray Baron
- Division of Rheumatology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Marie Hudson
- Division of Rheumatology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Nevskaya T, Pope JE, Turk MA, Shu J, Marquardt A, van den Hoogen F, Khanna D, Fransen J, Matucci-Cerinic M, Baron M, Denton CP, Johnson SR. Systematic Analysis of the Literature in Search of Defining Systemic Sclerosis Subsets. J Rheumatol 2021; 48:1698-1717. [PMID: 33993109 PMCID: PMC10613330 DOI: 10.3899/jrheum.201594] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is a multisystem disease with heterogeneity in presentation and prognosis.An international collaboration to develop new SSc subset criteria is underway. Our objectives were to identify systems of SSc subset classification and synthesize novel concepts to inform development of new criteria. METHODS Medline, Cochrane MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Web of Science were searched from their inceptions to December 2019 for studies related to SSc subclassification, limited to humans and without language or sample size restrictions. RESULTS Of 5686 citations, 102 studies reported original data on SSc subsets. Subset classification systems relied on extent of skin involvement and/or SSc-specific autoantibodies (n = 61), nailfold capillary patterns (n = 29), and molecular, genomic, and cellular patterns (n = 12). While some systems of subset classification confer prognostic value for clinical phenotype, severity, and mortality, only subsetting by gene expression signatures in tissue samples has been associated with response to therapy. CONCLUSION Subsetting on extent of skin involvement remains important. Novel disease attributes including SSc-specific autoantibodies, nailfold capillary patterns, and tissue gene expression signatures have been proposed as innovative means of SSc subsetting.
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Affiliation(s)
- Tatiana Nevskaya
- T. Nevskaya, MD, PhD, J.E. Pope, MD, MPH, M.A. Turk, MSc, J. Shu, MD, HBSc, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Janet E Pope
- T. Nevskaya, MD, PhD, J.E. Pope, MD, MPH, M.A. Turk, MSc, J. Shu, MD, HBSc, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Matthew A Turk
- T. Nevskaya, MD, PhD, J.E. Pope, MD, MPH, M.A. Turk, MSc, J. Shu, MD, HBSc, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Jenny Shu
- T. Nevskaya, MD, PhD, J.E. Pope, MD, MPH, M.A. Turk, MSc, J. Shu, MD, HBSc, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - April Marquardt
- A. Marquardt, DO, D. Khanna, MD, MS, University of Michigan, Ann Arbor, Michigan, USA
| | - Frank van den Hoogen
- F. van den Hoogen, MD, PhD, St. Maartenskliniek and Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Dinesh Khanna
- A. Marquardt, DO, D. Khanna, MD, MS, University of Michigan, Ann Arbor, Michigan, USA
| | - Jaap Fransen
- J. Fransen, MSc, PhD, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Marco Matucci-Cerinic
- M. Matucci-Cerinic, MD, PhD, Department of Experimental and Clinical Medicine & Division of Rheumatology AOUC, Florence Italy University of Florence, Florence, Italy
| | - Murray Baron
- M. Baron, MD, McGill University, Division Head Rheumatology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Christopher P Denton
- C.P. Denton, FRCP, PhD, University College London, Division of Medicine, London, UK
| | - Sindhu R Johnson
- S.R. Johnson, MD, PhD, Toronto Scleroderma Program, Toronto Western and Mount Sinai Hospitals, Department of Medicine, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
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Hoa S, Lazizi S, Baron M, Wang M, Fritzler MJ, Hudson M. Association between autoantibodies in systemic sclerosis and cancer in a national registry. Rheumatology (Oxford) 2021; 61:2905-2914. [PMID: 34599801 DOI: 10.1093/rheumatology/keab735] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/24/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE A close temporal relationship between systemic sclerosis (SSc) onset and cancer has been reported in anti-RNA polymerase III-positive patients. We investigated the association between cancer and other SSc autoantibodies in a national SSc registry. METHODS SSc patients enrolled in the Canadian Scleroderma Research Group registry from 2004 to 2019 were characterized according to autoantibodies to centromere, topoisomerase I/Scl70, RNA polymerase III, fibrillarin, Th/To (hPOP1), PM/Scl, Ku, NOR90, Ro52/TRIM21 and U1RNP. Logistic regression was used to examine the association between a close cancer-SSc interval and autoantibody status, adjusted for age, sex, race and smoking history. RESULTS Of 1698 SSc patients, 1481 (87%) had available autoantibody data. Cancer was diagnosed within 2, 3 and 5 years of the first non-Raynaud manifestation in 1.3%, 2.1% and 3.5% of patients. The most frequent cancers diagnosed within 2 years were breast (33%), gynaecological (19%) and haematological (14%) cancers. The risk of cancer within 2 years was increased among anti-topoisomerase I (OR 3.43, 95% CI 1.04-10.05) and anti-U1-RNP-positive patients (OR 5.54, 95% CI 1.16-20.40), but not with anti-RNA polymerase III. None of the anti-fibrillarin, Th/To, PM/Scl, Ku and NOR90-positive patients had cancer within 2 years. Patients with anti-centromere or none of the tested autoantibodies had numerically lower risks of developing cancer within two years. CONCLUSION Synchronous cancer was rare in this large cohort of predominantly female and White SSc patients. The risk of cancer within 2 years was increased among anti-topoisomerase I and anti-U1-RNP-positive patients. Screening strategies guided by autoantibodies require further careful consideration.
