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Wildt M, Andréasson K, Hamberg V, Hesselstrand R, Wuttge DM. Treatment with mycophenolate mofetil is associated with improved nailfold vasculature in systemic sclerosis. Rheumatology (Oxford) 2024; 63:385-391. [PMID: 37158586 PMCID: PMC10836996 DOI: 10.1093/rheumatology/kead207] [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: 10/13/2022] [Revised: 03/27/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVE To investigate the evolution of nailfold capillary density in patients with SSc in relation to immunosuppressive treatment and autoantibodies. METHODS This was a prospective study cohort. Consecutive newly diagnosed SSc patients were included into this study who, in a retrospective review, had at least two nailfold capillary microscopy measurements performed during the first 48 months of follow-up. Capillary density per 3 mm was measured with widefield nailfold capillary microscopy. Improvement of capillary density per finger and mean capillary density were analysed. Longitudinal measurements of mean capillary density were analysed by generalized estimating equation. RESULTS Eighty patients (68 women, 12 men) met the inclusion criteria. The median follow-up time was 27 months. Twenty-eight patients had an improved capillary density in per-finger analysis. MMF was associated with fewer numbers of fingers that had worsened in capillary density. Anti-topoisomerase antibodies were associated with low mean capillary density. Anti-RNA polymerase III antibodies were associated with improvement and anti-centromere antibodies with worsening of capillary density in per-finger analysis. MMF treatment was associated with less steep capillary density decline in a moderated generalized estimating equation model including presence of anti-topoisomerase antibodies and the interaction of MMF with follow-up time. CONCLUSION Nailfold capillary density improved over time in a substantial proportion of SSc patients. MMF treatment had a positive impact on the evolution of capillary density in these patients. SSc autoantibody phenotype may affect the capillary density development. The data support previous hypotheses that early immunosuppression may favourably affect vascular regeneration in SSc.
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Affiliation(s)
- Marie Wildt
- Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Kristofer Andréasson
- Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Viggo Hamberg
- Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Roger Hesselstrand
- Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Dirk M Wuttge
- Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University and Skåne University Hospital, Lund, Sweden
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Hamberg V, Sohrabian A, Volkmann ER, Wildt M, Löfdahl A, Wuttge DM, Hesselstrand R, Dellgren G, Westergren-Thorsson G, Rönnelid J, Andréasson K. Anti-Ro52 positivity is associated with progressive interstitial lung disease in systemic sclerosis-an exploratory study. Arthritis Res Ther 2023; 25:162. [PMID: 37667402 PMCID: PMC10476305 DOI: 10.1186/s13075-023-03141-4] [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: 06/25/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Interstitial lung disease (ILD) is the most common cause of death in patients with systemic sclerosis (SSc). Prognostic biomarkers are needed to identify SSc-ILD patients at risk for progressive pulmonary fibrosis. This study investigates autoantibodies measured in bronchoalveolar lavage (BAL) fluid and in serum in reference to the clinical disease course of SSc-ILD. METHODS Fifteen patients with new onset SSc-ILD underwent bronchoscopy. Autoantibody levels were analyzed using addressable laser bead immunoassay from BAL fluid and the serum. In a separate longitudinal cohort of 43 patients with early SSc-ILD, autoantibodies in serum were measured at baseline and pulmonary function tests were performed at least 2 times over the course of at least 2 or more years. Linear mixed effect models were created to investigate the relationship between specific autoantibodies and progression of SSc-ILD. Finally, lung tissue from healthy controls and from subjects with SSc was analyzed for the presence of the Ro52 antigen using immunohistochemistry. RESULTS Among SSc-ILD patients who were positive for anti-Ro52 (N = 5), 3 (60%) had enrichment of anti-Ro52 in BAL fluid at a ratio exceeding 50x. In the longitudinal cohort, 10/43 patients (23%) were anti-Ro52 positive and 16/43 (37%) were anti-scl-70 positive. Presence of anti-Scl-70 was associated with a lower vital capacity (VC) at baseline (-12.6% predicted VC [%pVC]; 95%CI: -25.0, -0.29; p = 0.045), but was not significantly associated with loss of lung function over time (-1.07%pVC/year; 95%CI: -2.86, 0.71; p = 0.230). The presence of anti-Ro52 was significantly associated with the loss of lung function over time (-2.41%pVC/year; 95% CI: -4.28, -0.54; p = 0.013). Rate of loss of lung function increased linearly with increasing anti-Ro52 antibody levels (-0.03%pVC per arbitrary units/mL and year; 95%CI: -0.05, -0.02; p < 0.001). Immunohistochemical staining localized the Ro52 antigen to alveolar M2 macrophages in peripheral lung tissue both in subjects with and without SSc. CONCLUSIONS This study suggests that antibodies targeting Ro52 are enriched in the lungs of patients with new-onset SSc-ILD, linking Ro52 autoimmunity to the pulmonary pathology of SSc. Clinical and immunohistochemical data corroborates these findings and suggest that anti-Ro52 may serve as a potential biomarker of progressive SSc-ILD.
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Affiliation(s)
- Viggo Hamberg
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Azita Sohrabian
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Elizabeth R Volkmann
- Department of Medicine, Division of Rheumatology, University of California, Los Angeles, CA, USA
- David Geffen School of Medicine, Los Angeles, CA, USA
| | - Marie Wildt
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anna Löfdahl
- Lung Biology, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Dirk M Wuttge
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Roger Hesselstrand
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Göran Dellgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Johan Rönnelid
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Kristofer Andréasson
- Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
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Kadefors M, Berlin F, Wildt M, Dellgren G, Rolandsson Enes S, Aspberg A, Westergren-Thorsson G. Dipeptidyl peptidase 4 expression is not associated with an activated fibroblast phenotype in idiopathic pulmonary fibrosis. Front Pharmacol 2022; 13:953771. [PMID: 36120350 PMCID: PMC9473336 DOI: 10.3389/fphar.2022.953771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/01/2022] [Indexed: 11/24/2022] Open
Abstract
Dipeptidyl peptidase 4 (DPP4) has been proposed as a marker for activated fibroblasts in fibrotic disease. We aimed to investigate whether a profibrotic DPP4 phenotype is present in lung tissue from patients with idiopathic pulmonary fibrosis (IPF). The presence of DPP4+ fibroblasts in normal and IPF lung tissue was investigated using flow cytometry and immunohistology. In addition, the involvement of DPP4 in fibroblast activation was examined in vitro, using CRISPR/Cas9 mediated genetic inactivation to generate primary DPP4 knockout lung fibroblasts. We observed a reduced frequency of primary DPP4+ fibroblasts in IPF tissue using flow cytometry, and an absence of DPP4+ fibroblasts in pathohistological features of IPF. The in vivo observations were supported by results in vitro showing a decreased expression of DPP4 on normal and IPF fibroblasts after profibrotic stimuli (transforming growth factor β) and no effect on the expression of activation markers (α-smooth muscle actin, collagen I and connective tissue growth factor) upon knockout of DPP4 in lung fibroblasts with or without activation with profibrotic stimuli.
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Affiliation(s)
- Måns Kadefors
- Department of Experimental Medical Science, Lund University, Lund, Sweden
- *Correspondence: Måns Kadefors,
| | - Frida Berlin
- Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Marie Wildt
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Göran Dellgren
- Transplant Institute and Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Anders Aspberg
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Santiago T, Santos EJF, Ruaro B, Lepri G, Green L, Wildt M, Watanabe S, Lescoat A, Hesselstrand R, Del Galdo F, Pauling JD, Reeve LJ, D'Agostino MA, Matucci-Cerinic M, Iagnocco A, da Silva JAP. Recommendations for the execution and reporting of skin ultrasound in systemic sclerosis: an international collaboration under the WSF skin ultrasound group. RMD Open 2022; 8:rmdopen-2022-002371. [PMID: 35850975 PMCID: PMC9297224 DOI: 10.1136/rmdopen-2022-002371] [Citation(s) in RCA: 6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Ultrasound is a promising tool to foster much-needed improvement of skin assessment in systemic sclerosis (SSc). Our aim was to develop evidence and expert opinion-based recommendations to promote the standardisation and harmonisation of technical execution and reporting of skin ultrasound studies in SSc. Methods A multidisciplinary task force of 16 members from five European countries and Japan was convened under the auspices of World Scleroderma Foundation. First, a systematic literature review (SLR) was performed. Then, each member proposed and formulated items to the overarching principles, recommendations and research agenda. Two rounds of mails exchange for consensus as well as an on-line meeting were performed to debate and refine the proposals. Two Delphi rounds of voting resulted in the final recommendations. Levels of evidence and strengths of recommendations were assigned, and task force members voted anonymously on the level of agreement with each of the items. Results Five overarching principles and seven recommendations were developed, based on an SLR and expert opinion, through consensus procedures. The overarching principles highlight the promising role of skin ultrasound in SSc assessment, the need for standardisation of technical aspects, sufficient training and adequate equipment. The recommendations provide standards for the execution and reporting of skin ultrasound in SSc. The research agenda includes the need for more research into unmet needs according to Outcome Measures in Rheumatology Algorithm requirements. Conclusion These are the first recommendations providing guidance on the execution and reporting of skin ultrasound in SSc patients, aiming at improving the interpretability, reliability and generalisability of skin ultrasound, thus consolidating its role in research and practice.
