Worsening premature death burden gap from systemic sclerosis in men and black persons: A US nationwide population-based study

Objective

Male sex and black race incur poor prognosis in systemic sclerosis (SSc). There is no nationwide population-based assessment of premature SSc death burden by sex and race.

Methods

This is a population-based study comprising all recorded SSc deaths across the United States. We constructed histograms depicting the number of SSc deaths for each age by sex and race, and calculated the cumulative percent death at each age and the median age of death. We determined the odds ratios for the risk of premature death from SSc by sex and race. We then calculated the percent of total SSc deaths for different age groups by sex and race from 1970 to 2015. We performed chi-square test with Yates's correction and quantified the odds ratio (OR) with 95% confidence interval (CI).

Results

The median age of SSc death was 63 years in males versus 68 years in females, and 57 years in blacks versus 70 years in whites. The odds for SSc death before 65 years age was 1.8 (95% CI, 1.6-2.0) for males compared with females and 5.1 (95% CI, 4.4-6.0) for blacks compared with whites. The higher odds for premature death in males than in females was similar for both races. Differences in the proportions of premature deaths from 1970 to 2015 increased between males and females (-5% to 17%) and between blacks and whites (14% to 36%).

Conclusion

Males and black persons die of SSc at younger ages. The worsening premature death burden gap between the two sexes and races over the last five decades is troublesome.

Reliability, validity, and responsiveness to change of the Patient-Reported Outcomes Measurement Information System self-efficacy for managing chronic conditions measure in systemic sclerosis

Objective

The aim of this study is to examine validity, reliability, and responsiveness to change of Patient-Reported Outcomes Measurement Information System Self-Efficacy for Managing Chronic Conditions in persons with systemic sclerosis.

Methods

We conducted a post hoc analysis of the Patient-Reported Outcomes Measurement Information System Self-Efficacy measure and other quality-of-life measures from systemic sclerosis participants from a 16-week randomized control trial. The trial compared an Internet-based self-management program to a control condition where participants were provided an educational book. All participants completed outcome measures at baseline and following the 16-week trial period.

Results

The mean age of participants was 53.7 years, 91% were female and systemic sclerosis subtype included 44.9% limited/sine and 43.1% diffuse; mean disease duration was 9.0 years. All self-efficacy subscales (Managing Emotions, Symptoms, Daily Activities, Social Interactions, and Medications/Treatment) demonstrated good internal consistency (.92-.96). All subscales showed statistically significant correlations with other validated measures of depressive symptoms and quality of life (.20-.86) but were not associated with satisfaction nor with appearance. The subscales appropriately discriminated between those with and without depressive symptoms and demonstrated responsiveness to change over the 16-week period for those who had a corresponding increase in reported quality of life.

Conclusion

The Patient-Reported Outcomes Measurement Information System Self-Efficacy measure is valid, reliable, and responsive to change for persons with systemic sclerosis.

Structural Morphology of Rabbit Patella and Suprapatella Cartilage by Microscopic MRI and Polarized Light Microscopy

OBJECTIVE

In order to appreciate the roles articular cartilage of sesamoid bones and sesamoid fibrocartilage play in anatomy and pathology, the articular cartilage of the patella (n = 4) and suprapatella (n = 4) (a sesamoid fibrocartilage) of 12 to 14 weeks old New Zealand rabbits were studied qualitatively and quantitatively.

DESIGN/METHOD

The intact knee joints and block specimens from the joints were imaged using microscopic magnetic resonance imaging (µMRI) at a 97.6-µm pixel resolution for the former and 19.5-µm resolution for the latter. Histological sections were made out of the µMRI-imaged specimens, which were imaged using polarized light microscopy (PLM) at 0.25-, 1-, and 4-µm pixel resolutions.

RESULTS

The patella cartilage varied in thickness across the medial to lateral ends of the sesamoid bone with the central medial aspect slightly thicker than the lateral aspect. The suprapatella fibrocartilage decreased proximally away from the knee joint. Quantitative results of patellar cartilage showed strong dependence of fiber orientation with the tissue depth. Three histological zones can be clearly observed, which are similar to articular cartilage from other large animals. The sesamoid fibrocartilage has one thin surface layer (10 µm thick) of parallel-arranged structured fibers followed immediately by the majority of random fibers in bulk tissue. T2 relaxation time anisotropy was observed in the patellar cartilage but not in the bulk fibrocartilage.

CONCLUSION

Given the different functions of these 2 different types of cartilages in joint motion, these quantitative results will be beneficial to future studies of joint diseases using rabbits as the animal model.

Fatigue Predicts Future Reduced Social Participation, not Reduced Physical Function or Quality of Life in People with Systemic Sclerosis

OBJECTIVE

Although fatigue is one of the most problematic symptoms for people with systemic sclerosis, little is known about how fatigue impacts daily life over time. Such information is important when developing fatigue management interventions. This study was conducted to examine 1) if fatigue severity predicted outcomes of worse functioning (social participation, physical function), and quality of life and 2) if level of self-efficacy moderated significant relationships between fatigue and these outcomes.

METHODS

Data were utilized from a clinical trial in which an online self-management intervention was tested (N = 267). Fatigue, social participation, and physical function were assessed by PROMIS measures. Quality of life was assessed by the EuroQol 5-domain instrument (EQ-5D-5L). Linear regressions were performed to examine how baseline fatigue related to functioning and quality of life outcomes 16 weeks later controlling for relevant covariates. PROMIS measures were used to measure self-efficacy in managing symptoms, daily activities, medications and treatments, emotions, and social interactions.

RESULTS

Fatigue at baseline significantly predicted social participation 16 weeks later; but did not predict physical functioning or quality of life. Self-efficacy variables did not moderate the association between fatigue and social participation.

CONCLUSION

Fatigue severity predicted decreased social participation in people with systemic sclerosis. Interventions targeting fatigue should include support to maintain participation of social roles and activities. The level of reported self-efficacy did not vary the strength of the association between fatigue and decline in social participation indicating that there may be other targets to treat fatigue intervention beyond self-management.

TRIAL REGISTRATION

NCT02494401.

The JAK/STAT pathway is activated in systemic sclerosis and is effectively targeted by tofacitinib

Rationale

Fibrosis leads to failure of the skin, lungs, and other organs in systemic sclerosis; accounts for substantial morbidity and mortality; and lacks effective therapy. Myofibroblast activation underlies organ fibrosis, but the key extracellular cues driving persistence of the process remain incompletely characterized.

Objectives

The objectives were to evaluate activation of the IL6/JAK/STAT axis associated with fibrosis in skin and lung biopsies from systemic sclerosis patients and effects of the Food and Drug Administration-approved JAK/STAT inhibitor, tofacitinib, on skin and lung fibrosis in animal models.

Methods

Bioinformatic analysis showed that IL6/JAK/STAT3 and tofacitinib gene signatures were aberrant in biopsies from systemic sclerosis patients in four independent cohorts. The results were confirmed by JAK and STAT3 phosphorylation in both skin and lung biopsies from patients with systemic sclerosis. Furthermore, treatment of mice with the selective JAK inhibitor tofacitinib not only prevented bleomycin-induced skin and lung fibrosis but also reduced skin fibrosis in TSK1/+ mice.

Conclusion

These findings implicate the JAK/STAT pathway in systemic sclerosis skin and lung fibrosis and identify tofacitinib as a potential antifibrotic agent for the treatment of systemic sclerosis and other fibrotic diseases.