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Affiliation(s)
- Sabrina Hoa
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Division of Rheumatology, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Research Center of the Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Selma Lazizi
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Murray Baron
- Department of Medicine, McGill University, Montreal, Quebec, Canada.,Division of Rheumatology, Jewish General Hospital, Montreal, Quebec, Canada.,Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Mianbo Wang
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Marvin J Fritzler
- Department of Medicine, Cumming School of Medicine, University of Calgary
| | - Marie Hudson
- Department of Medicine, McGill University, Montreal, Quebec, Canada.,Division of Rheumatology, Jewish General Hospital, Montreal, Quebec, Canada.,Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
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Wortman B, Post C, Powell M, Khaw P, Fyles A, D’Amico R, Haie-Meder C, Jurgenliemk-Schulz I, McCormack M, Do V, Katsaros D, Bessette P, Baron M, Nout R, Whitmarsh K, Mileshkin L, Lutgens L, Kitchener H, Brooks S, Nijman H, Astreinidou E, Putter H, Creutzberg C, de Boer S. OC-0298 Toxicity and patient-reported symptoms after 3D-conformal or intensity-modulated pelvic radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Richard N, Gyger G, Hoa S, Proudman S, Stevens W, Nikpour M, Wang M, Schnitzer ME, Baron M, Hudson M. Immunosuppression does not prevent severe gastrointestinal tract involvement in systemic sclerosis. Clin Exp Rheumatol 2021; 39 Suppl 131:142-148. [PMID: 34128797 DOI: 10.55563/clinexprheumatol/7683pg] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/19/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We aimed to test the hypothesis that exposure to immunosuppression in early systemic sclerosis (SSc) could modify the risk of developing new onset severe gastrointestinal (GIT) involvement. METHODS A total of 762 subjects with <3 years of disease duration and without severe GIT disease at baseline study visit were identified from combined longitudinal cohort data from the Canadian Scleroderma Research Group (CSRG) and Australian Scleroderma Interest Group (ASIG). The primary exposure was ever use of methotrexate, cyclophosphamide, mycophenolate mofetil and/or azathioprine during the study period. Severe GIT disease was defined as: 1-malabsorption, 2-hyperalimentation, 3-pseudo-obstruction, and/or 4-≥10% weight loss in association with the use of antibiotics for bacterial overgrowth or oesophageal stricture. The change in the hazard of severe GIT disease due to exposure was estimated using a marginal structural Cox proportional hazards model fit by inverse probability of treatment weights (IPTW) to address potential confounding. RESULTS Study subjects were 81.5% female, had a mean age of 53.7±13.0 years and mean disease duration at baseline of 1.4±0.8 years. During a mean follow-up of 4.0±2.6 years, severe GIT involvement developed in 11.6% of the 319 subjects exposed to immunosuppression and in 6.8% of the 443 unexposed subjects. In an IPTW-adjusted analysis, exposure to immunosuppression was not associated with severe GIT disease (weighted hazard ratio 0.91, 95% confidence interval 0.52-1.58). CONCLUSIONS In this large inception SSc cohort, the risk of severe GIT involvement was not modified by exposure to immunosuppression.
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Affiliation(s)
- Nicolas Richard
- Division of Rheumatology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, and Department of Medicine, Université de Montreal, Quebec, Canada
| | - Geneviève Gyger
- Department of Medicine, McGill University, Montreal, Quebec, and Division of Rheumatology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Sabrina Hoa
- Department of Medicine, Université de Montreal, Quebec, and Division of Rheumatology, Centre Hospitalier de l'Université de Montréal, Quebec, Canada
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, and Discipline of Medicine, University of Adelaide, South Australia
| | - Wendy Stevens
- Rheumatology, St. Vincent Hospital, Melbourne, Fitzroy, Victoria, Australia
| | - Mandana Nikpour
- Rheumatology, St. Vincent Hospital, Melbourne, Fitzroy, Victoria, and Department of Medicine, University of Melbourne at St Vincent Hospital, Melbourne, Victoria, Australia
| | - Mianbo Wang
- Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Mireille E Schnitzer
- Faculty of Pharmacy and School of Public Health, Université de Montreal, Quebec, Canada
| | - Murray Baron
- Department of Medicine, McGill University, Montreal, Quebec, and Division of Rheumatology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Marie Hudson
- Department of Medicine, McGill University, Montreal, Quebec; Division of Rheumatology, Jewish General Hospital, Montreal, Quebec, and Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.
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Spiera R, Khanna D, Kuwana M, Furst DE, Frech TM, Hummers L, Stevens W, Matucci-Cerinic M, Baron M, Distler O, Dgetluck N, Bloom BJ, Dinh Q, White B, Denton CP. A randomised, double-blind, placebo-controlled phase 3 study of lenabasum in diffuse cutaneous systemic sclerosis: RESOLVE-1 design and rationale. Clin Exp Rheumatol 2021; 39 Suppl 131:124-133. [PMID: 34323681 DOI: 10.55563/clinexprheumatol/i80zh7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/27/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The multi-systemic, heterogenous nature of diffuse cutaneous systemic sclerosis (dcSSc) presents challenges in designing clinical studies that can demonstrate a treatment effect on overall disease burden. We describe the design of the first Phase 3 study in dcSSc patients where the American College of Rheumatology (ACR) Combined Response Index in diffuse cutaneous Systemic Sclerosis (CRISS) score was chosen prospectively as the primary outcome. The CRISS measures key clinical disease parameters and patient-reported outcomes (PROs). METHODS RESOLVE-1 is a Phase 3, randomised, double-blind, placebo-controlled trial of dcSSc patients evaluating the efficacy and safety of lenabasum. Patients ≥18 years of age with dc-SSc and disease duration ≤6 years were eligible. Patients could continue stable background therapy for dcSSc, including stable immunosuppressive therapies. They were randomised to lenabasum 5 or 20 mg twice daily or placebo. The primary efficacy outcome was the mean change from baseline to 52 weeks in the ACR CRISS score. RESULTS The study enrolled 365 patients over 1.5 years at 77 sites in 13 countries in North America, Europe, Israel, and Asia-Pacific, with the last patient first visit on May 1, 2019. CONCLUSIONS RESOLVE-1 is the first Phase 3 interventional study to date in dcSSc to prospectively use the ACR CRISS as the primary efficacy outcome. Eligibility criteria allowed background therapy as might occur in clinical practice. This approach also facilitated timely patient enrolment. RESOLVE-1 provides a novel study design that may be used for future Phase 3 dcSSc studies to assess the holistic efficacy of therapy.