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Affiliation(s)
- Tânia Santiago
- Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal .,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | | | - Barbara Ruaro
- Pulmonology, University Hospital of Cattinara, Trieste, Italy
| | - Gemma Lepri
- Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Department of Internal Medicine, University of Florence, Firenze, Italy
| | - Lorraine Green
- Leeds Institute of Molecular Medicine Section of Musculoskeletal Disease, Leeds, UK
| | - Marie Wildt
- Department of Rheumatology, Lund University, Lund, Sweden
| | - Shinji Watanabe
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Alain Lescoat
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Université de Rennes 1, Rennes, France
| | | | - Francesco Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Scleroderma Programme, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds, UK
| | - John D Pauling
- Royal National Hospital for Rheumatic Diseases, Royal United Hospital Bath NHS Trust, Bath, UK.,Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | | | - Maria Antonieta D'Agostino
- Rheumatology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Roma, Italy
| | - Marco Matucci-Cerinic
- Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Department of Internal Medicine, University of Florence, Firenze, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Department of Clinical and Biological Science, University of Turin, Tourin, Italy
| | - Jose Antonio Pereira da Silva
- Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Santiago T, Santos E, Ruaro B, Lepri G, Green L, Wildt M, Watanabe S, Lescoat A, Hesselstrand R, Galdo FD, Pauling JD, Iagnocco A, da Silva J. Ultrasound and elastography in the assessment of skin involvement in systemic sclerosis: A systematic literature review focusing on validation and standardization - WSF Skin Ultrasound Group. Semin Arthritis Rheum 2022; 52:151954. [PMID: 35039184 DOI: 10.1016/j.semarthrit.2022.151954] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 10/12/2021] [Revised: 12/07/2021] [Accepted: 01/04/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To summarize the published evidence in the literature on the role of ultrasound and elastography to assess skin involvement in systemic sclerosis (SSc). METHODS A systematic literature review (SLR) was performed within the "Skin Ultrasound Working Group" of the World Scleroderma Foundation, according to the Cochrane Handbook. A search was conducted in Pubmed, Cochrane Library and Embase databases from 1/1/1979 to 31/5/2021, using the participants, intervention, comparator and outcomes (PICO) framework. Only full-text articles involving adults, reported in any language, assessing ultrasound to quantify skin pathology in SSc patients. Two reviewers performed the assessment of risk of bias, data extraction and synthesis, independently. RESULTS Forty-six studies out of 3248 references evaluating skin ultrasound and elastography domains were included. B-mode ultrasound was used in 30 studies (65.2%), elastography in nine (19.6%), and both methods in seven (15.2%). The ultrasound outcome measure domains reported were thickness (57.8%) and echogenicity (17.2%); the elastography domain was stiffness (25%). Methods used for image acquisition and analysis were remarkably heterogeneous and frequently under-reported, precluding data synthesis across studies. The same applies to contextual factors and feasibility. Our data syntheses indicated evidence of good reliability and convergent validity for ultrasound thickness evaluation against mRSS and skin histological findings. Stiffness and echogenicity have limited evidence for validity against histological findings. Evidence for sensitivity to change, test-retest reliability, clinical trial discrimination or thresholds of meaning is limited or absent for reported ultrasound domains. CONCLUSION Ultrasound is a valid and reliable tool for skin thickness measurement in SSc but there are significant knowledge gaps regarding skin echogenicity assessment by ultrasound and skin stiffness evaluation by elastography in terms of feasibility, validity and discrimination. Standardization of image acquisition and analysis is needed to foster progress.
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Affiliation(s)
- Tânia Santiago
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Eduardo Santos
- Health School of the Polytechnic Institute of Viseu, Portugal; Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Portugal
| | - Barbara Ruaro
- Department of Pulmonology, University Hospital of Cattinara, Trieste, Italy
| | - Gemma Lepri
- Rheumatology Unit, University of Florence, Florence, Italy
| | - Lorraine Green
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Marie Wildt
- Department of Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Shinji Watanabe
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Alain Lescoat
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France,; Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - Roger Hesselstrand
- Department of Rheumatology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Francesco Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John D Pauling
- Royal National Hospital for Rheumatic Diseases (at Royal United Hospitals NHS FT), Bath, UK:; Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Department of Clinical and Biological Science, University of Turin, Turin, Italy
| | - Jap da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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6
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Wuttge DM, Carlsen AL, Teku G, Wildt M, Rådegran G, Vihinen M, Heegaard NHH, Hesselstrand R. Circulating Plasma microRNAs In Systemic Sclerosis-Associated Pulmonary Arterial Hypertension. Rheumatology (Oxford) 2021; 61:309-318. [PMID: 33784391 PMCID: PMC8742821 DOI: 10.1093/rheumatology/keab300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objectives SSc-associated pulmonary arterial hypertension (SSc-APAH) is a late but devastating complication of SSc. Early identification of SSc-APAH may improve survival. We examined the role of circulating miRNAs in SSc-APAH. Methods Using quantitative RT-PCR the abundance of mature miRNAs in plasma was determined in 85 female patients with ACA-positive lcSSc. Twenty-two of the patients had SSc-APAH. Sixty-three SSc controls without PAH were matched for disease duration. Forty-six selected miRNA plasma levels were correlated with clinical data. Longitudinal samples were analysed from 14 SSc-APAH and 27 SSc patients. Results The disease duration was 12 years for the SSc-APAH patients and 12.7 years for the SSc controls. Plasma expression levels of 11 miRNAs were lower in patients with SSc-APAH. Four miRNAs displayed higher plasma levels in SSc-APAH patients compared with SSc controls. There was significant difference between groups for miR-20a-5p and miR-203a-3p when correcting for multiple comparisons (P = 0.002 for both). Receiver operating characteristics curve showed AUC = 0.69–0.83 for miR-21-5p and miR-20a-5p or their combination. miR-20a-5p and miR-203a-3p correlated inversely with NT-pro-Brain Natriuretic Protein levels (r = −0.42 and −0.47). Mixed effect model analysis could not identify any miRNAs as predictor of PAH development. However, miR-20a-5p plasma levels were lower in the longitudinal samples of SSc-APAH patients than in the SSc controls. Conclusions Our study links expression levels of the circulating plasma miRNAs, especially miR-20a-5p and miR-203a-3p, to the occurrence of SSc-APAH in female patients with ACA-positive lcSSc.
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Affiliation(s)
- Dirk M Wuttge
- Department of Clinical Sciences Lund, Rheumatology, Lund University and Skåne University Hospital, SE-22185, Sweden, Lund
| | - Anting L Carlsen
- Department of Autoimmunology & Biomarkers, Statens Serum Institut, Copenhagen S, DK-2300, Denmark
| | - Gabriel Teku
- Department of Experimental Medical Science, Protein Structure Bioinformatics, Lund University, Lund, SE-22185, Sweden
| | - Marie Wildt
- Department of Clinical Sciences Lund, Rheumatology, Lund University and Skåne University Hospital, SE-22185, Sweden, Lund
| | - Göran Rådegran
- Department of Clinical Sciences Lund, Cardiology, Lund University and the Hemodynamic Lab, the Section for Heart failure and Valvular Disease, VO Heart and Lung Medicine, Skåne University Hospital, Lund, SE-22185, Sweden
| | - Mauno Vihinen
- Department of Experimental Medical Science, Protein Structure Bioinformatics, Lund University, Lund, SE-22185, Sweden
| | - Niels H H Heegaard
- Department of Autoimmunology & Biomarkers, Statens Serum Institut, Copenhagen S, DK-2300, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, University of Southern Denmark, Odense, DK-5000, Denmark.,Institute of Clinical Research, Clinical Biochemistry, University of Southern Denmark, DK-5000, Odense, Denmark
| | - Roger Hesselstrand
- Department of Clinical Sciences Lund, Rheumatology, Lund University and Skåne University Hospital, SE-22185, Sweden, Lund
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Dinsdale G, Roberts C, Moore T, Manning J, Berks M, Allen J, Anderson ME, Cutolo M, Hesselstrand R, Howell K, Pizzorni C, Smith V, Sulli A, Wildt M, Taylor C, Murray A, Herrick AL. Nailfold capillaroscopy-how many fingers should be examined to detect abnormality? Rheumatology (Oxford) 2019; 58:284-288. [PMID: 30247696 DOI: 10.1093/rheumatology/key293] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Indexed: 11/08/2023] Open
Abstract
Objectives Nailfold capillaroscopy is being increasingly used by rheumatologists in the diagnosis of SSc. However, assessment of all nailfolds can be time-consuming in a busy outpatient clinic. Our aim was to answer the question as to how many (and which) fingers a clinician should routinely assess to capture accurately the true state. Methods A total of 2994 assessments (by an international panel of expert observers) of 1600 images from 173 participants (101 with SSc, 22 with primary RP and 50 healthy controls) were included in this analysis. Seven single-finger or finger combinations (derived from the middle and ring fingers) were then tested for sensitivity for the presence of two markers of capillary abnormality [presence of giant capillaries and an SSc grade (early, active or late)] compared with assessment of all eight fingers. Results For the eight-finger gold standard, sensitivity against the diagnostic criteria was 74.6% (53.0% for the presence of giants alone and 73.1% for image grade alone). Examining only one finger gave low sensitivity (ranging from right middle 31.7% to left ring 46.6%). Examining both ring fingers gave a sensitivity of 59.8%, whereas examining the four-finger combination of both ring and both middle fingers gave a sensitivity of 66.7%. Conclusion During routine capillaroscopic examination, ideally all eight nailbeds (excluding thumbs) should be examined, otherwise some abnormalities will be missed. Examining only four fingers reduces capillaroscopy sensitivity.
