OBJECTIVE: To compare clinical diagnosis with two validated classification criteria for systemic sclerosis (SSc) in a cohort of Swiss patients with SSc and associated disorders. METHODS: Charts of 54 patients with SSc and associated disorders were reviewed and compared with data obtained at a thorough clinical examination using a standardised protocol (Raynaud's phenomen [RP], skin involvement, nailfold capillary microscopy and determination of autoantibody pattern). RESULTS: According to patient records 6 patients had diffuse cutaneous SSc (dcSSc), 23 limited cutaneous SSc (lcSSc) and 20 were not classified. Two patients had mixed connective tissue disease (MCTD) and 3 overlap syndromes. At the time of clinical examination, 7 patients showed dcSSc (6 plus 1 patient originally classified as lcSSc), 26 lcSSc (20 plus 6 originally not classified) and 16 patients had severe RP which was arbitrarily classified as Raynaud's syndrome (RS). 15 of the latter 16 were antinuclear antibody positive and 7 exhibited pathological nailfold capillaries. On the basis of LeRoy and Medsger's criteria, 6 of these patients could be further classified as limited SSc (lSSc). Of 49 sera tested, 14 contained centromere antibodies at clinical examination, 16 Scl-70, 5 RNA-pol, 1 Ku, 12 antibodies with unknown specificity, and one serum was autoantibody negative. CONCLUSIONS: A substantial number of patients with minor cutaneous manifestations do not fulfil ACR classification criteria, though they have typical clinical signs of SSc. Characteristic features in these patients are presence of Raynaud's phenomenon, antinuclear antibodies and pathological changes in nailfold capillary microscopy. Application of the diagnostic criteria recently proposed by LeRoy and Medsger makes it possible to name many of these patients. The use of these criteria is recommended for clinical management.
OBJECTIVE: To compare clinical diagnosis with two validated classification criteria for systemic sclerosis (SSc) in a cohort of Swiss patients with SSc and associated disorders. METHODS: Charts of 54 patients with SSc and associated disorders were reviewed and compared with data obtained at a thorough clinical examination using a standardised protocol (Raynaud's phenomen [RP], skin involvement, nailfold capillary microscopy and determination of autoantibody pattern). RESULTS: According to patient records 6 patients had diffuse cutaneous SSc (dcSSc), 23 limited cutaneous SSc (lcSSc) and 20 were not classified. Two patients had mixed connective tissue disease (MCTD) and 3 overlap syndromes. At the time of clinical examination, 7 patients showed dcSSc (6 plus 1 patient originally classified as lcSSc), 26 lcSSc (20 plus 6 originally not classified) and 16 patients had severe RP which was arbitrarily classified as Raynaud's syndrome (RS). 15 of the latter 16 were antinuclear antibody positive and 7 exhibited pathological nailfold capillaries. On the basis of LeRoy and Medsger's criteria, 6 of these patients could be further classified as limited SSc (lSSc). Of 49 sera tested, 14 contained centromere antibodies at clinical examination, 16 Scl-70, 5 RNA-pol, 1 Ku, 12 antibodies with unknown specificity, and one serum was autoantibody negative. CONCLUSIONS: A substantial number of patients with minor cutaneous manifestations do not fulfil ACR classification criteria, though they have typical clinical signs of SSc. Characteristic features in these patients are presence of Raynaud's phenomenon, antinuclear antibodies and pathological changes in nailfold capillary microscopy. Application of the diagnostic criteria recently proposed by LeRoy and Medsger makes it possible to name many of these patients. The use of these criteria is recommended for clinical management.
Authors: Rohit Aggarwal; Sarah Ringold; Dinesh Khanna; Tuhina Neogi; Sindhu R Johnson; Amy Miller; Hermine I Brunner; Rikke Ogawa; David Felson; Alexis Ogdie; Daniel Aletaha; Brian M Feldman Journal: Arthritis Care Res (Hoboken) Date: 2015-07 Impact factor: 4.794
Authors: Pia Moinzadeh; Elisabeth Aberer; Keihan Ahmadi-Simab; Norbert Blank; Joerg H W Distler; Gerhard Fierlbeck; Ekkehard Genth; Claudia Guenther; Ruediger Hein; Joerg Henes; Lena Herich; Ilka Herrgott; Ina Koetter; Alexander Kreuter; Thomas Krieg; Kathrin Kuhr; Hanns-Martin Lorenz; Florian Meier; Inga Melchers; Hartwig Mensing; Ulf Mueller-Ladner; Christiane Pfeiffer; Gabriela Riemekasten; Miklós Sárdy; Marc Schmalzing; Cord Sunderkoetter; Laura Susok; Ingo H Tarner; Peter Vaith; Margitta Worm; Gottfried Wozel; Gabriele Zeidler; Nicolas Hunzelmann Journal: Ann Rheum Dis Date: 2014-01-03 Impact factor: 19.103