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Affiliation(s)
- Robert Spiera
- Weill Cornell Medical College, New York City, NY, USA.
| | - Dinesh Khanna
- University of Michigan Scleroderma Program, Ann Arbor, MI, USA
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Daniel E Furst
- Department of Rheumatology, University of California in Los Angeles, CA, USA
| | - Tracy M Frech
- University of Utah and Salt Lake City VA Health Care System Salt Lake City, UT, USA
| | - Laura Hummers
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wendy Stevens
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Marco Matucci-Cerinic
- Department of Experimental Rheumatology, University of Florence and Division of Rheumatology AOUC, Florence, Italy
| | - Murray Baron
- Division of Rheumatology, Jewish General Hospital, Montreal, Canada
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Switzerland
| | | | | | - Quinn Dinh
- Corbus Pharmaceuticals, Inc. Norwood, MA, USA
| | | | - Christopher P Denton
- UCL Centre for Rheumatology and Connective Tissue Diseases, Royal Free Campus, University College London, UK
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Hoa S, Bernatsky S, Baron M, Proudman S, Stevens W, Sahhar J, Wang M, Steele RJ, Nikpour M, Hudson M. Association Between Immunosuppressive Therapy and Incident Risk of Interstitial Lung Disease in Systemic Sclerosis. Chest 2021; 160:2158-2162. [PMID: 34153341 DOI: 10.1016/j.chest.2021.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/14/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sabrina Hoa
- Division of Rheumatology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Department of Medicine, Université de Montréal, Montreal, QC, Canada; Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.
| | - Sasha Bernatsky
- Department of Medicine, McGill University, Montreal, QC, Canada; Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Murray Baron
- Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada; Department of Medicine, McGill University, Montreal, QC, Canada; Division of Rheumatology, Jewish General Hospital, Montreal, QC, Canada
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, Adelaide, SA, Australia; Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Wendy Stevens
- Department of Rheumatology, St. Vincent's Hospital (Melbourne), Fitzroy, VIC, Australia
| | - Joanne Sahhar
- Department of Rheumatology, Monash Health, Clayton, VIC, Australia
| | - Mianbo Wang
- Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Russell J Steele
- Department of Mathematics and Statistics, McGill University, Montreal, QC, Canada
| | | | | | - Mandana Nikpour
- Department of Rheumatology, St. Vincent's Hospital (Melbourne), Fitzroy, VIC, Australia; Department of Medicine, University of Melbourne at St. Vincent's Hospital (Melbourne), Fitzroy, VIC, Australia
| | - Marie Hudson
- Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada; Department of Medicine, McGill University, Montreal, QC, Canada; Division of Rheumatology, Jewish General Hospital, Montreal, QC, Canada
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Mancini OK, Acevedo M, Fazez N, Cuillerier A, Ruiz AF, Huynh DN, Burelle Y, Ferbeyre G, Baron M, Servant MJ. Oxidative stress-induced senescence mediates inflammatory and fibrotic phenotypes in fibroblasts from systemic sclerosis patients. Rheumatology (Oxford) 2021; 61:1265-1275. [PMID: 34115840 DOI: 10.1093/rheumatology/keab477] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 05/28/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Systemic sclerosis (SSc) is an autoimmune connective tissue disorder characterized by inflammation and fibrosis. Although constitutive activation of fibroblasts is proposed to be responsible for the fibrotic and inflammatory features of the disease, the underlying mechanism remains elusive and, effective therapeutic targets are still lacking. The aim of this study was to evaluate the role of oxidative stress-induced senescence and its contribution to the pro-fibrotic and pro-inflammatory phenotypes of fibroblasts from SSc patients. METHODS Dermal fibroblasts were isolated from SSc (n = 13) and healthy (n = 10) donors. Fibroblast's intracellular and mitochondrial reactive oxygen species were determined by flow cytometry. Mitochondrial function measured by Seahorse XF24 analyzer. Fibrotic and inflammatory gene expressions were assessed by qPCR and key pro-inflammatory components of the fibroblasts' secretome (interleukin (IL) 6 and IL8) were quantified by ELISA. RESULTS Compared to healthy fibroblasts, SSc fibroblasts displayed higher levels of both intracellular and mitochondrial ROS. Oxidative stress in SSc fibroblasts induced the expression of fibrotic genes and activated the transforming growth factor-β-activated kinase 1 (TAK1) -IκB kinase β (IKKβ)- interferon regulatory factor 5 (IRF5) inflammatory signaling cascade. These cellular responses paralleled the presence of a DNA damage response, a senescence-associated secretory phenotype and a fibrotic response. Treatment of SSc fibroblasts with ROS scavengers reduced their pro-inflammatory secretome production and fibrotic gene expression. CONCLUSIONS Oxidative stress-induced cellular senescence in SSc fibroblasts underlies their pro-inflammatory and pro-fibrotic phenotypes. Targeting redox imbalance of SSc fibroblasts enhances their in vitro functions and could be of relevance for SSc therapy.