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Affiliation(s)
- Graham Dinsdale
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Salford Royal Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Chris Roberts
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Tonia Moore
- Rheumatology Department, Salford Royal Hospital NHS Foundation Trust, Salford, UK
| | - Joanne Manning
- Rheumatology Department, Salford Royal Hospital NHS Foundation Trust, Salford, UK
| | - Michael Berks
- Centre for Imaging Sciences, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - John Allen
- Microvascular Diagnostics, Northern Medical Physics and Clinical Engineering, Freeman Hospital, Newcastle upon Tyne, UK
| | - Marina E Anderson
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Roger Hesselstrand
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
| | - Kevin Howell
- Institute of Immunity and Transplantation, University College London, Royal Free Campus, London, UK
| | - Carmen Pizzorni
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Faculty of Internal Medicine, Ghent University, Ghent, Belgium
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Marie Wildt
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
| | - Christopher Taylor
- Centre for Imaging Sciences, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Andrea Murray
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Salford Royal Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Ariane L Herrick
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Salford Royal Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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8
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Dinsdale G, Peytrignet S, Moore T, Berks M, Roberts C, Manning J, Allen J, Anderson M, Cutolo M, Hesselstrand R, Howell K, Pizzorni C, Smith V, Sulli A, Wildt M, Taylor C, Murray A, Herrick AL. The assessment of nailfold capillaries: comparison of dermoscopy and nailfold videocapillaroscopy. Rheumatology (Oxford) 2018; 57:1115-1116. [PMID: 29447411 DOI: 10.1093/rheumatology/key018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Graham Dinsdale
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Sebastien Peytrignet
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Tonia Moore
- Rheumatology Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - Michael Berks
- Centre for Imaging Sciences, Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK
| | - Christopher Roberts
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Joanne Manning
- Rheumatology Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - John Allen
- Microvascular Diagnostics, Northern Medical Physics and Clinical Engineering, Freeman Hospital, Newcastle upon Tyne
| | - Marina Anderson
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Italy
| | - Roger Hesselstrand
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
| | - Kevin Howell
- Institute of Immunity and Transplantation, University College London, Royal Free Campus, London, UK
| | - Carmen Pizzorni
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Italy
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Faculty of Internal Medicine, Ghent University, Ghent, Belgium
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Italy
| | - Marie Wildt
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
| | - Christopher Taylor
- Centre for Imaging Sciences, Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK
| | - Andrea Murray
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Ariane L Herrick
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Dinsdale G, Peytrignet S, Moore T, Berks M, Roberts C, Manning J, Allen J, Anderson M, Cutolo M, Hesselstrand R, Howell K, Pizzorni C, Smith V, Sulli A, Wildt M, Taylor C, Murray A, Herrick A. 159 Dermoscopy versus videocapillaroscopy in the assessment of nailfold capillaroscopy images in patients with systemic sclerosis and healthy controls. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.383] [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: 11/14/2022] Open
Affiliation(s)
- Graham Dinsdale
- Centre for Musculoskeletal Research, University of Manchester, Salford Royal Hospital NHS Foundation Trust, MAHSC, Manchester, UNITED KINGDOM
| | - Sebastien Peytrignet
- Centre for Musculoskeletal Research, University of Manchester, Salford Royal Hospital NHS Foundation Trust, MAHSC, Manchester, UNITED KINGDOM
| | - Tonia Moore
- Centre for Musculoskeletal Research, University of Manchester, Salford Royal Hospital NHS Foundation Trust, MAHSC, Manchester, UNITED KINGDOM
| | - Michael Berks
- Centre for Imaging Sciences, Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UNITED KINGDOM
| | - Christopher Roberts
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UNITED KINGDOM
| | - Joanne Manning
- Centre for Musculoskeletal Research, University of Manchester, Salford Royal Hospital NHS Foundation Trust, MAHSC, Manchester, UNITED KINGDOM
| | - John Allen
- Microvascular Diagnostics, Northern Medical Physics and Clinical Engineering, Freeman Hospital, Newcastle-upon-Tyne, UNITED KINGDOM
| | - Marina Anderson
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UNITED KINGDOM
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genova, ITALY
| | - Roger Hesselstrand
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, SWEDEN
| | - Kevin Howell
- Institute of Immunity and Transplantation, University College London, Royal Free Campus, London, UNITED KINGDOM
| | - Carmen Pizzorni
- Research Laboratory and Academic Division of Clinical Rheumatology, Dept. Internal Medicine, University of Genova, Genova, ITALY
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Faculty of Internal Medicine, Ghent University, Ghent, BELGIUM
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Dept. Internal Medicine, University of Genova, Manchester, ITALY
| | - Marie Wildt
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, SWEDEN
| | - Christopher Taylor
- Centre for Imaging Sciences, Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UNITED KINGDOM
| | - Andrea Murray
- Centre for Musculoskeletal Research, University of Manchester, Salford Royal Hospital NHS Foundation Trust, MAHSC, Manchester, UNITED KINGDOM
| | - Ariane Herrick
- Centre for Musculoskeletal Research, University of Manchester, Salford Royal Hospital NHS Foundation Trust, MAHSC, Manchester, UNITED KINGDOM
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UNITED KINGDOM
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Dinsdale G, Moore T, O'Leary N, Berks M, Roberts C, Manning J, Allen J, Anderson M, Cutolo M, Hesselstrand R, Howell K, Pizzorni C, Smith V, Sulli A, Wildt M, Taylor C, Murray A, Herrick AL. Quantitative outcome measures for systemic sclerosis-related Microangiopathy - Reliability of image acquisition in Nailfold Capillaroscopy. Microvasc Res 2017; 113:56-59. [PMID: 28495471 DOI: 10.1016/j.mvr.2017.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 03/13/2017] [Revised: 05/04/2017] [Accepted: 05/06/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nailfold capillaroscopic parameters hold increasing promise as outcome measures for clinical trials in systemic sclerosis (SSc). Their inclusion as outcomes would often naturally require capillaroscopy images to be captured at several time points during any one study. Our objective was to assess repeatability of image acquisition (which has been little studied), as well as of measurement. METHOD 41 patients (26 with SSc, 15 with primary Raynaud's phenomenon) and 10 healthy controls returned for repeat high-magnification (300×) videocapillaroscopy mosaic imaging of 10 digits one week after initial imaging (as part of a larger study of reliability). Images were assessed in a random order by an expert blinded observer and 4 outcome measures extracted: (1) overall image grade and then (where possible) distal vessel locations were marked, allowing (2) vessel density (across the whole nailfold) to be calculated (3) apex width measurement and (4) giant vessel count. Intra-rater, intra-visit and intra-rater inter-visit (baseline vs. 1week) reliability were examined in 475 and 392 images respectively. A linear, mixed-effects model was used to estimate variance components, from which intra-class correlation coefficients (ICCs) were determined. RESULTS Intra-visit and inter-visit reliability estimates (ICCs) were (respectively): overall image grade, 0.97 and 0.90; vessel density, 0.92 and 0.65; mean vessel width, 0.91 and 0.79; presence of giant capillary, 0.68 and 0.56. These estimates were conditional on each parameter being measurable. CONCLUSION Within-operator image analysis and acquisition are reproducible. Quantitative nailfold capillaroscopy, at least with a single observer, provides reliable outcome measures for clinical studies including randomised controlled trials.
