Joint and fascial chronic graft-vs-host disease: correlations with clinical and laboratory parameters

Abstract

AimTo determine if there are correlations between joint and fascial chronic graft-vs-host disease (cGVHD) with clinical findings, laboratory parameters, and measures of functional capacity.Methods29 patients were diagnosed with cGVHD based on National Institutes of Health (NIH) Consensus Criteria at the University Hospital Centre Zagreb from October 2013 to October 2015. Physical examination, including functional measures such as 2-minute walk test and hand grip strength, as well as laboratory tests were performed. The relationship between these evaluations and the severity of joint and fascial cGVHD was tested by logistical regression analysis.Results12 of 29 patients (41.3%) had joint and fascial cGVHD diagnosed according to NIH Consensus Criteria. There was a significant positive correlation of joint and fascial cGVHD and skin cGVHD (P < 0.001), serum C3 complement level (P = 0.045), and leukocytes (P = 0.032). There was a significant negative correlation between 2-minute walk test (P = 0.016), percentage of cytotoxic T cells CD3+/CD8+ (P = 0.022), serum albumin (P = 0.047), and Karnofsky score (P < 0.001). Binary logistic regression model found that a significant predictor for joint and fascial cGVHD was cGVHD skin involvement (odds ratio, 7.79; 95 confidence interval 1.87-32.56; P = 0.005).ConclusionJoint and fascial cGVHD manifestations correlated with multiple laboratory measurements, clinical features, and cGVHD skin involvement, which was a significant predictor for joint and fascial cGVHD.

Psychometric properties of the Activities Scale for Kids-performance after allogeneic hematopoietic stem cell transplantation in adolescents and children

“…Performance scales, such as the Karnofsky performance scale (KPS) [ 20 ] for adolescents and adults over 16 years of age, and the Lansky play performance scale (PSS) for children below 16 years of age [ 21 ] are also in use to assess functional status after HSCT [ 22 – 24 ]. Some studies have shown a negative correlation with global severity of cGVHD and with joint and fascial involvement of cGVHD [ 25 , 26 ].…”

Joint and Fascia Manifestations in the Course of Graft-Versus-Host Disease (Gvhd) as a Diagnostic Trail for Doctors of Various Specialties - Case Report

“…The Inamoto et al, (2014) study suggests that joint and fascia manifestations were associated with longer duration from transplantation (over a year), prevalent GVHD cases and the use of high-dose total-body irradiation conditioning. However, Vukić et al, (2016) found no significant association between these parameters and joint/fascia manifestations in cGVHD.…”

“…The involvement of joints was more prevalent in the upper limbs, most notably in the interphalangeal, wrist, and elbow (31%). It was documented that these patients ROM was reduced by as much as 66.7% (Vukić et al, 2016).…”

“…Moreover, multiple studies have presented a strong correlation between joint and skin symptoms during the course of graftversus-host disease (Martires et al, 2011;Grkovic et al, 2012). According to Vukić joint changes appeared in 83.3% of subjects with coexisting erythematous lesions, superficial or deep skin sclerosis (Vukić et al, 2016).…”

“…Among the often-overlooked tissues are joints, muscles, and fascia. These changes predominantly affect the elbow, wrist and interphalangeal joints, which manifest themselves as stiffness, erythema, restricted range of motion, arthralgia and less-often arthritis or synovitis (Vukić et al, 2016). However, edema is often the first finding on physical exam of fascial involvement in GVHD (Filipovich et al, 2005).…”