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Affiliation(s)
| | | | - Nesrine Fazez
- Faculty of Pharmacy, Université de Montréal, Québec, Canada
| | - Alexanne Cuillerier
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Ana Fernandez Ruiz
- Département de biochimie et médecine moléculaire, Université de Montréal, Montréal, Québec, Canada
| | - David N Huynh
- Faculty of Pharmacy, Université de Montréal, Québec, Canada
| | - Yan Burelle
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Gerardo Ferbeyre
- Département de biochimie et médecine moléculaire, Université de Montréal, Montréal, Québec, Canada
| | - Murray Baron
- McGill University, Jewish General Hospital, Montréal, Québec, Canada
| | - Marc J Servant
- Faculty of Pharmacy, Université de Montréal, Québec, Canada
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Martin Calderon L, Baron M, Pope J. AB0419 ACCESS TO TREATMENT FOR RAYNAUD’S PHENOMENON AND DIGITAL ULCERS FOR PATIENTS WITH SYSTEMIC SCLEROSIS DOESN’T FOLLOW EULAR/EUSTAR GUIDELINES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Patients with Raynaud’s Phenomenon (RP) from systemic sclerosis (SSc) may experience severe complications. Digital ulcers (DUs), occur in approximately half the patients with SSc, and cause hand dysfunction, severe pain, and decreased quality of life. DUs lead to increased healthcare utilization and systemic economic burden through hospitalizations, ED visits, and ambulatory services (1). However, access to medications such as PDE5 inhibitors and prostacyclins that are within the EULAR/EUSTAR SSc guidelines (2) in a country with global health care but patchy pharmacare such as Canada has not been studied.Objectives:The purpose of this study was to elucidate the access to treatment of medications for RP and DU in patients with SSc in Canadian provinces through identifying the provincial and private insurance coverage of PDE5 inhibitors (PDE5i) and prostanoids, the timelines and procedures of requesting these medications, and the process of administering IV prostanoids if required for patient care.Methods:We designed an online survey and collected data through the Survey Monkey platform. The survey was administered to rheumatologists affiliated with the Canadian Scleroderma Research Group (CSRG) from December 2020 to January 2021. Responders were asked to report if the province or private insurance automatically provided PDE5i for patients with RP and DU or if a dedicated process was required to attain these medications. Additionally, responders were asked to describe the process of administering Iloprost, Epoprostenol and Alprostadil and the barriers inherent to their administration. Of note, there is no DIN number for Iloprost in Canada so every time it is used there must be an application to Health Canada.Results:The survey was completed by 100% of CSRG researchers (17/17), representing 8 provinces in Canada. None of the provincial governments provided coverage for PDE5i without special requests that were adjudicated on a case by case basis with approximately half the provinces paying for PDE5i upon special request if a patient was eligible for provincial drug insurance (ex elderly, youths, low income families). Two provinces, Quebec and Saskatchewan, provided PDE5i “all the time”. Whereas NS, MB, ON, BC, and AB provided them “sometimes”; NFLD provided them “never”. Provincial governments and private insurance fulfilled requests “within 1 month” 62% of the time and the other requests took longer to be answered. Private insurance approved coverage with special request in AB, MB, QC, ON, and NS. Respondents described administration of IV prostanoids as “inconsistent”, requiring “a lot of work”, and that patients in most jurisdictions be admitted as in-patients for provinces to cover these medications.Conclusion:Most jurisdiction within Canada do not provide coverage for PDE5i and the process to obtain access for patients is delayed, non-uniform, and often not approved. Intravenous prostanoid infusions are difficult to obtain and have system barriers. Advocacy and cost effectiveness data should be used to advocate for access to medications that are recommended within SSc recommendations.References:[1]Morrisroe K, et al. Digital ulcers in systemic sclerosis: their epidemiology, clinical characteristics, and associated clinical and economic burden. Arthritis research & therapy. 2019 Dec;21(1):1-2.[2]Kowal-Bielecka O, et al. Update of EULAR recommendations for the treatment of systemic sclerosis. Annals of the rheumatic diseases. 2017 Aug 1;76(8):1327-39.Disclosure of Interests:None declared
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Bérubé A, Clément MÈ, Lafantaisie V, LeBlanc A, Baron M, Picher G, Turgeon J, Ruiz-Casares M, Lacharité C. How societal responses to COVID-19 could contribute to child neglect. Child Abuse Negl 2021; 116:104761. [PMID: 33077248 PMCID: PMC7561330 DOI: 10.1016/j.chiabu.2020.104761] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND The ecosystemic approach to children's needs demands a cohesive response from societies, communities, and families. During the COVID-19 pandemic, the choices societies made to protect their community members from the virus could have created contexts of child neglect. With the closure of services and institutions, societies were no longer available to help meet the needs of children. OBJECTIVE The purpose of this study is to examine parents' reports on the response their children received to their needs during the COVID-19 crisis. METHODS During the period of the spring 2020 lockdown, 414 parents in the province of Quebec, Canada, completed an online questionnaire about the impact of the crisis on the response their children received to their needs. RESULTS Compared to parents of younger children, parents of older children reported less fulfillment of their child's needs in three measured domains, namely cognitive and affective, security, and basic care needs. CONCLUSION These results are discussed in light of the policies and the resources societies have put in place during the crisis to help families meet the needs of their children. Societies must learn from this crisis to put children at the top of their priorities in the face of a societal crisis. Thoughtful discussions and energy must be given to ensure that, while facing a crisis, the developmental trajectories of children are not sacrificed.
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Affiliation(s)
- A Bérubé
- Université du Québec en Outaouais, 283 Boul Alexandre-Taché, Gatineau, J8X 3X7, Canada.