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Affiliation(s)
- Graham Dinsdale
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Salford Royal Hospital NHS Foundation Trust, Salford Royal Hospital, Stott Lane, Manchester, UK.
| | - Tonia Moore
- Salford Royal Hospital NHS Foundation Trust, Salford, UK
| | - Neil O'Leary
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Michael Berks
- Centre for Imaging Sciences, Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK
| | - Christopher Roberts
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Joanne Manning
- Salford Royal Hospital NHS Foundation Trust, Salford, UK
| | - John Allen
- Microvascular Diagnostics, Northern Medical Physics and Clinical Engineering, Freeman Hospital, Newcastle upon Tyne, UK
| | - Marina Anderson
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Dept. Internal Medicine, University of Genova, Italy
| | - Roger Hesselstrand
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
| | - Kevin Howell
- Institute of Immunity and Transplantation, University College London, Royal Free Campus, London, UK
| | - Carmen Pizzorni
- Research Laboratory and Academic Division of Clinical Rheumatology, Dept. Internal Medicine, University of Genova, Italy
| | - Vanessa Smith
- Department of Rheumatology, Ghent University, Hospital, Faculty of Internal Medicine, Ghent University, Ghent, Belgium
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Dept. Internal Medicine, University of Genova, Italy
| | - Marie Wildt
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
| | - Christopher Taylor
- Centre for Imaging Sciences, Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK
| | - Andrea Murray
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Salford Royal Hospital NHS Foundation Trust, Salford Royal Hospital, Stott Lane, Manchester, UK
| | - Ariane L Herrick
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Salford Royal Hospital NHS Foundation Trust, Salford Royal Hospital, Stott Lane, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Sandqvist G, Wollmer P, Scheja A, Wildt M, Hesselstrand R. Raynaud's phenomenon and its impact on activities in daily life during one year of follow-up in early systemic sclerosis. Scand J Rheumatol 2017; 47:206-209. [PMID: 28803485 DOI: 10.1080/03009742.2017.1350745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate Raynaud's phenomenon (RP) and its impact on daily life activities during 1 year of follow-up in early systemic sclerosis (SSc). METHOD Fourteen SSc patients with a median disease duration of 2 years were enrolled in the study. Every 7 weeks the patients completed a 7 day diary documenting the frequency and duration of RP attacks, the activity causing the attack, and how they handled the attack. The patients also recorded in the diary daily self-assessments of the difficulties with RP, using a 0-10 ordinal scale according to the Raynaud's Condition Score. RESULTS Ninety-eight RP weekly diaries were analysed. The median number of RP attacks varied between six and nine per week, and the median score reflecting the difficulty associated with the attacks varied between 2.0 and 2.9. No difference was found in the number of attacks or the difficulties associated with them between winter, spring, and autumn. Fewer attacks and less difficulty were reported in August than in any of the other documented weeks (p < 0.05). In all diaries, all patients reported RP attacks associated with domestic activities. The use of heating devices varied during the follow-up. In February, all patients except one used such devices, while about half of the group used devices during the rest of the year. CONCLUSIONS Difficulties resulting from RP are present and disabling all year round, which underscore the importance of intense vasoactive therapy and non-pharmacological strategies throughout the year.
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Affiliation(s)
- G Sandqvist
- a Department of Clinical Sciences Lund, Section of Rheumatology , Lund University, Skåne University Hospital , Lund , Sweden
| | - P Wollmer
- b Department of Translational Medicine , Lund University , Lund , Sweden
| | - A Scheja
- a Department of Clinical Sciences Lund, Section of Rheumatology , Lund University, Skåne University Hospital , Lund , Sweden
| | - M Wildt
- a Department of Clinical Sciences Lund, Section of Rheumatology , Lund University, Skåne University Hospital , Lund , Sweden
| | - R Hesselstrand
- a Department of Clinical Sciences Lund, Section of Rheumatology , Lund University, Skåne University Hospital , Lund , Sweden
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Dinsdale G, Moore T, Manning J, Murray AK, Berks M, Tresadern P, Taylor CJ, O'Leary N, Roberts C, Allen J, Anderson M, Cutolo M, Hesselstrand R, Howell K, Pizzorni C, Smith V, Sulli A, Wildt M, Herrick A. 051. QUANTITATIVE OUTCOME MEASURES FOR SYSTEMIC SCLEROSIS–RELATED MICROANGIOPATHY: RELIABILITY OF IMAGE ACQUISITION IN NAILFOLD CAPILLAROSCOPY. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex062.051] [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: 11/12/2022] Open
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Dinsdale G, Moore T, O'Leary N, Tresadern P, Berks M, Roberts C, Manning J, Allen J, Anderson M, Cutolo M, Hesselstrand R, Howell K, Pizzorni C, Smith V, Sulli A, Wildt M, Taylor C, Murray A, Herrick AL. Intra-and inter-observer reliability of nailfold videocapillaroscopy - A possible outcome measure for systemic sclerosis-related microangiopathy. Microvasc Res 2017; 112:1-6. [PMID: 28163035 DOI: 10.1016/j.mvr.2017.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 11/29/2016] [Revised: 01/12/2017] [Accepted: 02/01/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Our aim was to assess the reliability of nailfold capillary assessment in terms of image evaluability, image severity grade ('normal', 'early', 'active', 'late'), capillary density, capillary (apex) width, and presence of giant capillaries, and also to gain further insight into differences in these parameters between patients with systemic sclerosis (SSc), patients with primary Raynaud's phenomenon (PRP) and healthy control subjects. METHODS Videocapillaroscopy images (magnification 300×) were acquired from all 10 digits from 173 participants: 101 patients with SSc, 22 with PRP and 50 healthy controls. Ten capillaroscopy experts from 7 European centres evaluated the images. Custom image mark-up software allowed extraction of the following outcome measures: overall grade ('normal', 'early', 'active', 'late', 'non-specific', or 'ungradeable'), capillary density (vessels/mm), mean vessel apical width, and presence of giant capillaries. RESULTS Observers analysed a median of 129 images each. Evaluability (i.e. the availability of measures) varied across outcome measures (e.g. 73.0% for density and 46.2% for overall grade in patients with SSc). Intra-observer reliability for evaluability was consistently higher than inter- (e.g. for density, intra-class correlation coefficient [ICC] was 0.71 within and 0.14 between observers). Conditional on evaluability, both intra- and inter-observer reliability were high for grade (ICC 0.93 and 0.78 respectively), density (0.91 and 0.64) and width (0.91 and 0.85). CONCLUSIONS Evaluability is one of the major challenges in assessing nailfold capillaries. However, when images are evaluable, the high intra- and inter-reliabilities suggest that overall image grade, capillary density and apex width have potential as outcome measures in longitudinal studies.
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Affiliation(s)
- Graham Dinsdale
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - Tonia Moore
- Salford Royal Hospital NHS Foundation Trust, Salford, UK
| | - Neil O'Leary
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Philip Tresadern
- Centre for Imaging Sciences, Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK
| | - Michael Berks
- Centre for Imaging Sciences, Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK
| | - Christopher Roberts
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Joanne Manning
- Salford Royal Hospital NHS Foundation Trust, Salford, UK
| | - John Allen
- Microvascular Diagnostics, Northern Medical Physics and Clinical Engineering, Freeman Hospital, Newcastle upon Tyne, UK
| | - Marina Anderson
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Dept. Internal Medicine, University of Genova, Italy
| | - Roger Hesselstrand
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
| | - Kevin Howell
- Institute of Immunity and Transplantation, University College London, Royal Free Campus, London, UK
| | - Carmen Pizzorni
- Research Laboratory and Academic Division of Clinical Rheumatology, Dept. Internal Medicine, University of Genova, Italy
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Faculty of Internal Medicine, Ghent University, Ghent, Belgium
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Dept. Internal Medicine, University of Genova, Italy
| | - Marie Wildt
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
| | - Christopher Taylor
- Centre for Imaging Sciences, Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK
| | - Andrea Murray
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Ariane L Herrick
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Dinsdale G, Moore T, O'Leary N, Manning J, Murray A, Berks M, Tresadern P, Allen J, Anderson M, Cutolo M, Hesselstrand R, Howell K, Pizzorni C, Pyrkotsch P, Smith V, Sulli A, Wildt M, Taylor C, Roberts C, Herrick A. FRI0530 Intra-and Inter-Observer Reliability of Nailfold Videocapillaroscopy – A Possible Outcome Measure for Systemic Sclerosis-Related Microangiopathy?: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2248] [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: 11/03/2022]
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Hesselstrand R, Carlestam J, Wildt M, Sandqvist G, Andréasson K. High frequency ultrasound of skin involvement in systemic sclerosis - a follow-up study. Arthritis Res Ther 2015; 17:329. [PMID: 26584645 PMCID: PMC4653845 DOI: 10.1186/s13075-015-0853-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 11/05/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION High-frequency ultrasound offers a potential for objective and quantitative assessment of skin thickness and skin echogenicity in systemic sclerosis (SSc). Few studies have however assessed the longitudinal changes of skin involvement using ultrasound. The aim of the study was to investigate changes in skin thickness in early SSc using high frequency ultrasound during one year of follow-up in comparison to other measurements of skin fibrosis. METHODS This retrospective study comprised 75 consecutive patients with disease duration shorter than 3 years, in whom ultrasound examination of skin thickness was performed at baseline and at the one year follow-up at five predefined sites. RESULTS Repeated ultrasound examination identified significant changes in a majority of patients. In 21 patients, the total sum of skin thickness (TST) increased, while TST decreased in 37 patients. On a group level there were significant decreases in skin thickness of the chest (p = 0.024) and in the TST (p = 0.011) during the observation time. Both baseline and follow-up TST correlated to serum-COMP (rS: 0.41; p = 0.001; rS: 0.49; p < 0.001), modified Rodnan skin score (mRSS; rS: 0.48; p < 0.001; rS: 0.48; p < 0.001) and hand mobility in scleroderma (HAMIS; rS: 0.30; p = 0.043; rS: 0.64; p < 0.001). Changes in TST correlated with changes in serum-COMP (rS: 0.30; p = 0.034), changes in mRSS (rS: 0.43; p < 0.001) and changes in HAMIS (rS: 0.53; p = 0.001) during follow-up. CONCLUSIONS In early SSc, skin thickness measured by high frequency ultrasound develops in parallel with serum-COMP, mRSS and the HAMIS test. Ultrasound examination of the skin allows for objective assessment of one facet of the complex process of skin fibrosis in early SSc.
