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Joint and tendon involvement predict disease progression in systemic sclerosis: a EUSTAR prospective study

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Abstract
Objective: To determine whether joint synovitis and tendon friction rubs (TFRs) can predict the progression of systemic sclerosis (SSc) over time. Patients and methods: We performed a prospective cohort study that included 1301 patients with SSc from the EUSTAR database with disease duration <= 3 years at inclusion and with a follow-up of at least 2 years. Presence or absence at clinical examination of synovitis and TFRs was extracted at baseline. Outcomes were skin, cardiovascular, renal and lung progression. Overall disease progression was defined according to the occurrence of at least one organ progression. Results: Joint synovitis (HR: 1.26, 95% CI 1.01 to 1.59) and TFRs (HR: 1.32, 95% CI 1.03 to 1.70) were independently predictive of overall disease progression, as were also the diffuse cutaneous subset (HR: 1.30, 95% CI 1.05 to 1.61) and positive antitopoisomerase-I antibodies (HR: 1.25, 95% CI 1.02 to 1.53). Regarding skin progression, joint synovitis (HR: 1.67, 95% CI 1.06 to 2.64) and TFRs (HR: 1.69, 95% CI 1.02 to 2.77) were also independently predictive of worsening of the modified Rodnan skin score. For cardiovascular progression, joint synovitis was predictive of the occurrence of new digital ulcer(s) (HR: 1.45, 95% CI 1.08 to 1.96) and decreased left ventricular ejection fraction (HR: 2.20, 95% CI 1.06 to 4.57); TFRs were confirmed to be an independent predictor of scleroderma renal crisis (HR: 2.33, 95% CI 1.03 to 6.19). Conclusions: Joint synovitis and TFRs are independent predictive factors for disease progression in patients with early SSc. These easily detected clinical markers may be useful for the risk stratification of patients with SSc.
Keywords
HYPERTENSION, METAANALYSIS, MANIFESTATIONS, COHORT, FRICTION RUBS, ORGAN INVOLVEMENT, RESEARCH GROUP DATABASE, DIFFUSE SCLERODERMA, ISCHEMIC DIGITAL ULCERS, EULAR SCLERODERMA TRIALS

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Chicago
Avouac, Jérôme, Ulrich A Walker, Eric Hachulla, Gabriela Riemekasten, Giovanna Cuomo, Patricia E Carreira, Paola Caramaschi, et al. 2016. “Joint and Tendon Involvement Predict Disease Progression in Systemic Sclerosis: a EUSTAR Prospective Study.” Annals of the Rheumatic Diseases 75 (1): 103–109.
APA
Avouac, J., Walker, U. A., Hachulla, E., Riemekasten, G., Cuomo, G., Carreira, P. E., Caramaschi, P., et al. (2016). Joint and tendon involvement predict disease progression in systemic sclerosis: a EUSTAR prospective study. ANNALS OF THE RHEUMATIC DISEASES, 75(1), 103–109.
Vancouver
1.
Avouac J, Walker UA, Hachulla E, Riemekasten G, Cuomo G, Carreira PE, et al. Joint and tendon involvement predict disease progression in systemic sclerosis: a EUSTAR prospective study. ANNALS OF THE RHEUMATIC DISEASES. 2016;75(1):103–9.
MLA
Avouac, Jérôme et al. “Joint and Tendon Involvement Predict Disease Progression in Systemic Sclerosis: a EUSTAR Prospective Study.” ANNALS OF THE RHEUMATIC DISEASES 75.1 (2016): 103–109. Print.
@article{8039043,
  abstract     = {Objective: To determine whether joint synovitis and tendon friction rubs (TFRs) can predict the progression of systemic sclerosis (SSc) over time. 
Patients and methods: We performed a prospective cohort study that included 1301 patients with SSc from the EUSTAR database with disease duration <= 3 years at inclusion and with a follow-up of at least 2 years. Presence or absence at clinical examination of synovitis and TFRs was extracted at baseline. Outcomes were skin, cardiovascular, renal and lung progression. Overall disease progression was defined according to the occurrence of at least one organ progression. 
Results: Joint synovitis (HR: 1.26, 95% CI 1.01 to 1.59) and TFRs (HR: 1.32, 95% CI 1.03 to 1.70) were independently predictive of overall disease progression, as were also the diffuse cutaneous subset (HR: 1.30, 95% CI 1.05 to 1.61) and positive antitopoisomerase-I antibodies (HR: 1.25, 95% CI 1.02 to 1.53). Regarding skin progression, joint synovitis (HR: 1.67, 95% CI 1.06 to 2.64) and TFRs (HR: 1.69, 95% CI 1.02 to 2.77) were also independently predictive of worsening of the modified Rodnan skin score. For cardiovascular progression, joint synovitis was predictive of the occurrence of new digital ulcer(s) (HR: 1.45, 95% CI 1.08 to 1.96) and decreased left ventricular ejection fraction (HR: 2.20, 95% CI 1.06 to 4.57); TFRs were confirmed to be an independent predictor of scleroderma renal crisis (HR: 2.33, 95% CI 1.03 to 6.19). 
Conclusions: Joint synovitis and TFRs are independent predictive factors for disease progression in patients with early SSc. These easily detected clinical markers may be useful for the risk stratification of patients with SSc.},
  author       = {Avouac, Jérôme and Walker, Ulrich A and Hachulla, Eric and Riemekasten, Gabriela and Cuomo, Giovanna and Carreira, Patricia E and Caramaschi, Paola and Ananieva, Lidia P and Matucci-Cerinic, Marco and Czirjak, Laszlo and Denton, Christopher and Müller Ladner, Ulf and Allanore, Yannick and EUSTAR collaborators, the and Smith, Vanessa},
  issn         = {0003-4967},
  journal      = {ANNALS OF THE RHEUMATIC DISEASES},
  keywords     = {HYPERTENSION,METAANALYSIS,MANIFESTATIONS,COHORT,FRICTION RUBS,ORGAN INVOLVEMENT,RESEARCH GROUP DATABASE,DIFFUSE SCLERODERMA,ISCHEMIC DIGITAL ULCERS,EULAR SCLERODERMA TRIALS},
  language     = {eng},
  number       = {1},
  pages        = {103--109},
  title        = {Joint and tendon involvement predict disease progression in systemic sclerosis: a EUSTAR prospective study},
  url          = {http://dx.doi.org/10.1136/annrheumdis-2014-205295},
  volume       = {75},
  year         = {2016},
}

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