| | - M-È Clément
- Université du Québec en Outaouais, 283 Boul Alexandre-Taché, Gatineau, J8X 3X7, Canada
| | - V Lafantaisie
- Université du Québec en Outaouais, 283 Boul Alexandre-Taché, Gatineau, J8X 3X7, Canada
| | - A LeBlanc
- Université Laval, 2325 Rue de l'Université, Québec, QC G1V 0A6, Canada; VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center (CIUSSS de la Capitale Nationale), Canada
| | - M Baron
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center (CIUSSS de la Capitale Nationale), Canada
| | - G Picher
- Université Laval, 2325 Rue de l'Université, Québec, QC G1V 0A6, Canada; CERVO Research Center, Quebec Integrated University Health and Social Services Center (CIUSSS de la Capitale Nationale), Canada
| | - J Turgeon
- Université du Québec en Outaouais, 283 Boul Alexandre-Taché, Gatineau, J8X 3X7, Canada
| | - M Ruiz-Casares
- McGill University, 845 Sherbrooke Ouest, Montreal, H3A 0G4, Canada
| | - C Lacharité
- Université du Québec à Trois-Rivières, 3351 Boulevard des Forges, Trois-Rivières, G8Z 4M3, Canada
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Hurtubise R, Hudson M, Gyger G, Wang M, Steele RJ, Baron M, Hoa S. Association between gastroprotective agents and risk of incident interstitial lung disease in systemic sclerosis. Respir Med 2021; 185:106482. [PMID: 34089970 DOI: 10.1016/j.rmed.2021.106482] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Although interstitial lung disease (ILD) occurs in over half of systemic sclerosis (SSc) patients and represents a leading cause of mortality, there are currently no preventative strategies. We evaluated if gastroprotective agents were associated with a lower incident risk of SSc-ILD. METHODS An SSc cohort without clinically apparent ILD at baseline was constructed from the Canadian Scleroderma Research Group registry. The primary exposure was any use of gastroprotective agents. Treatment with promotility agents was assessed as a secondary exposure. Time to development of clinically apparent ILD was compared between exposed and unexposed person-time, using a multivariable marginal structural Cox model incorporating inverse probability of treatment weights to address time-varying confounding. RESULTS In total, 798 subjects met inclusion criteria. At cohort entry, median disease duration was 7.6 (IQR 3.9-15.6) years. During a median 4.4 (IQR 2.6-7.2) years of follow-up, 158 new ILD cases were diagnosed, for a crude incidence of 4.4 (95% CI 3.8-5.1) events per 100 person-years. Most (2085, 73.4%) person-visits were exposed to gastroprotective agents, 579 (20.4%) were exposed to promotility agents, and 554 (19.5%) were exposed to both agents. The marginal structural weighted hazard ratio (HR) for incident ILD related to gastroprotective agents was 0.86 (95% CI 0.52-1.41). When exposure was defined as treatment with promotility agents, the weighted adjusted HR was 0.79 (95% CI: 0.35-1.77). CONCLUSION In this large retrospective cohort study, we were unable to demonstrate a protective role for gastroprotective and promotility agents in preventing clinically apparent SSc-ILD.
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Affiliation(s)
- Raphaël Hurtubise
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Marie Hudson
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Rheumatology, Jewish General Hospital, Montreal, Quebec, Canada; Lady Davis Institute of Medical Research, Montreal, Quebec, Canada
| | - Geneviève Gyger
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Rheumatology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Mianbo Wang
- Lady Davis Institute of Medical Research, Montreal, Quebec, Canada
| | - Russell J Steele
- Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada
| | - Murray Baron
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Rheumatology, Jewish General Hospital, Montreal, Quebec, Canada; Lady Davis Institute of Medical Research, Montreal, Quebec, Canada
| | - Sabrina Hoa
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada; Division of Rheumatology, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
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Muntyanu A, Ouchene L, Hudson M, Baron M, Netchiporouk E. 317 Geographical distribution of systemic sclerosis in Canada: A large Canadian database study. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fosse A, Karam G, Kerleau C, Perrouin-Verbe, Rigaud J, Baron M, Mesnard B, Hedhli O, Ville S, De Vergie S, Chelghaf I, Loubersac T, Boutin JM, Faivre d'Arcier B, Bruyère F, Cantarovich D, Branchereau J. [Acute renal failure of the donor in encephalic death: A real contraindication to kidney transplantation?]. Prog Urol 2021; 31:519-530. [PMID: 33478867 DOI: 10.1016/j.purol.2020.11.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The shortage of kidney transplants encourages the expansion of the limits of eligibility criteria for donation. Many donors who are brain dead display acute renal failure at the time of death; is this a real contraindication to harvesting? The aim of this study was to assess kidney graft survival from donors after brain death with confirmed acute renal failure, with or without anuria previous donation. MATERIALS AND METHODS All of the transplants performed in two university hospitals between 2010 and 2017 were analyzed retrospectively. All patients who underwent single kidney transplant from a brain-dead donor with acute renal failure (ARF) were included in this study. ARI was defined here by a decrease over 50 % of glomerular filtration rate (GFR) to a threshold below 45mL/min/1.73 m2 at the time of kidney procurement. Kidney graft survival, incidence of delayed graft function (DGF) and the GFR at 12 months were analyzed. Analysis of kidney transplant survival based on pre-implantation biopsies was additionally done. RESULTS One hundred and sixty four patients were transplanted with a kidney from donor with ARF during the selected period. At the admission in ICU the average GFR was 67,7±19mL/min/1,73m2. At the time of donation, the average age of donors was 56.4±17.7 years, the GFR was 33.7±8.0mL/min/1.73 m2 16 % of donors were anuric. Cold ischemia time (CIT) was 16.8±5.0hours. The average age of recipients was 55.6±14.1 years. 81 % of the cases were primary transplants. Graft function took place within 7.8±9.4 days after transplantation. There were two non-primary functions (PNF). One hundred and fifty two patients (93 %) had a functional graft at 12 months. The mean GFR at 12 months was 46.8±20.1mL/min/1.73 m2 and 122 patients (73 %) had a GFR greater than 30mL/min/1.73 m2. Seventy-one percent of preimplantation biopsies revealed acute tubular necrosis (ATU); no cortical necrosis was observed. Survival of theses grafts was 85 %, comparable to the total population of study (P=0,21) CONCLUSION: The acute renal failure of the brain-dead donor should not alone be systematically a contraindication to harvesting and kidney transplantation.
