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e-ISSN: 2448-5667
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Características de los pacientes con esclerosis sistémica que desarrollan enfermedad pulmonar intersticial / Characteristics of patients with systemic sclerosis who develop interstitial lung disease

Luis Daniel Fajardo-Hermosillo, Mario César Ocampo-Torres, Juan Rodríguez-Silverio

Resumen


Resumen

Introducción: la enfermedad pulmonar intersticial (EPI) está relacionada a una mayor mortalidad en esclerosis sistémica (ES). Los factores asociados a su presentación han mostrado variabilidad en diferentes poblaciones. Pocos estudios se han realizado en mestizos mexicanos.

Objetivo: analizar los factores clínicos y paraclínicos asociados a EPI en pacientes con ES.

Material y métodos: estudio retrospectivo de casos y controles en el que se incluyeron pacientes > 18 años con diagnóstico de ES, según criterios EULAR/ACR 2013 y EPI por capacidad vital forzada (CVF) < 70% y > 5% de área pulmonar efectada en tomografía. La fuerza de asociación de los factores para EPI se midió por razón de momios (RM) con intervalos de confianza del 95% (IC95%). Las variables significativas se analizaron por regresión logística múltiple con ajuste.

Resultados: de los 80 pacientes con ES, 38 (47.5%) tenían EPI. Factores de riesgo como tabaquismo, mayor índice de actividad, menor CVF, anticuerpos antitopoisomerasa I y factores protectores como variedad limitada de ES, patrón capilaroscópico temprano y anticuerpos anticentrómero estuvieron asociados a EPI. En el análisis multivariado un mayor índice de actividad con RM 4.17, (IC95%: 2.01-8.65) persistió como un factor de riesgo; en cambio, los anticuerpos anticentrómero con RM 0.17, (IC95%: 0.03-0.85) persistieron como un factor protector asociado a EPI.

Conclusiones: un mayor índice de actividad y la presencia anticuerpos anticentrómero persistieron como factores asociados a la presencia de EPI en ES.

 

Abstract

Background: Systemic sclerosis associated-interstitial lung disease (SSc-ILD) show a high mortality. The factors associated SSc-ILD have shown variability in different populations. There are few studies in Mexican mestizos.

Objective: To analyze the epidemiological, clinical and paraclinical factors associated with SSc-ILD.

Material and methods: Cross-sectional study, where patients > 18 years of age with a diagnosis of SSc according to EULAR/ACR 2013 criteria and diagnosis of ILD by forced vital capacity (FVC) < 70% and > 5% of affected lung area on tomography were included. The strength of association of the factors for ILD was measured by odds ratio (OR) with 95% confidence intervals (95% CI). The significant variables were analyzed by multiple logistic regression with adjustment.

Results: Of the 80 patients with SSc, 38 (47.5%) had ILD. Risk factors such as smoking, higher activity index, lower FVC, anti-topoisomerase I antibodies, and protective factors such as a limited SSc, early capillaroscopic pattern, and anti-centromere antibodies (ACA) were associated with ILD. In the multivariate analysis, a higher activity index with OR 4.17, (95% CI 2.01-8.65) persisted as a risk factor, while ACA with OR 0.17, (95% CI 0.03-0.85) persisted as a protective factor associated with SSc-ILD.

Conclusions: A higher index of activity and ACA persisted as factors associated with SSc-ILD.


Palabras clave


Esclerodermia Sistémica; Enfermedades Pulmonares Intersticiales; Factores de Riesgo; Estudios Transversales ; Anticuerpos Anticentrómero / Scleroderma, Systemic; Lung Diseases, Interstitial; Risk Factor; Cross-Sectional Studies Anticentromere Antibodies

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Referencias


Perelas A, Silver RM, Arrossi AV, Highland KB. Systemic sclerosis-associated interstitial lung disease. Lancet Respir Med. 2020;8(3):304-320. doi: 10.1016/S2213-2600(19)30480-1. 

Hoffmann-Vold AM, Allanore Y, Bendstrup E, Bruni C, Distler O, Maher TM, et al. The need for a holistic approach for SSc-ILD - achievements and ambiguity in a devastating disease. Respir Res. 2020;21(1):197. doi: 10.1186/s12931-020-01459-0.

Molberg Ø, Hoffmann-Vold AM. Interstitial lung disease in systemic sclerosis: progress in screening and early diagnosis. Curr Opin Rheumatol. 2016;28(6):613-8. doi: 10.1097/BOR.0000000000000323.

Chung JH, Cox CW, Montner SM, Adegunsoye A, Oldham JM, Husain AN, et al. CT Features of the Usual Interstitial Pneumonia Pattern: Differentiating Connective Tissue Disease-Associated Interstitial Lung Disease From Idiopathic Pulmonary Fibrosis. AJR Am J Roentgenol. 2018;210(2):307-13. DOI: 10.2214/AJR.17.18384.

Wallace B, Vummidi D, Khanna D. Management of connective tissue diseases associated interstitial lung disease: a review of the published literature. Curr Opin Rheumatol. 2016;28(3):236-45. doi: 10.1097/BOR.0000000000000270.

Goh NS, Desai SR, Veeraraghavan S, Hansell DM, Copley SJ, Maher TM, et al. Interstitial lung disease in systemic sclerosis: a simple staging system. Am J Respir Crit Care Med. 2008;177(11):1248-54. doi: 10.1164/rccm.200706-877OC.

Amjadi SS, Roofeh D, Namas R, Khanna D. Management of systemic sclerosis-associated interstitial lung disease in the current era. Int J Rheum Dis. 2020;23(2):137-139. doi: 10.1111/1756-185X.13799.

