Login Register Cart 0
Generic placeholder image

Current Rheumatology Reviews

Editor-in-Chief

ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Do We Have Good Activity Indices in Systemic Sclerosis?

Author(s): Laura Groseanu*, Sorana Petrescu, Andra Balanescu, Violeta Bojinca, Daniela Opris-Belinski, Florian Berghea, Diana Mazilu, Ioana Saulescu, Andreea Borangiu, Sanziana Daia-Iliescu, Cosmin Constantinescu, Claudia Cobilinschi, Mihai Abobului, Maria Magdalena Negru and Ruxandra Ionescu

Volume 18, Issue 1, 2022

Published on: 13 September, 2021

Page: [39 - 47] Pages: 9

DOI: 10.2174/1573397117666210913102759

Price: $65

Abstract

Background: No fully validated index is available for assessing overall disease activity in systemic sclerosis (SSc).

Objectives: To estimate the effect of disease activity as measured by different disease activity indices on the risk of subsequent organ damage.

Methods: The European Systemic sclerosis study group activity index (EScSG AI), the European Scleroderma Trials and Research Group Activity Index (r-EUSTAR AI), 12 point activity index proposed by Minier (12point AI) were calculated for 91 patients; the CRISS (The Composite Response Index for Systemic Sclerosis) for patients included after 2016. Data were analysed by parametric and non-parametric tests and logistic regression.

Results: EscSG AI, r-EUSTAR AI and 12point AI correlated with lung involvement. EScSG AI and r-EUSTAR AI correlated with diffuse skin involvement. EscSG AI correlated with digital ulcers and diffuse cutaneous involvement and r-EUSTAR AI with a renal crisis. Bivariate analysis showed an inverse correlation between the three disease activity scores and forced vital capacity (FVC) (p<0.001) and diffusing capacity for carbon monoxide (DLCO) (p<0.001) and positive correlation with pulmonary fibrosis (p<0.001), modified Rodnan skin score (mRSS) (p<0.001), health assessment questionnaire (HAQ) (p<0.001), systolic pulmonary pressure (sPAP) (p<0.001), C-reactive protein (CRP) (p<0.001) and capillaroscopy scoring (p<0.001) at both baseline visit and the 3-year follow-up visit. Logistic regression revealed that baseline EScSG AI adjusted for gender and age and that baseline 12-point AI both adjusted and unadjusted predicted worse skin involvement at 3-year follow-up; while adjusted EScSG AI predicted decreasing DLCO. Also, 12-point AI predicted a decline of FVC and higher HAQ scores at 3-year follow up; while baseline r-EUSTAR AI was able to predict muscular deterioration, decline of FVC and the increase of HAQ score during 3 years of following. An active disease according to EScSG AI at first visit predicted progression of joint involvement while an active disease at baseline showed by r- EUSTAR AI predicted muscular deterioration, FVC and DLCO worsening, as well as an increase in HAQ score during the follow-up period. r-EUSTAR AI was the only score to predict the decrease of FVC in a multiple regression prediction model (OR= 1.306 (1.025, 1.665), p=0.31) while baseline EScSG AI best predicted worsening of DLCO (OR=1.749 (1.104, 2.772), p=0.017).

Conclusion: Our study could not establish a gold standard to assess disease activity in SSc; especially EscSG AI and r-EUSTAR AI could quantify and predict major organ involvement in daily practice. CRISS can be useful as an outcome measure for patients with short disease duration included in clinical studies.

Keywords: Systemic Sclerosis, EScSG AI, r-EUSTAR AI, SSc, CRISS, 12point AI.