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Affiliation(s)
- A Fosse
- Service d'urologie et de transplantations rénales, CHRU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
| | - G Karam
- Service d'urologie et de transplantations rénales, CHRU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France; Institut de transplantation urologie-néphrologie, 30, boulevard Jean-Monnet, 44093 Nantes, France
| | - C Kerleau
- Institut de transplantation urologie-néphrologie, 30, boulevard Jean-Monnet, 44093 Nantes, France; Centre de recherche en transplantation et immunologie, UMR 1064, Inserm, 30, boulevard Jean-Monnet, 44093 Nantes, France
| | - Perrouin-Verbe
- Institut de transplantation urologie-néphrologie, 30, boulevard Jean-Monnet, 44093 Nantes, France
| | - J Rigaud
- Service d'urologie et de transplantations rénales, CHRU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France; Institut de transplantation urologie-néphrologie, 30, boulevard Jean-Monnet, 44093 Nantes, France
| | - M Baron
- Service d'urologie, CHU de Rouen, 76031 Rouen cedex 1, France
| | - B Mesnard
- Service d'urologie et de transplantations rénales, CHRU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - O Hedhli
- Service d'urologie et de transplantations rénales, CHRU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - S Ville
- Institut de transplantation urologie-néphrologie, 30, boulevard Jean-Monnet, 44093 Nantes, France; Centre de recherche en transplantation et immunologie, UMR 1064, Inserm, 30, boulevard Jean-Monnet, 44093 Nantes, France
| | - S De Vergie
- Service d'urologie et de transplantations rénales, CHRU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - I Chelghaf
- Service d'urologie et de transplantations rénales, CHRU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - T Loubersac
- Service d'urologie et de transplantations rénales, CHRU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - J M Boutin
- Service d'urologie, CHRU de Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - B Faivre d'Arcier
- Service d'urologie, CHRU de Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - F Bruyère
- Service d'urologie, CHRU de Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - D Cantarovich
- Institut de transplantation urologie-néphrologie, 30, boulevard Jean-Monnet, 44093 Nantes, France; Centre de recherche en transplantation et immunologie, UMR 1064, Inserm, 30, boulevard Jean-Monnet, 44093 Nantes, France
| | - J Branchereau
- Service d'urologie et de transplantations rénales, CHRU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France; Institut de transplantation urologie-néphrologie, 30, boulevard Jean-Monnet, 44093 Nantes, France; Centre de recherche en transplantation et immunologie, UMR 1064, Inserm, 30, boulevard Jean-Monnet, 44093 Nantes, France; Nuffield department of surgical sciences, Oxford university, Oxford, UK
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Maltez N, Choi MY, Troyanov Y, Wang M, Jantz M, Fritzler MJ, Baron M, Hudson M. Trigeminal neuralgia in systemic sclerosis. Semin Arthritis Rheum 2021; 51:318-323. [PMID: 33461050 DOI: 10.1016/j.semarthrit.2021.01.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/29/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Although trigeminal neuralgia (TN) has been associated with systemic sclerosis (SSc), there is a paucity of evidence and pathophysiological processes remain unknown. We undertook a nested case-control study to identify associations between TN and SSc in a large multi-centered cohort and identify possible pathophysiological links. METHODS Data were derived from a longitudinal cohort of 1652 SSc subjects. Cases with a physician-reported diagnosis of TN were identified at baseline visit (prevalent) and during follow-up (incident). Each case was matched on study visit to four SSc patients without TN. Sociodemographic, clinical and serological characteristics of cases and controls were compared. RESULTS At enrolment, 43/1652 (2.6%) subjects had a history of TN. During follow-up, an additional 36 subjects developed TN over 6193 person-years of observation (incidence rate 5.8 per 1000 person-years). Cases were identified and matched to 172 and 144 controls, respectively. Compared to controls, prevalent cases had more inflammatory myositis (24.4% versus 5.2%, p<0.001) and inflammatory arthritis (46.5% versus 30.2%, p = 0.043). Incident cases also had more inflammatory myositis (19.4% versus. 6.3%, p = 0.033) and inflammatory arthritis (50.0% versus. 16.2%, p<0.001) compared to controls. There was a trend towards more interstitial lung disease in prevalent (32.6% versus 23.8%, p = 0.241) and incident (55.6% versus 40.6%, p = 0.105) cases compared to controls. CONCLUSION This study provides novel evidence for a clinical association linking TN, inflammatory myositis, inflammatory arthritis and possibly interstitial lung disease. In addition to ischemia, we propose that TN in SSc could also be a consequence of inflammatory and possibly fibrotic processes.
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Affiliation(s)
- Nancy Maltez
- Department of Medicine, Division of Rheumatology, The Ottawa Hospital, Ottawa, ON, Canada.
| | - May Y Choi
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Yves Troyanov
- Division of Rheumatology, Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Mianbo Wang
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Mackenzie Jantz
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marvin J Fritzler
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Murray Baron
- Division of Rheumatology, Jewish General Hospital, Montreal, QC, Canada; Department of Medicine, McGill University, Montreal, QC, Canada
| | - Marie Hudson
- Lady Davis Institute for Medical Research, Montreal, QC, Canada; Division of Rheumatology, Jewish General Hospital, Montreal, QC, Canada; Department of Medicine, McGill University, Montreal, QC, Canada