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Affiliation(s)
- Roger Hesselstrand
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
| | - Johanna Carlestam
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
| | - Marie Wildt
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
| | - Gunnel Sandqvist
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
| | - Kristofer Andréasson
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
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Wuttge DM, Carlsen AL, Teku G, Steen SO, Wildt M, Vihinen M, Hesselstrand R, Heegaard NHH. Specific autoantibody profiles and disease subgroups correlate with circulating micro-RNA in systemic sclerosis. Rheumatology (Oxford) 2015; 54:2100-7. [PMID: 26163687 DOI: 10.1093/rheumatology/kev234] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 12/15/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the expression profiles of cell-free plasma miRNAs in SSc and to characterize their correlation with disease subgroups (lcSSc and dcSSc) and with autoantibody profiles. METHODS Using quantitative RT-PCR, the abundance of 45 mature miRNAs in plasma was determined in 95 patients (lcSSc = 63; dcSSc = 32), representing the following autoantibody subgroups: ACA, anti-DNA topoisomerase I, anti-RNA polymerase III and anti-U1-ribonucleoprotein. MiRNA data were correlated with clinical and paraclinical data. Multiple regression was used to model membership of the lcSSc, dcSSc and autoantibody subgroups, based on miRNA expression profiles. RESULTS Thirty-six miRNAs were measurable in all samples. Four (miRNA-223, -181b, -342-3p and -184) were differently expressed in lcSSc and dcSSc (false discovery rate < 0.05). Ten miRNAs exhibited statistically significantly different levels in one or more autoantibody groups, and five (miRNA-409, -184, -92a, -29a and -101) remained significant after correction for multiple comparisons. Multiple regression models accurately predicted ACA and anti-DNA topoisomerase I antibody-positive patients (area under the curve (AUC) = 0.97 and 0.93, respectively) as well as membership of the dcSSc and lcSSc groups (AUC = 0.88). CONCLUSION Circulating miRNA profiles differ between lcSSc and dcSSc patients and between patients with different autoantibodies. This is the first time autoantibody profiles, disease phenotypes and plasma miRNA profiles have been shown to correlate in an autoimmune disease. The data support a pathobiological role of miRNAs because specific miRNAs associate with autoantibody profiles of known diagnostic and prognostic value.
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Affiliation(s)
- Dirk M Wuttge
- Section of Rheumatology, Department of Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden,
| | - Anting Liu Carlsen
- Department of Autoimmunology & Biomarkers, Statens Serum Institut, Copenhagen S, Denmark
| | - Gabriel Teku
- Department of Experimental Medical Science, Protein Structure Bioinformatics, Lund University, Lund, Sweden
| | - Samantha O Steen
- Department of Autoimmunology & Biomarkers, Statens Serum Institut, Copenhagen S, Denmark
| | - Marie Wildt
- Section of Rheumatology, Department of Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
| | - Mauno Vihinen
- Department of Experimental Medical Science, Protein Structure Bioinformatics, Lund University, Lund, Sweden
| | - Roger Hesselstrand
- Section of Rheumatology, Department of Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
| | - Niels H H Heegaard
- Department of Autoimmunology & Biomarkers, Statens Serum Institut, Copenhagen S, Denmark, Department of Clinical Biochemistry and Pharmacology, Odense University Hospital and Institute of Clinical Research, Clinical Biochemistry, University of Southern Denmark, Odense, Denmark
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Hesselstrand R, Carlestam J, Andréasson K, Wildt M, Sandqvist G. AB0641 High Frequency Ultrasound of Skin Involvement in Systemic Sclerosis – A Follow-Up Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4209] [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: 11/03/2022]
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Hofstee HMA, Serne EH, Roberts C, Hesselstrand R, Scheja A, Moore TL, Wildt M, Manning JB, Vonk Noordegraaf A, Voskuyl AE, Herrick AL. Comment on: A multicentre study on the reliability of qualitative and quantitative nailfold videocapillaroscopy assessment: reply. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hallgren O, Malmström J, Malmström L, Andersson-Sjöland A, Wildt M, Tufvesson E, Juhasz P, Marko-Varga G, Westergren-Thorsson G. Splicosomal and serine and arginine-rich splicing factors as targets for TGF-β. Fibrogenesis Tissue Repair 2012; 5:6. [PMID: 22541002 PMCID: PMC3472233 DOI: 10.1186/1755-1536-5-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 04/28/2012] [Indexed: 11/29/2022]
Abstract
Background Transforming growth factor-β1 (TGF-β1) is a potent regulator of cell growth and differentiation. TGF-β1 has been shown to be a key player in tissue remodeling processes in a number of disease states by inducing expression of extracellular matrix proteins. In this study a quantitative proteomic analysis was undertaken to investigate if TGF-β1 contributes to tissue remodeling by mediating mRNA splicing and production of alternative isoforms of proteins. Methodology/Principal findings The expression of proteins involved in mRNA splicing from TGF-β1-stimulated lung fibroblasts was compared to non-stimulated cells by employing isotope coded affinity tag (ICATTM) reagent labeling and tandem mass spectrometry. A total of 1733 proteins were identified and quantified with a relative standard deviation of 11% +/− 8 from enriched nuclear fractions. Seventy-six of these proteins were associated with mRNA splicing, including 22 proteins involved in splice site selection. In addition, TGF-β1 was observed to alter the relative expression of splicing proteins that may be important for alternative splicing of fibronectin. Specifically, TGF-β1 significantly induced expression of SRp20, and reduced the expression of SRp30C, which has been suggested to be a prerequisite for generation of alternatively spliced fibronectin. The induction of SRp20 was further confirmed by western blot and immunofluorescence. Conclusions The results show that TGF-β1 induces the expression of proteins involved in mRNA splicing and RNA processing in human lung fibroblasts. This may have an impact on the production of alternative isoforms of matrix proteins and can therefore be an important factor in tissue remodeling and disease progression.
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Affiliation(s)
- Oskar Hallgren
- Department of Experimental Medical Science, Lund University, Lund, Sweden.
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Wildt M, Wuttge DM, Hesselstrand R, Scheja A. Assessment of capillary density in systemic sclerosis with three different capillaroscopic methods. Clin Exp Rheumatol 2012; 30:S50-S54. [PMID: 22691209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 12/21/2011] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Capillary abnormalities, such as the enlargement and/or disappearance of capillary loops, occur early in the majority of patients with systemic sclerosis (SSc). The aim of this study was to compare three capillaroscopic methods of determining the capillary density in patients with SSc. METHODS Two of the three methods involved stereo-zoom microscopy at a magnification of 20 times, used either for direct counting, or with a camera and imaging software for determination of the capillary density on coded images. The third method was computerised nailfold video capillaroscopy with 300 x magnification using coded images. The capillary density (loops/mm) was determined on the fourth finger of the non-dominant hand with all three methods in 40 patients, 32 with limited cutaneous SSc (lcSSc) and 8 with diffuse cutaneous SSc (dcSSc), and in 21 healthy control subjects. RESULTS The median values of capillary density assessed with the three methods were: 4.3, 5.4 and 6.1 loops/mm in lc-SSc patients, 4.5, 5.0 and 6.3 loops/mm in dcSSc patients, and 7.0, 7.0 and 6.9 loops/mm in the controls. Capillary density was thus lower in lcSSc and dcSSc patients than in the controls according to all three methods. Agreement between the three methods was good in the controls. In patients, direct counting resulted in lower values than in the two computer-based methods. CONCLUSIONS Assessment of capillary density with three different methods showed good agreement between methods. All methods could differentiate between SSc patients and controls.
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Affiliation(s)
- Marie Wildt
- Department of Clinical Science, Lund University, Lund, Sweden.
