Victoria A Flower1, Shaney L Barratt2, Darren J Hart3, Amanda B Mackenzie4, Jacqueline A Shipley3, Stephen G Ward5, John D Pauling6. 1. V.A. Flower, Consultant Rheumatologist, MBBS, PhD, J.D. Pauling, Consultant Rheumatologist and Senior Lecturer, BMBS, PhD, Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust, Bath, Department of Pharmacy and Pharmacology, University of Bath, Bath; v.flower@nhs.net. 2. S.L. Barratt, BMBS, PhD, Department of Respiratory Medicine, North Bristol NHS Trust, Bristol, Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol. 3. D.J. Hart, Clinical Scientist, PhD, J.A. Shipley, Clinical Scientist, PhD, Clinical Measurement and Imaging Department, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust, Bath. 4. A.B. Mackenzie, Senior Lecturer, PhD, Department of Pharmacy and Pharmacology, University of Bath, Bath. 5. S.G. Ward, Professor, PhD, Centre for Therapeutic Innovation & Department of Pharmacy and Pharmacology, University of Bath, Bath, UK. 6. V.A. Flower, Consultant Rheumatologist, MBBS, PhD, J.D. Pauling, Consultant Rheumatologist and Senior Lecturer, BMBS, PhD, Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust, Bath, Department of Pharmacy and Pharmacology, University of Bath, Bath.
Abstract
OBJECTIVE: The modified Rodnan skin score (mRSS) remains the preferred method for skin assessment in systemic sclerosis (SSc). There are concerns regarding high interobserver variability of mRSS and negative clinical trials utilizing mRSS as the primary endpoint. High-frequency ultrasound (HFUS) allows objective assessment of cutaneous fibrosis in SSc. We investigated the relationship between HFUS with both mRSS and dermal collagen. METHODS: Skin thickness (ST), echogenicity, and novel shear wave elastography (SWE) were assessed in 53 patients with SSc and 15 healthy controls (HCs) at the finger, hand, forearm, and abdomen. The relationship between HFUS parameters with mRSS (n = 53) and dermal collagen (10 patients with SSc and 10 HCs) was investigated. Intraobserver repeatability of HFUS was calculated using intraclass correlation coefficients (ICCs). RESULTS: HFUS assessment of ST (hand/forearm) and SWE (finger/hand) correlated with local mRSS at some sites. Subclinical abnormalities in ST, echogenicity, and SWE were present in clinically uninvolved SSc skin. Additionally, changes in echogenicity and SWE were sometimes apparent despite objectively normal ST on HFUS. ST, SWE, and local mRSS correlated strongly with collagen quantification (r = 0.697, 0.709, 0.649, respectively). Intraobserver repeatability was high for all HFUS parameters (ICCs for ST = 0.946-0.978; echogenicity = 0.648-0.865; and SWE = 0.953-0.973). CONCLUSION: Our data demonstrate excellent reproducibility and reassuring convergent validity with dermal collagen content. Detection of subclinical abnormalities is an additional benefit of HFUS. The observed correlations with collagen quantification support further investigation of HFUS as an alternative to mRSS in clinical trial settings.
OBJECTIVE: The modified Rodnan skin score (mRSS) remains the preferred method for skin assessment in systemic sclerosis (SSc). There are concerns regarding high interobserver variability of mRSS and negative clinical trials utilizing mRSS as the primary endpoint. High-frequency ultrasound (HFUS) allows objective assessment of cutaneous fibrosis in SSc. We investigated the relationship between HFUS with both mRSS and dermal collagen. METHODS: Skin thickness (ST), echogenicity, and novel shear wave elastography (SWE) were assessed in 53 patients with SSc and 15 healthy controls (HCs) at the finger, hand, forearm, and abdomen. The relationship between HFUS parameters with mRSS (n = 53) and dermal collagen (10 patients with SSc and 10 HCs) was investigated. Intraobserver repeatability of HFUS was calculated using intraclass correlation coefficients (ICCs). RESULTS: HFUS assessment of ST (hand/forearm) and SWE (finger/hand) correlated with local mRSS at some sites. Subclinical abnormalities in ST, echogenicity, and SWE were present in clinically uninvolved SSc skin. Additionally, changes in echogenicity and SWE were sometimes apparent despite objectively normal ST on HFUS. ST, SWE, and local mRSS correlated strongly with collagen quantification (r = 0.697, 0.709, 0.649, respectively). Intraobserver repeatability was high for all HFUS parameters (ICCs for ST = 0.946-0.978; echogenicity = 0.648-0.865; and SWE = 0.953-0.973). CONCLUSION: Our data demonstrate excellent reproducibility and reassuring convergent validity with dermal collagen content. Detection of subclinical abnormalities is an additional benefit of HFUS. The observed correlations with collagen quantification support further investigation of HFUS as an alternative to mRSS in clinical trial settings.
Authors: Tânia Santiago; Eduardo José Ferreira Santos; Barbara Ruaro; Gemma Lepri; Lorraine Green; Marie Wildt; Shinji Watanabe; Alain Lescoat; Roger Hesselstrand; Francesco Del Galdo; John D Pauling; Lucy Jean Reeve; Maria Antonieta D'Agostino; Marco Matucci-Cerinic; Annamaria Iagnocco; Jose Antonio Pereira da Silva Journal: RMD Open Date: 2022-07
Authors: Barbara Ruaro; Tania Santiago; Michael Hughes; Gemma Lepri; Gabriele Poillucci; Elisa Baratella; Francesco Salton; Marco Confalonieri Journal: Open Access Rheumatol Date: 2021-04-28