Inflammatory arthritis in systemic sclerosis: What to do?

Blank, Rebecca B.; Nwawka, O. Kenechi; Yusov, Anna; Gordon, Jessica

doi:10.1177/2397198318779532

Cited by 11 publications

(8 citation statements)

References 89 publications

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“…The individual reductions in the TOF group varied within a larger range (− 0.12 mm to 0.57 mm) versus − 0.02 mm to − 0.17 mm in the MTX group. Musculoskeletal US may be used to assess articular and periarticular involvement in SSc patients [38][39][40][41]. Elhai et al showed that signs of tendon involvement were more frequent in SSc than in RA patients [42].…”

Section: Discussionmentioning

confidence: 99%

Tofacitinib in the treatment of skin and musculoskeletal involvement in patients with systemic sclerosis, evaluated by ultrasound

et al. 2021

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Systemic sclerosis (SSc) is a rare autoimmune connective tissue disease characterized by fibrosis of the skin and internal organs, autoimmunity-driven damage and vasculopathy. The current approved disease-modifying treatments have limited efficacy, and treatment is guided toward alleviating organ complications. Thus, there is an unmet need for discovering new effective treatment options. There is recent evidence that the JAK/STAT signaling pathway is markedly activated in SSc patients. To assess the efficacy and safety of tofacitinib (TOF) on skin and musculoskeletal involvement as compared to methotrexate (MTX) in systemic sclerosis (SSc). In this 52-week pilot study, 66 patients with SSc were enrolled: 33 patients received 5 mg of oral TOF twice a day; 33 received 10 mg of MTX weekly. The proportion of dcSSc and lcSSc patients was similar (dcSSc: 42% TOF group and 36% MTX group; lcSSc: 58% TOF group and 64% MTX group). The primary outcome was the change in the modified Rodnan skin score (mRSS). Secondary outcomes included ultrasound (US) skin thickness and musculoskeletal involvement (US10SSc score). Digital ulcers (DUs) and adverse events (AEs) were documented through the treatment. Both groups had similar characteristics and medians on the outcome measures at baseline. At week 52, the TOF median mRSS was significantly lower than the MTX (p < 0.001) with a mean reduction of 13 points versus MTX 2.57. The mean percent improvement in the TOF group was 44% higher than in the MTX group. TOF median US skin thickness was significantly lower than MTX (p < 0.001), with a mean reduction of 0.31 mm versus 0.075 mm in the MTX group. The US10SSc median score was significantly lower in the TOF group (p = 0.002); mean reduction of 10.21 versus 5.27 in the MTX group. Healing of DUs with no new occurrences was observed in the TOF group. There was no significant difference between the groups in the number of AEs from baseline to week 52. TOF showed greater efficacy than MTX in reducing mRSS, skin thickness and musculoskeletal involvement in SSc and a satisfactory safety profile.

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Section: Discussionmentioning

confidence: 99%

Tofacitinib in the treatment of skin and musculoskeletal involvement in patients with systemic sclerosis, evaluated by ultrasound

et al. 2021

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“…Thus, it seems that in order to determine the severity of the locomotor system involvement more objectively, the scales for the assessment of pSS activity, i.e. SDAI, CDAI, DAS28–CRP or DAS28–ESR, that are also reliable in the assessment of arthritis in the course of SSc, should be used [ 51 , 52 ].…”

Section: Methods Of Assessment Of Joint Involvement In the Course Of ...mentioning

confidence: 99%

Methods of assessment of joint involvement in various systemic connective tissue diseases

Kardas¹,

Wielosz²,

Majdan³

2022

Reumatologia

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Joint involvement is one of the most common clinical manifestations of systemic connective tissue diseases (CTD). Joint symptoms can take various forms, ranging from joint pain to mono-arthritis or symmetrical poly-arthritis. In most cases, arthritis takes a non-destructive form, such as in the course of systemic lupus erythematosus or primary Sjögren's syndrome, to destructive arthritis in overlap syndromes of CTD with rheumatoid arthritis. In addition, apart from the wide variety of forms of joint involvement, it should be noted that joint symptoms may be one of the domains suggesting a severe course of the disease. The study attempts to present the methods of assessing the involvement of the locomotor system. The search for appropriate scales to determine the degree of joint involvement is important in assessing the severity of joint changes, has an impact on the overall degree of disease activity, and allows for timely implementation of appropriate treatment.

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“…Data from our single tertiary care centre showed that the prevalence of any contracture (defined as more than a 25% decrease in the range of motion in any of the joint axes) was 82% (9). Arthritis predominantly affects the joints of the hands and usually appears early in the disease course of SSc (1,8,(10)(11)(12), resulting in contractures which are one of the primary causes of disability and poor quality of life in patients with SSc (13)(14)(15). The newly developed Scleroderma Clinical Trials Consortium Damage Index (SCTC-DI) includes joint contractures as part of musculoskeletal damage (16).…”

Section: Introductionmentioning

confidence: 99%

Sensitivity to change of joint count composite indices in 72 patients with systemic sclerosis

Lóránd

Nagy

Bálint

et al. 2021

Clinical and Experimental Rheumatology

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Objective. We validated the responsiveness of joint count composite indices (JCCIs) in 72 patients with systemic sclerosis (SSc). Methods. Changes in Disease Activity Score of 28 Joints using ESR and CRP (DAS28-ESR, DAS28-CRP), Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI) were evaluated in a one-year followup study. Charts of patients including swollen/tender joint counts, laboratory signs of inflammation, and visual analogue scales referring to disease activity, severity and pain were also blindly categorised by two rheumatologists as improved, unchanged or deteriorated. These categories were used as references for the determination of effect size (ES) and standardised response mean (SRM). (r >0.68; p<0.001). Arthritis was predominantly prone to change in patients with high JCCIs, impaired functional status, anti-RNA polymerase III antibodies and patients on DMARD therapy. Synovitis was more prevalent in patients with early diffuse SSc, and tended to improve during the follow-up. Conclusion. All four JCCIs were sensitive to changes, if tender/swollen joints were present at baseline. Articular inflammation was most prone to change in patients with high JCCIs, impaired functional status and already decreased health-related quality of life at baseline. Results. Articular inflammation improved in 15, deteriorated in 12, and remained unchanged in 45 (63%) patients with SSc based on the concordant opinion of two clinical investigators. All four JCCIs were sensitive to changes (ES>1; SRM>1). The correlation between changes in JCCIs and the physicians' evaluation was high

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Inflammatory arthritis in systemic sclerosis: What to do?

Cited by 11 publications

References 89 publications

Tofacitinib in the treatment of skin and musculoskeletal involvement in patients with systemic sclerosis, evaluated by ultrasound

Tofacitinib in the treatment of skin and musculoskeletal involvement in patients with systemic sclerosis, evaluated by ultrasound

Methods of assessment of joint involvement in various systemic connective tissue diseases

Sensitivity to change of joint count composite indices in 72 patients with systemic sclerosis

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