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Hofstee HMA, Serne EH, Roberts C, Hesselstrand R, Scheja A, Moore TL, Wildt M, Manning JB, Vonk Noordegraaf A, Voskuyl AE, Herrick AL. A multicentre study on the reliability of qualitative and quantitative nail-fold videocapillaroscopy assessment. Rheumatology (Oxford) 2011; 51:749-55. [DOI: 10.1093/rheumatology/ker403] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Scheja A, Wildt M, Wuttge DM, Hesselstrand R. Progressive capillary loss over a decade in patients with systemic sclerosis, in particular in patients with early digital ischaemic manifestations. Scand J Rheumatol 2011; 40:457-61. [PMID: 21936615 DOI: 10.3109/03009742.2011.599070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Characteristic capillary abnormalities occur early in systemic sclerosis (SSc). Our aim was to study the longitudinal development of capillary density in SSc patients. METHODS Forty-eight consecutive patients with SSc fulfilling a follow-up of at least 8 years were retrospectively analysed for capillary loss over the observation period. Eleven had diffuse cutaneous SSc (dcSSc) and 37 limited cutaneous SSc (lcSSc). The median disease duration at first assessment was 2.5 years. Capillary density was determined by direct counting of capillaries in the distal row on eight fingers in a stereo-zoom microscope at 20× magnification. RESULTS Capillary density decreased over the observation period in dcSSc (from median 5.1 to 4.4 loops/mm, p < 0.05) and in lcSSc (from 5.1 to 4.2 loops/mm, p < 0.001). No significant difference was found between the two forms at start or at follow-up. Digital ischaemic manifestations had already been found at the first assessment in 19 patients. They did not differ in capillary density from those without ischaemic manifestations at the first assessment (5.0 and 5.3 loops/mm), but did differ at follow-up (3.6 and 4.7 loops/mm, p < 0.001). Capillary loss was more pronounced in patients who already had digital ischaemic manifestations at the first assessment compared to those without (p < 0.02). CONCLUSION In SSc, early digital ischaemic manifestations may precede a subsequent progressive capillary loss. The association between capillary loss and serious internal vascular complications remains to be studied.
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Affiliation(s)
- A Scheja
- Department of Clinical Sciences, Division of Rheumatology, Lund University, Lund, Sweden.
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Hesselstrand R, Wildt M, Ekmehag B, Wuttge DM, Scheja A. Survival in patients with pulmonary arterial hypertension associated with systemic sclerosis from a Swedish single centre: prognosis still poor and prediction difficult. Scand J Rheumatol 2010; 40:127-32. [DOI: 10.3109/03009742.2010.508751] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wildt M, Hesselstrand R, Åkesson A, Scheja A. Simple counting of nailfold capillary density in suspected systemic sclerosis – 9 years' experience. Scand J Rheumatol 2009; 36:452-7. [DOI: 10.1080/03009740701483030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wuttge DM, Wildt M, Geborek P, Wollheim FA, Scheja A, Åkesson A. Serum IL-15 in patients with early systemic sclerosis: a potential novel marker of lung disease. Arthritis Res Ther 2008; 9:R85. [PMID: 17784951 PMCID: PMC2212554 DOI: 10.1186/ar2284] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 08/09/2007] [Accepted: 09/04/2007] [Indexed: 11/18/2022] Open
Abstract
The pathogenesis of systemic sclerosis (SSc) is characterized by autoimmunity, vasculopathy and fibrosis. IL-15 is a pleiotropic cytokine that has impact on immune, vascular and connective tissue cells. We therefore investigated IL-15 in the circulation of patients with early SSc and explored possible associations of serum IL-15 with vasculopathy and fibrosis. Serum levels of IL-15 were analysed in 63 consecutive patients with SSc of disease duration less than 4 years and without disease-modifying treatment. Thirty-three age-matched healthy control individuals were enrolled. Serum IL-15 levels were increased in the sera of SSc patients compared with that of healthy control individuals (P < 0.01). Serum IL-15 levels correlated with impaired lung function, assessed both by the vital capacity (P < 0.05) and by the carbon monoxide diffusion capacity (P < 0.05). The association between IL-15 and the vital capacity remained after multiple linear regression analysis. Patients with intermediate serum IL-15 levels had a higher prevalence of increased systolic pulmonary pressure compared with patients with either low or high serum IL-15 levels (P < 0.05). Moreover, increased serum IL-15 levels were associated with a reduced nailfold capillary density in multivariable logistic regression analysis (P < 0.01). Serum IL-15 levels also correlated inversely with the systolic blood pressure (P < 0.01). We conclude that IL-15 is associated with fibrotic as well as vascular lung disease and vasculopathy in early SSc. IL-15 may contribute to the pathogenesis of SSc. IL-15 could also be a candidate biomarker for pulmonary involvement and a target for therapy in SSc.
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Affiliation(s)
- Dirk M Wuttge
- Department of Rheumatology, Lund University Hospital, S-221 85 Lund, Sweden
| | - Marie Wildt
- Department of Rheumatology, Lund University Hospital, S-221 85 Lund, Sweden
| | - Pierre Geborek
- Department of Rheumatology, Lund University Hospital, S-221 85 Lund, Sweden
| | - Frank A Wollheim
- Department of Rheumatology, Lund University Hospital, S-221 85 Lund, Sweden
| | - Agneta Scheja
- Department of Rheumatology, Lund University Hospital, S-221 85 Lund, Sweden
| | - Anita Åkesson
- Department of Rheumatology, Lund University Hospital, S-221 85 Lund, Sweden
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Hesselstrand R, Scheja A, Wildt M, Akesson A. High-frequency ultrasound of skin involvement in systemic sclerosis reflects oedema, extension and severity in early disease. Rheumatology (Oxford) 2008; 47:84-7. [DOI: 10.1093/rheumatology/kem307] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Scheja A, Hesselstrand R, Wildt M, Akesson A. Relapse of skin thickening after discontinuation or decrease of azathioprine therapy in a patient with diffuse cutaneous systemic sclerosis. Rheumatology (Oxford) 2007; 46:1862-3. [PMID: 17971385 DOI: 10.1093/rheumatology/kem272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Scheja
- Department of Rheumatology, Lund University Hospital, S-221 85, Lund, Sweden.
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Scheja A, Larsen K, Todorova L, Tufvesson E, Wildt M, Akesson A, Hansson L, Ellis S, Westergren Thorsson G. BALF-derived fibroblasts differ from biopsy-derived fibroblasts in systemic sclerosis. Eur Respir J 2006; 29:446-52. [PMID: 17107986 DOI: 10.1183/09031936.00135205] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Growth of fibroblasts from bronchoalveolar lavage fluid (BALF) in patients with systemic sclerosis (SSc) has previously been described. The purpose of the present study was to characterise fibroblasts from BALF and bronchial biopsies from SSc patients with alveolitis and from controls, to analyse fibroblast proliferation, migration, stress fibres and proteoglycan production. BALF and bronchial biopsies were collected from 10 patients with SSc and alveolitis and from 15 controls. Outgrowth of fibroblasts was observed from the BALF of four patients, particularly in those with a markedly increased percentage of eosinophils in BALF, but not in any member of the control group. Increased levels of granulocyte-macrophage colony-stimulating factor, correlating with the percentage of eosinophils in BALF, were found in patients when compared with controls. Fibroblasts from BALF showed an elongated, mobile phenotype and increased proteoglycan production compared to the corresponding biopsy fibroblasts. In conclusion, outgrowth of fibroblasts with an altered phenotype is reported from bronchoalveolar lavage fluid in systemic sclerosis patients with alveolitis and an increased percentage of eosinophils in the bronchoalveolar lavage fluid. These findings indicate a possible role for eosinophil-fibroblast interaction in pulmonary fibrosis in systemic sclerosis.
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Affiliation(s)
- A Scheja
- Dept of Rheumatology, Lund University Hospital, S-221 85 Lund, Sweden.
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Larsen K, Malmström J, Wildt M, Dahlqvist C, Hansson L, Marko-Varga G, Bjermer L, Scheja A, Westergren-Thorsson G. Functional and phenotypical comparison of myofibroblasts derived from biopsies and bronchoalveolar lavage in mild asthma and scleroderma. Respir Res 2006; 7:11. [PMID: 16430780 PMCID: PMC1386661 DOI: 10.1186/1465-9921-7-11] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Accepted: 01/23/2006] [Indexed: 11/10/2022] Open
Abstract
Background Activated fibroblasts, which have previously been obtained from bronchoalveolar lavage fluid (BALF), are proposed to be important cells in the fibrotic processes of asthma and scleroderma (SSc). We have studied the motility for BALF derived fibroblasts in patients with SSc that may explain the presence of these cells in the airway lumen. Furthermore, we have compared phenotypic alterations in activated fibroblasts from BALF and bronchial biopsies from patients with mild asthma and SSc that may account for the distinct fibrotic responses. Methods Fibroblasts were cultured from BALF and bronchial biopsies from patients with mild asthma and SSc. The motility was studied using a cell migration assay. Western Blotting was used to study the expression of alpha-smooth muscle actin (α-SMA), ED-A fibronectin, and serine arginine splicing factor 20 (SRp20). The protein expression pattern was analyzed to reveal potential biomarkers using two-dimensional electrophoresis (2-DE) and sequencing dual matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-TOF). The Mann-Whitney method was used to calculate statistical significance. Results Increased migration and levels of ED-A fibronectin were observed in BALF fibroblasts from both groups of patients, supported by increased expression of RhoA, Rac1, and the splicing factor SRp20. However, these observations were exclusively accompanied by increased expression of α-SMA in patients with mild asthma. Compared to BALF fibroblasts in mild asthma, fibroblasts in SSc displayed a differential protein expression pattern of cytoskeletal- and scavenger proteins. These identified proteins facilitate cell migration, oxidative stress, and the excessive deposition of extracellular matrix observed in patients with SSc. Conclusion This study demonstrates a possible origin for fibroblasts in the airway lumen in patients with SSc and important differences between fibroblast phenotypes in mild asthma and SSc. The findings may explain the distinct fibrotic processes and highlight the motile BALF fibroblast as a potential target cell in these disorders.