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Wu Y, Levis B, Riehm KE, Saadat N, Levis AW, Azar M, Rice DB, Boruff J, Cuijpers P, Gilbody S, Ioannidis JPA, Kloda LA, McMillan D, Patten SB, Shrier I, Ziegelstein RC, Akena DH, Arroll B, Ayalon L, Baradaran HR, Baron M, Bombardier CH, Butterworth P, Carter G, Chagas MH, Chan JCN, Cholera R, Conwell Y, de Manvan Ginkel JM, Fann JR, Fischer FH, Fung D, Gelaye B, Goodyear-Smith F, Greeno CG, Hall BJ, Harrison PA, Härter M, Hegerl U, Hides L, Hobfoll SE, Hudson M, Hyphantis T, Inagaki M, Jetté N, Khamseh ME, Kiely KM, Kwan Y, Lamers F, Liu SI, Lotrakul M, Loureiro SR, Löwe B, McGuire A, Mohd-Sidik S, Munhoz TN, Muramatsu K, Osório FL, Patel V, Pence BW, Persoons P, Picardi A, Reuter K, Rooney AG, Santos IS, Shaaban J, Sidebottom A, Simning A, Stafford L, Sung S, Tan PLL, Turner A, van Weert HC, White J, Whooley MA, Winkley K, Yamada M, Benedetti A, Thombs BD. Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis - ERRATUM. Psychol Med 2020; 50:2816. [PMID: 31423953 DOI: 10.1017/s0033291719002137] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ross L, Stevens W, Wilson M, Strickland G, Walker J, Sahhar J, Ngian GS, Roddy J, Major G, Proudman S, Baron M, Nikpour M. Can Patient-Reported Symptoms Be Used to Measure Disease Activity in Systemic Sclerosis? Arthritis Care Res (Hoboken) 2020; 72:1459-1465. [PMID: 31421031 DOI: 10.1002/acr.24053] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/13/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To evaluate the association between patient-reported symptoms and changes in disease activity over time in systemic sclerosis (SSc). METHODS Using data from 1,636 patients enrolled in the Australian Scleroderma Cohort Study, we used generalized estimating equations to determine the relationship between patient-reported worsening of Raynaud's phenomenon (RP), skin involvement, and breathlessness in the month preceding each study visit and features of disease activity in the corresponding organ systems. The associations between the following parameters were analyzed: patient-reported worsening RP and the presence of new-onset digital pitting and digital ulcers; patient-reported worsening skin involvement and increasing modified Rodnan skin thickness score (MRSS); new areas of skin involvement and new-onset joint contractures; patient-reported worsening breathlessness and deteriorating respiratory functions test (RFT) results, indicated by a 10% decrease in forced vital capacity (FVC) and a 15% decrease in diffusing capacity for carbon monoxide (DLco), new-onset interstitial lung disease (ILD), and new-onset pulmonary arterial hypertension (PAH). RESULTS We found a significant association between patient-reported worsening RP and the presence of digital ulcers (odds ratio [OR] 1.53 [95% confidence interval (95% CI) 0.60-0.93]), patient-reported worsening skin involvement and increasing MRSS (OR 2.10 [95% CI 1.54-2.86]), and worsening patient breathlessness and deteriorating RFTs (FVC OR 2.12 [95% CI 1.70-2.65]; DLco OR 1.97 [95% CI 1.34-2.02]), new-onset ILD (OR 1.91 [95% CI 1.40-2.61]), and new-onset PAH (OR 5.08 [95% CI 3.59-7.19]). CONCLUSION These results demonstrate that patient-reported symptoms are associated with clinically meaningful changes in disease activity in patients with SSc. This suggests that when objective measures of change in disease status are unavailable, patient-reported symptoms could be used to indicate a change in SSc disease activity.
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Affiliation(s)
- Laura Ross
- St. Vincent's Hospital Melbourne and the University of Melbourne, Fitzroy, Victoria, Australia
| | - Wendy Stevens
- St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Michelle Wilson
- St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | | | - Jennifer Walker
- Flinders Medical Centre, Bedford Park, South Australia, Australia, and Royal Adelaide Hospital and Flinders University, Adelaide, South Australia, Australia
| | - Joanne Sahhar
- Monash Health and Monash University, Clayton, Victoria, Australia
| | - Gene-Siew Ngian
- Monash Health and Monash University, Clayton, Victoria, Australia
| | - Janet Roddy
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Gabor Major
- Royal Newcastle Centre, New Lambton Heights, New South Wales, Australia
| | - Susanna Proudman
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Murray Baron
- Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
| | - Mandana Nikpour
- St. Vincent's Hospital Melbourne and the University of Melbourne, Fitzroy, Victoria, Australia
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Post C, De Boer S, Powell M, Mileshkin L, Katsaros D, Bessette P, Haie-Meder C, Ottevanger P, Ledermann J, Khaw P, D'Amico R, Fyles A, Baron M, Kitchener H, Nijman H, Lutgens L, Brooks S, Jürgenliemk-Schulz I, Feeney A, Nout R, Verhoeven-Adema K, Smit V, Putter H, Creutzberg C. OC-0369: Long-Term Quality of Life after (chemo)radiotherapy for high-risk Endometrial Cancer in PORTEC-3. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00393-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ouchene L, Muntyanu A, Lavoué J, Baron M, Litvinov IV, Netchiporouk E. Toward Understanding of Environmental Risk Factors in Systemic Sclerosis [Formula: see text]. J Cutan Med Surg 2020; 25:188-204. [PMID: 32988228 DOI: 10.1177/1203475420957950] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Systemic sclerosis (SSc) is a severe, chronic, and incurable autoimmune fibrotic skin disease with significant extracutaneous involvement. Low concordance rate in twin studies and unequal geographic distribution of SSc argues for importance of environment in disease initiation and progression. OBJECTIVE In this manuscript we provide a summary of all investigated potential external risk factors for SSc. DATA SOURCES A literature search in PubMed and EMBASE database was performed for studies published until January 1, 2020 by 2 reviewers (EN and LO) independently. FINDINGS Occupational and/or environmental exposures to silica and organic solvents are associated with increased incidence and severity of SSc. Exposure to epoxy resins, asbestos, and particulate air pollution favors increased risk of SSc, but data are based on limited number of observational studies. There is insufficient evidence to conclude an association between SSc development and other occupational (eg, welding fumes) or personal exposures (eg, smoking, vitamin D deficiency). Association of SSc with silicone breast implants has been disproven. Infectious pathogens (eg, Helicobacter pylori and angiotropic viruses) and dysbiosis seem to play a role in SSc development and severity, but their role remains to be clarified. CONCLUSIONS AND RELEVANCE It may be prudent to counsel our patients with SSc (or those at risk of SSc) to avoid occupations with exposure to silica, organic solvents, asbestos and epoxy resins; restraint from smoking, using cocaine or drugs with pro-fibrotic potential. While the association between low vitamin D and SSc remains to be confirmed, we believe that SSc patients should be encouraged to maintain healthy vitamin D levels as benefits outweigh the risks.