Freire M, Rivera A, Sopeña B, Tolosa Vilella C, Guillén-Del Castillo A, Colunga Argüelles D, et al; RESCLE investigators, Autoimmune Diseases Study Group (GEAS). Clinical and epidemiological differences between men and women with systemic sclerosis: a study in a Spanish systemic sclerosis cohort and literature review. Clin Exp Rheumatol. 2017;35 Suppl 106(4):89-97.

Volkmann ER, Steen V, Li N, Roth MD, Clements PJ, Furst DE, et al. Racial Disparities in Systemic Sclerosis: Short- and Long-Term Outcomes Among African American Participants of SLS I and II. ACR Open Rheumatol. 2021;3(1):8-16.  doi: 10.1002/acr2.11206. 

Ballerie A, Cavalin C, Lederlin M, Nicolas A, Garlantézec R, Jouneau S, et al. Association of silica exposure with chest HRCT and clinical characteristics in systemic sclerosis. Semin Arthritis Rheum. 2020;50(5):949-956. doi: 10.1016/j.semarthrit.2020.08.014. 

Nihtyanova SI, Denton CP. Pathogenesis of systemic sclerosis associated interstitial lung disease. Journal of Scleroderma and Related Disorders. 2020;5(2_suppl):6-16. doi: 10.1177/2397198320903867.

Nihtyanova SI, Sari A, Harvey JC, Leslie A, Derrett-Smith EC, Fonseca C, et al. Using Autoantibodies and Cutaneous Subset to Develop Outcome-Based Disease Classification in Systemic Sclerosis. Arthritis Rheumatol. 2020;72(3):465-476. doi: 10.1002/art.41153.

Sánchez-Cano D, Ortego-Centeno N, Callejas JL, Fonollosa Plá V, Ríos-Fernández R, Tolosa-Vilella C, et al. Interstitial lung disease in systemic sclerosis: data from the spanish scleroderma study group. Rheumatol Int. 2018;38(3):363-374. doi: 10.1007/s00296-017-3916-x.

Ashmore P, Tikly M, Wong M, Ickinger C. Interstitial lung disease in South Africans with systemic sclerosis. Rheumatol Int. 2018;38(4):657-662. doi: 10.1007/s00296-017-3893-0.

Rodriguez-Reyna TS, Hinojosa-Azaola A, Martinez-Reyes C, Nuñez-Alvarez CA, Torrico-Lavayen R, García-Hernández JL, et al. Distinctive autoantibody profile in Mexican Mestizo systemic sclerosis patients. Autoimmunity. 2011;44(7):576-84. doi: 10.3109/08916934.2011.592886. 

Gonzalez-Lopez L, Rocha-Muñoz AD, Olivas-Flores EM, Garcia-Gonzalez A, Peguero-Gómez AR, Flores-Navarro J, et al. Procollagen Type I and III Aminoterminal Propeptide Levels and Severity of Interstitial Lung Disease in Mexican Women With Progressive Systemic Sclerosis. Arch Bronconeumol. 2015;51(9):440. doi: 10.1016/j.arbres.2014.06.018.

17. Valentini G, Iudici M, Walker UA, Jaeger VK, Baron M, Carreira P, et al. The European Scleroderma Trials and Research group (EUSTAR) task force for the development of revised activity criteria for systemic sclerosis: derivation and validation of a preliminarily revised EUSTAR activity index. Ann Rheum Dis. 2017;76(1):270-276. doi: 10.1136/annrheumdis-2016-209768.

Ross L, Baron M, Nikpour M. The challenges and controversies of measuring disease activity in systemic sclerosis. J Scleroderma Relat Disord. 2018;3(2):115-121. doi: 10.1177/2397198318765061.

Cutolo M, Sulli A, Smith V. Assessing microvascular changes in systemic sclerosis diagnosis and management. Nat Rev Rheumatol. 2010;6(10):578-87. doi: 10.1038/nrrheum.2010.104.

Medsger TA Jr, Bombardieri S, Czirjak L, Scorza R, Della Rossa A, Bencivelli W. Assessment of disease severity and prognosis. Clin Exp Rheumatol. 2003;21(3 Suppl 29):S42-6. 

Matucci-Cerinic M, D'Angelo S, Denton CP, Vlachoyiannopoulos P, Silver R. Assessment of lung involvement. Clin Exp Rheumatol. 2003;21(3 Suppl 29):S19-23.

Sambataro D, Sambataro G, Pignataro F, Maglione W, Malatino L, Vancheri C, et al. Quantification of Ground Glass Opacities Can Be Useful to Describe Disease Activity in Systemic Sclerosis. Diagnostics (Basel). 2020;10(4):225. doi: 10.3390/diagnostics10040225. 

Stock CJW, Renzoni EA. Genetic predictors of systemic sclerosis-associated interstitial lung disease: a review of recent literature. Eur J Hum Genet. 2018;26(6):765-777. doi: 10.1038/s41431-018-0104-8. 

Bonhomme O, André B, Gester F, de Seny D, Moermans C, Struman I, et al. Biomarkers in systemic sclerosis-associated interstitial lung disease: review of the literature. Rheumatology (Oxford). 2019;58(9):1534-1546. doi: 10.1093/rheumatology/kez230.

Kawashiri SY, Nishino A, Igawa T, Takatani A, Shimizu T, Umeda M, et al. Prediction of organ involvement in systemic sclerosis by serum biomarkers and peripheral endothelial function. Clin Exp Rheumatol. 2018;36 Suppl 113(4):102-108.

 


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