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Affiliation(s)
- Kristoffer Larsen
- Experimental Medical Science, Division of Vascular and Airway Research, Lund University, S-221 84 Lund, Sweden
| | - Johan Malmström
- Experimental Medical Science, Division of Vascular and Airway Research, Lund University, S-221 84 Lund, Sweden
- Institute for Molecular Systems Biology, ETH Hönggerberg, CH-8093 Zürich, Switzerland
| | - Marie Wildt
- Experimental Medical Science, Division of Vascular and Airway Research, Lund University, S-221 84 Lund, Sweden
- Department of Rheumatology, Lund University Hospital, S-221 85 Lund, Sweden
| | - Camilla Dahlqvist
- Experimental Medical Science, Division of Vascular and Airway Research, Lund University, S-221 84 Lund, Sweden
| | - Lennart Hansson
- Department of Respiratory Medicine and Allergology, Lund University Hospital, S-221 85 Lund, Sweden
| | | | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Lund University Hospital, S-221 85 Lund, Sweden
| | - Agneta Scheja
- Department of Rheumatology, Lund University Hospital, S-221 85 Lund, Sweden
| | - Gunilla Westergren-Thorsson
- Experimental Medical Science, Division of Vascular and Airway Research, Lund University, S-221 84 Lund, Sweden
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Abstract
OBJECTIVES The study explores, by the use of manometry, the frequency and severity of small intestinal involvement in patients with systemic sclerosis, and relates the manometric findings to clinical symptoms, radiology, and some intestinal regulatory peptides. METHODS Stationary antroduodeno-jejunal manometry was used to study small bowel involvement in 10 patients with systemic sclerosis and dysmotility of the oesophagus or signs of malabsorption. Measurements were made during fasting, after a meal, and after octreotide administration and were then compared with a sex-matched control group of healthy individuals. Plasma samples were taken in order to analyse levels of motilin, peptide YY, cholecystokinin, and somatostatin. RESULTS Manometry was abnormal, with signs of intestinal pseudo-obstruction in eight out of 10 patients. In the control group, one individual had an abnormal manometry, as a result of burst activity. The mean contractile amplitudes during fasting and periods after food, spontaneous phase III periods, and octreotide-induced activity complexes were significantly reduced in the systemic sclerosis group when compared with controls. None of the patients, including two with advanced manometric intestinal disturbances, had small intestinal dilatation when examined by radiography. The plasma peptide levels did not differ significantly between the two groups. CONCLUSIONS In eight out of 10 patients the manometric criteria for intestinal pseudo-obstruction were fulfilled, with a motility pattern consistent with both neuropathy and myopathy. The release of motility-regulating peptides was unaffected.
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Affiliation(s)
- Kristina Sjölund
- Department of Internal Medicine, Lund University Hospital, Sweden.
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Larsen K, Nilsson K, Tufvesson E, Malmström J, Wildt M, Andersson A, Malmström A, Löfdahl CG, Marko-Varga G, Bjermer L, Westergren-Thorsson G. Presence of Activated Mobile Fibroblasts in Bronchial Alveolar Lavage from Mild Asthmatic Patients. Wound Repair Regen 2005. [DOI: 10.1111/j.1067-1927.2005.130117ab.x] [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: 11/30/2022]
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Abstract
SUMMARY
This study examined whether serotonin levels in the brain of the American lobster, Homarus americanus, are under circadian control. Using high-performance liquid chromatography and semi-quantitative immunocytochemical methods, we measured serotonin levels in the brains of lobsters at six time points during a 24-h period. Lobsters were maintained for 2 weeks on a 12 h:12 h light:dark cycle followed by 3 days of constant darkness. Under these conditions, brain serotonin levels varied rhythmically,with a peak before subjective dusk and a trough before subjective dawn. This persistent circadian rhythm in constant darkness indicates that serotonin levels are controlled by an endogenous clock. Animals exposed to a shifted light cycle for >10 days, followed by 3 days in constant darkness,demonstrate that this rhythm is light entrainable. Separate analyses of two pairs of large deutocerebral neuropils, the accessory and olfactory lobes,show that serotonin levels in these functionally distinct areas also exhibit circadian rhythms but that these rhythms are out of phase with one another. The olfactory and accessory lobe rhythms are also endogenous and light entrainable, suggesting the presence of multiple clock mechanisms regulating serotonin levels in different brain regions.
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Affiliation(s)
- M Wildt
- Department of Biological Sciences, Wellesley College, Wellesley, MA 02481, USA
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Akesson A, Hesselstrand R, Scheja A, Wildt M. Longitudinal development of skin involvement and reliability of high frequency ultrasound in systemic sclerosis. Ann Rheum Dis 2004; 63:791-6. [PMID: 15194573 PMCID: PMC1755078 DOI: 10.1136/ard.2003.012146] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Measurement of skin involvement is essential for diagnosis and prognosis in systemic sclerosis. Assessment by palpation skin score is the current method. OBJECTIVE To explore high frequency ultrasound as an objective method to improve skin characterisation by combining measurements of skin thickness and echogenicity. METHODS Skin thickness and echogenicity were measured at the proximal phalanx of the second digit, the back of the hand, the forearm, and the lower leg and, in order to separate limited (lSSc) from diffuse SSc (dSSc), at the chest in 16 patients with early disease and in 16 controls. Measurements were repeated in each patient three or four times with an interval of 1-2 years. Ultrasound measurements of skin thickness were compared with the palpation skin score. RESULTS Compared with controls, the skin was thickened on the phalanx, hand, forearm, and chest of patients with dSSc, but not patients with lSSc, at the 1 year examination. In dSSc the degree of thickening tended to diminish with time, and at 4 years, thickness was significantly decreased on the forearm and chest compared with the 1 year measurements. Low reflectancy was most pronounced at the 1 year evaluation on the forearm, hand, and phalanx in dSSc, and on the phalanx in lSSc. CONCLUSION Separate measurements of skin thickness and echogenicity by high frequency ultrasound add a new dimension to the assessment of skin involvement in SSc, and this seems to be an objective non-invasive tool for use in the study of disease development and in clinical trials.
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Affiliation(s)
- A Akesson
- Department of Rheumatology, Lund University Hospital Lund, 221 85 Sweden.
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Larsen K, Tufvesson E, Malmström J, Mörgelin M, Wildt M, Andersson A, Lindström A, Malmström A, Löfdahl CG, Marko-Varga G, Bjermer L, Westergren-Thorsson G. Presence of activated mobile fibroblasts in bronchoalveolar lavage from patients with mild asthma. Am J Respir Crit Care Med 2004; 170:1049-56. [PMID: 15256392 DOI: 10.1164/rccm.200404-507oc] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Activated fibroblasts are suggested to be involved in the deposition of extracellular matrix in the formation of peribronchial fibrosis in asthma. We report the novel finding of activated elongated fibroblasts accompanied by elevated numbers of eosinophils in bronchoalveolar lavage fluid from 5 out of 12 patients with mild asthma (= 42%), whereas no fibroblasts were observed in the control subjects without asthma (n = 17). The elongated fibroblasts migrated twice as far when compared with fibroblasts from corresponding bronchial biopsies from the same patients, accompanied by an induced expression of RhoA and Rac1, indicating that the increased expression of these proteins are linked to increased migratory capabilities. Moreover, the elongated fibroblasts had an elevated production of the proteoglycans biglycan, versican, perlecan, and decorin, which correlated to an active cytoplasm in these cells. Differential expression patterns between the two fibroblast groups in motility-regulating proteins, such as cofilin, nuclear chloride ion channel protein, and heat-shock protein 20, were identified by two-dimensional electrophoresis and mass spectrometry. These findings indicate the presence of activated and mobile fibroblasts accompanied by an induced inflammatory response outside the airway epithelium in patients with mild asthma, results that may play a role in formation of airway fibrosis.
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Affiliation(s)
- Kristoffer Larsen
- Department of Cell and Molecular Biology, Lund University, Lund, Sweden.