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Affiliation(s)
- Lydia Ouchene
- 12367 Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Anastasiya Muntyanu
- 54473 Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Jérôme Lavoué
- 5622 Department of Environmental and Occupational Health, School of Public Health, Université de Montreal, Montreal, Québec, Canada
| | - Murray Baron
- 5621 Division of Rheumatology, Department of Medicine, Jewish General Hospital, Montreal, QC, Canada
| | - Ivan V Litvinov
- 54473 Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Elena Netchiporouk
- 54473 Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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Nevskaya T, Zheng B, Baxter CA, Ramey DR, Pope JE, Baron M. Skin improvement is a surrogate for favourable changes in other organ systems in early diffuse cutaneous systemic sclerosis. Rheumatology (Oxford) 2020; 59:1715-1724. [PMID: 31774531 DOI: 10.1093/rheumatology/kez529] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/26/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Skin improvement in diffuse cutaneous SSc (dcSSc), measured with modified Rodnan skin score (mRSS), is frequently used as a primary outcome in clinical trials, but it is uncertain whether mRSS changes reflect changes in other organ systems. This aim of this study was to explore if skin changes in early dcSSc over 1 and 2 years are associated with changes in severity of other organ involvement. METHODS Canadian Scleroderma Research Group database patients with dcSSc, disease duration of ≤5 years, no evidence of initial end-stage organ damage and/or significant comorbidity who had 1 year (n = 154) and 2 years (n = 128) of follow-up data were included. mRSS changes of 25% and/or ≥5 points were considered significant. Organ involvement was assessed by Medsger Disease Severity Score and Canadian Scleroderma Research Group definitions using bivariate, chi-square, ANOVA, adjusted regression and longitudinal mixed effect model analyses. RESULTS Improvement in mRSS was found in 41% of patients at 1 year and in 50% at 2 years. Improved patients showed less forced vital capacity decline (P = 0.012) and less frequent new cardiac involvement (P = 0.02) over 1 year, as well as better lung (by both Disease Severity Score, P = 0.006, and Δforced vital capacity%, P = 0.026), peripheral vascular (P = 0.006) and joint/tendon (P = 0.002) involvement over 2 years. mRSS worsening was consistently linked to less favourable lung outcomes at both 1- and 2-year follow-up visits, and more severe gastrointestinal disease at 2 years. CONCLUSION Changes in lung function in early dcSSc closely parallel skin changes. mRSS improvement reflects better prognosis for visceral disease and may be a reliable outcome measure in clinical trials.
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Affiliation(s)
| | - Boyang Zheng
- Division of Rheumatology, McGill University, Montreal, QC, Canada
| | | | | | | | - Murray Baron
- Division of Rheumatology, McGill University, Montreal, QC, Canada.,Department of Medicine, Jewish General Hospital, Montreal, QC, Canada
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Maltez N, Puyade M, Wang M, Lansiaux P, Marjanovic Z, Charles C, Steele R, Baron M, Colmegna I, Hudson M, Farge D. Association of Autologous Hematopoietic Stem Cell Transplantation in Systemic Sclerosis With Marked Improvement in Health-Related Quality of Life. Arthritis Rheumatol 2020; 73:305-314. [PMID: 32909693 DOI: 10.1002/art.41519] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 08/18/2020] [Accepted: 09/03/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To quantify the magnitude, domains, and duration of change in health-related quality of life (HRQoL) in patients with systemic sclerosis (SSc) who underwent autologous hematopoietic stem cell transplantation (HSCT) as compared to SSc patients with similar characteristics who did not undergo autologous HSCT. METHODS The study was designed as a retrospective study comparing SSc patients who underwent autologous HSCT and SSc patients who met the criteria for transplantation but were treated with conventional care. Outcomes included scores on the 36-item Short Form (SF-36) health survey and the Health Assessment Questionnaire (HAQ) and its disease-specific symptom scales. Differences in scores between the groups were compared using linear models, adjusting for baseline scores and inverse probability of treatment and censoring weights. RESULTS In total, 41 SSc patients who underwent autologous HSCT and 65 SSc patients treated with conventional care were compared. In marginal linear weighted models, the SF-36 physical component summary score was a mean ± SEM 7.02 ± 1.94 points higher at the first annual visit (P = 0.001) and 14.40 ± 6.16 points higher at the seventh annual visit (P = 0.03) in patients treated with autologous HSCT compared to the conventional care group. HAQ scores were significantly better in the autologous HSCT group compared to the conventional care group during follow-up (mean ± SEM difference from baseline -0.57 ± 0.13 [P < 0.001] at the first annual visit and -0.94 ± 0.49 [P = 0.07] at the seventh annual visit). There were no differences in the SF-36 mental component summary scores between the 2 groups either at baseline or during follow-up. CONCLUSION This study provides robust complementary HRQoL data, including overall and event-free survival data, to expand on the standard repertoire of biomedical variables, thus potentially supporting the physical benefits of autologous HSCT in patients with SSc.
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Affiliation(s)
| | | | - Mianbo Wang
- Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Pauline Lansiaux
- Centre de Référence des Maladies Auto-Immunes Systémiques Rares d'Ile-de-France, AP-HP, Hôpital St. Louis, Université de Paris, Institut de Recherche St. Louis, EA 3518, Paris, France
| | | | - Catney Charles
- Centre de Référence des Maladies Auto-Immunes Systémiques Rares d'Ile-de-France, AP-HP, Hôpital St. Louis, Université de Paris, Institut de Recherche St. Louis, EA 3518, Paris, France
| | | | - Murray Baron
- Jewish General Hospital and McGill University Health Center, Montreal, Quebec, Canada
| | - Ines Colmegna
- Jewish General Hospital and McGill University Health Center, Montreal, Quebec, Canada
| | - Marie Hudson
- Lady Davis Institute, Jewish General Hospital, and McGill University, Montreal, Quebec, Canada
| | - Dominique Farge
- Centre de Référence des Maladies Auto-Immunes Systémiques Rares d'Ile-de-France, AP-HP, Hôpital St. Louis, Université de Paris, Institut de Recherche St. Louis, EA 3518, Hôpital St. Antoine, Paris, France, and McGill University, Montreal, Quebec, Canada
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