« Previous Next »
[1]
Barsotti S, Stagnaro C, Della Rossa A. Systemic sclerosis: a critical digest of the recent literature. Clin Exp Rheumatol 2015; 33(4)(Suppl. 91): S3-S14.
[PMID: 26243174]
[2]
Medsger TA Jr. Natural history of systemic sclerosis and the assessment of disease activity, severity, functional status, and psychologic well-being. Rheum Dis Clin North Am 2003; 29(2): 255-273, vi.
[http://dx.doi.org/10.1016/S0889-857X(03)00023-1] [PMID: 12841294]
[3]
Melsens K, De Keyser F, Decuman S, Piette Y, Vandecasteele E, Smith V. Disease activity indices in systemic sclerosis: a systematic literature review. Clin Exp Rheumatol 2016; 34(5): 186-92.
[4]
Furst D, Khanna D, Matucci-Cerinic M, et al. Systemic sclerosis - continuing progress in developing clinical measures of response. J Rheumatol 2007; 34(5): 1194-200.
[PMID: 17477486]
[5]
Merkel PA, Clements PJ, Reveille JD, Suarez-Almazor ME, Valentini G, Furst DE. Current status of outcome measure development for clinical trials in systemic sclerosis. Report from OMERACT 6. J Rheumatol 2003; 30(7): 1630-47.
[PMID: 12858472]
[6]
Furst DE. Outcome measures in rheumatologic clinical trials and systemic sclerosis. Rheumatology (Oxford) 2008; 47(Suppl. 5): v29-30.
[http://dx.doi.org/10.1093/rheumatology/ken269] [PMID: 18784136]
[7]
Ross L, Baron M, Nikpour M. The challenges and controversies of measuring disease activity in systemic sclerosis. J Scleroderma Relat Disord 2018; 3(2): 115-21.
[http://dx.doi.org/10.1177/2397198318765061]
[8]
Valentini G, Della Rossa A, Bombardieri S, et al. European multicentre study to define disease activity criteria for systemic sclerosis. II. Identification of disease activity variables and development of preliminary activity indexes. Ann Rheum Dis 2001; 60(6): 592-8.
[http://dx.doi.org/10.1136/ard.60.6.592] [PMID: 11350848]
[9]
Minier T, Nagy Z, Bálint Z, et al. Construct validity evaluation of the European Scleroderma Study Group activity index, and investigation of possible new disease activity markers in systemic sclerosis. Rheumatology (Oxford) 2010; 49(6): 1133-45.
[http://dx.doi.org/10.1093/rheumatology/keq022] [PMID: 20236952]
[10]
Valentini G, Iudici M, Walker UA. The European Scleroderma Trials and Research group (EUSTAR) task force for the development of revised activity criteria for systemic sclerosis: derivation and validation of a preliminarily revised EUSTAR activity indexAnnals of the Rheumatic Diseases. 2017; 76: 270-6.
[11]
Khanna D, Berrocal VJ, Giannini EH, et al. The American College of Rheumatology Provisional Composite Response Index for Clinical Trials in Early Diffuse Cutaneous Systemic Sclerosis. Arthritis Rheumatol 2016; 68(2): 299-311.
[http://dx.doi.org/10.1002/art.39501] [PMID: 26808827]
[12]
Sulli A, Secchi ME, Pizzorni C, Cutolo M. Scoring the nailfold microvascular changes during the capillaroscopic analysis in systemic sclerosis patients. Ann Rheum Dis 2008; 67(6): 885-7.
[http://dx.doi.org/10.1136/ard.2007.079756] [PMID: 18037628]
[13]
Penn H, Howie AJ, Kingdon EJ, et al. Scleroderma renal crisis: patient characteristics and long-term outcomes. QJM 2007; 100(8): 485-94.
[http://dx.doi.org/10.1093/qjmed/hcm052] [PMID: 17601770]
[14]
Medsger TA Jr, Silman AJ, Steen VD, et al. A disease severity scale for systemic sclerosis: development and testing. J Rheumatol 1999; 26(10): 2159-67.
[PMID: 10529133]
[15]
Tabachnick BG, Fidell LS. Using multivariate statistics. 4th ed. Boston: Allyn and Bacon 2001.
[16]
Nevskaya T, Baron M, Pope JE. Predictive value of European Scleroderma Group Activity Index in an early scleroderma cohort. Rheumatology (Oxford) 2017; 56(7): 1111-22.
[http://dx.doi.org/10.1093/rheumatology/kex015] [PMID: 28340090]
[17]
Fasano S, Riccardi A, Messiniti V, et al. Revised European Scleroderma Trials and Research Group Activity Index is the best predictor of short-term severity accrual. Ann Rheum Dis 2019; 78(12): 1681-5.
[http://dx.doi.org/10.1136/annrheumdis-2019-215787] [PMID: 31422354]
[18]
Horimoto AMC, Camargo CZ, Kayser C. Less severe disease in patients with early systemic sclerosis? Mod Rheumatol 2019; 29(6): 977-83.
[http://dx.doi.org/10.1080/14397595.2018.1551265] [PMID: 30472907]
[19]
Ovsyannikova O, Ananyeva LP, Koneva O, et al. Association of European Scleroderma Study Group Activity Index (EScSG-AI) with progression pulmonary alterations by HRCT in patients with systemic sclerosis over a five year period. Ann Rheum Dis 2019; 78: 1565-6.
[20]
Nihtyanova SI, Denton CP. Current approaches to the management of early active diffuse scleroderma skin disease. Rheum Dis Clin North Am 2008; 34(1): 161-179, viii.
[http://dx.doi.org/10.1016/j.rdc.2007.11.005] [PMID: 18329538]
[21]
Amjadi S, Maranian P, Furst DE, et al. Course of the modified Rodnan skin thickness score in systemic sclerosis clinical trials: analysis of three large multicenter, double-blind, randomized controlled trials. Arthritis Rheum 2009; 60(8): 2490-8.
[http://dx.doi.org/10.1002/art.24681] [PMID: 19644851]
[22]
Hudson M, Thombs BD, Steele R, Panopalis P, Newton E, Baron M. Health-related quality of life in systemic sclerosis: a systematic review. Arthritis Rheum 2009; 61(8): 1112-20.
[http://dx.doi.org/10.1002/art.24676] [PMID: 19644906]
[23]
Hudson M, Thombs BD, Steele R, Panopalis P, Newton E, Baron M. Quality of life in patients with systemic sclerosis compared to the general population and patients with other chronic conditions. J Rheumatol 2009; 36(4): 768-72.
[http://dx.doi.org/10.3899/jrheum.080281] [PMID: 19228662]
[24]
Park EH, Strand V, Oh YJ, Song YW, Lee EB. Health-related quality of life in systemic sclerosis compared with other rheumatic diseases: a cross-sectional study. Arthritis Res Ther 2019; 21(1): 61.
[http://dx.doi.org/10.1186/s13075-019-1842-x] [PMID: 30770765]
[25]
Chan PT, Mok CC, Chan KL, Ho LY. Functioning and health-related quality of life in Chinese patients with systemic sclerosis: a case-control study. Clin Rheumatol 2014; 33(5): 659-66.
[http://dx.doi.org/10.1007/s10067-014-2525-2] [PMID: 24531870]

Rights & Permissions Print Cite
Article Metrics
24
1
© 2024 Bentham Science Publishers | Privacy Policy