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Hesselstrand R, Westergren-Thorsson G, Scheja A, Wildt M, Akesson A. The association between changes in skin echogenicity and the fibroblast production of biglycan and versican in systemic sclerosis. Clin Exp Rheumatol 2002; 20:301-8. [PMID: 12102465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVE To investigate a possible association between the longitudinal changes in skin involvement and the fibroblast production of proteoglycans in vitro, among patients with early and untreated systemic sclerosis (SSc). METHODS In 11 patients, 6 with diffuse cutaneous systemic sclerosis (dSSc) and 5 with limited cutaneous systemic sclerosis (ISSc), and in 6 controls skin thickness and skin echogenicity of the forearm was measured by high frequency (20 MHz) ultrasound. A skin biopsy was taken from the area of the ultrasound measurements, and from cultivated fibroblasts the production of the proteoglycans versican, perlecan, biglycan and decorin were measured. To investigate longitudinal changes in skin involvement, the ultrasound examination was repeated after 1-3 years. RESULTS Compared to controls, SSc patients had increased skin thickness at the first evaluation. Patients with dSSc had lower skin echogenicity than both patients with lSSc and the controls. Patients with greater changes in skin thickness and skin echogenicity produced more versican, whereas the production of biglycan and decorin was higher only in patients with greater changes in skin echogenicity. There was a negative correlation between fibroblast production of biglycan and disease duration. CONCLUSION High fibroblast synthesis of the proteoglycans versican and biglycan is associated with changes in skin echogenicity and may predict more progressive skin sclerosis in SSc.
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Affiliation(s)
- R Hesselstrand
- Department of Rheumatology, Lund University Hospital, Sweden.
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Scheja A, Akesson A, Geborek P, Wildt M, Wollheim CB, Wollheim FA, Vischer UM. Von Willebrand factor propeptide as a marker of disease activity in systemic sclerosis (scleroderma). Arthritis Res 2001; 3:178-82. [PMID: 11299058 PMCID: PMC30710 DOI: 10.1186/ar295] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2000] [Revised: 12/12/2000] [Accepted: 01/29/2001] [Indexed: 12/03/2022]
Abstract
In 44 consecutive patients with systemic sclerosis (SSc), plasma concentrations of von Willebrand factor (vWf) were higher than those of the vWf propeptide, but the propeptide showed less variability within patient subgroups. Higher values of the propeptide were observed in patients with early pulmonary involvement. A closer correlation of the propeptide than of vWf to biochemical markers of activity was also evident. Our results suggest that the propeptide, despite a shorter circulating half-time and lower plasma concentrations than vWf, is more useful in the assessment of disease activity in SSc.
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Affiliation(s)
- A Scheja
- Department of Rheumatology, University Hospital, Lund, Sweden
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Scheja A, Wildt M, Wollheim FA, Akesson A, Saxne T. Circulating collagen metabolites in systemic sclerosis. Differences between limited and diffuse form and relationship with pulmonary involvement. Rheumatology (Oxford) 2000; 39:1110-3. [PMID: 11035131 DOI: 10.1093/rheumatology/39.10.1110] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To study collagen metabolites in systemic sclerosis (SSc) and their relationship with clinical manifestations of the disease. METHODS Forty-eight SSc patients, 13 with a diffuse form (dcSSc), 23 with a limited form (lcSSc) and 12 with suspected SSc not fulfilling the ACR criteria, and 31 healthy controls were examined. Serum concentrations of aminoterminal type III procollagen peptide (PIIINP), aminoterminal and carboxyterminal type I procollagen peptides (PINP and PICP) and cross-linked carboxyterminal telopeptide of collagen I (ICTP) were determined by radioimmunoassay. RESULTS Increased serum concentrations of ICTP were found in SSc patients compared with controls. Distinctly higher levels of ICTP were observed in dcSSc than in lcSSc. High serum ICTP was correlated with skin score and acute phase reactants, and with reduced pulmonary function. Serum PIIINP concentration was elevated in both lcSSc and dcSSc. CONCLUSION Augmented collagen catabolism accompanies the increased collagen synthesis in SSc. Serum ICTP concentration is a marker of this feature and also reflects clinical severity.
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Affiliation(s)
- A Scheja
- Department of Rheumatology, University Hospital, Lund, Sweden
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Scheja A, Elborgh R, Wildt M. Decreased capillary density in juvenile dermatomyositis and in mixed connective tissue disease. J Rheumatol 1999; 26:1377-81. [PMID: 10381059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
OBJECTIVE To assess whether quantitative capillary microscopy is a useful tool to evaluate capillary abnormalities in children with connective tissue diseases. METHODS Eight children with juvenile dermatomyositis (JDM), 6 with mixed connective tissue disease (MCTD) and 23 healthy children were investigated with computer based quantitative capillary microscopy. Median disease duration was 1 year among JDM (1-4) and 3 years (1-7) among MCTD. RESULTS Capillary density was decreased in JDM [median 2.5 (1.4-4.3) loops/mm (p < 0.001)] and in MCTD [median 5.0 (4.1-7.0) loops/mm (p < 0.05)] compared to healthy controls [median 6.8 (5.3-8.0) loops/mm]. Median capillary loop area was increased in JDM [median 8.5 (3.0-15.8) 10(-3) mm2 (p < 0.001)] and in MCTD [median 4.5 (3.0-6.0) 10(-3) mm2 (p < 0.02)] compared to controls [median 2.5 (1.0-4.0) 10(-3) mm2]. CONCLUSION Quantitative nailfold capillary microscopy is a sensitive indicator of JDM. In MCTD this technique is less discriminative.
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Affiliation(s)
- A Scheja
- Department of Rheumatology, University Hospital at Lund, Sweden
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Wildt M, Hesselstrand R, Scheja A, Akesson A. Capillary density in patients with systemic sclerosis, as determined by microscopy counts and compared with computer-based analysis. Clin Exp Rheumatol 1999; 17:219-22. [PMID: 10342049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE To develop a method enabling capillary density to be determined rapidly and accurately in patients with systemic sclerosis. METHOD Capillary density was determined in 11 controls and 22 patients: 5 with diffuse cutaneous systemic sclerosis (dSSc), 12 with limited cutaneous systemic sclerosis (lSSc), two with suspected systemic sclerosis (suspSSc), 2 with sclerodermatomyositis, and one with undifferentiated connective tissue disease. Using a microscope equipped with a graticule, nailfold capillaries were counted within a 3 mm length of the nailfold; these counts were made by 4 different observers. The results were compared with the corresponding values obtained by the computerbased analysis of photographs. RESULTS The median capillary density according to the direct counts was 8.0 loops/mm (6.7-10.0) in the controls, 6.0 loops/mm (range 4.8-8.8) in the dSSc subgroup, 5.6 loops/mm (4.2-6.5) in the lSSc subgroup, and 7.2 loops/mm (6.2-8.2) in the suspSSc subgroup. In the series as a whole, there was no significant difference between the median values for the left hands and those for the right hands, nor between the median value for all digit IVs and the median value for all four digits analysed (II, III, IV, and V). Interobserver variation was small between the 4 different observers. Direct microscopy counts were slightly higher than the corresponding values obtained by computer-based analysis. CONCLUSION Direct microscopy counting is a rapid, simple, and reliable means of determining capillary density for screening purposes.
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Affiliation(s)
- M Wildt
- Department of Rheumatology, Lund University Hospital, Sweden
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Scheja A, Akesson A, Niewierowicz I, Wallin L, Wildt M, Wollheim FA. Computer based quantitative analysis of capillary abnormalities in systemic sclerosis and its relation to plasma concentration of von Willebrand factor. Ann Rheum Dis 1996; 55:52-6. [PMID: 8572735 PMCID: PMC1010082 DOI: 10.1136/ard.55.1.52] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To evaluate an objective and quantitative method for assessment of capillary abnormalities in systemic sclerosis (SSc). METHODS Nailfold capillaries were investigated by capillary microscopy and photographed in 17 consecutive SSc patients (five with diffuse cutaneous systemic sclerosis (dSSc) and 12 with limited cutaneous systemic sclerosis (lSSc)) and in 17 healthy controls. Investigators having no access to clinical data made drawings from magnified projections of coded photographs and analysed them using a computer program. Capillary density (capillary loops/mm in the distal row) and median capillary loop area were calculated. Presence of functional or organic arterial changes was evaluated by measurement of finger pressure with finger cooling. Plasma concentration of von Willebrand factor (VWF) was analysed using an enzyme linked immunosorbent assay (ELISA). RESULTS In 16 of 17 SSc patients and 13 of 17 controls the technical quality of the photographs was sufficient for computer analysis. Capillary density was decreased in dSSc (median 6.9 loops/mm) and in lSSc (median 3.8 loops/mm) compared with healthy controls (8.9 loops/mm) and median capillary loop area was increased in dSSc (7.3 x 10(-3) mm2) and in lSSc (8.5 x 10(-3) mm2) compared with healthy controls (5.0 x 10(-3) mm2). An inverse relation was found between capillary density and median capillary loop area in SSc patients. Plasma VWF was increased in patients (median 401 IE/l in dSSc and 409 IE/l in lSSc) compared with controls matched for age and sex (median 276 IE/l). Computer based analysis showed capillary density below the control range and median capillary loop area above the control range in 14 of 16 SSc patients. Measurement of finger pressure with finger cooling showed organic vascular changes in nine of 13 SSc patients. CONCLUSION Computer based quantitative analysis has low interobserver variability and is a quantitative and sensitive method of assessing capillary abnormalities in SSc.
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Affiliation(s)
- A Scheja
- Department of Rheumatology, Lund University Hospital, Sweden
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