Longitudinal Analysis of Modified Rodnan Skin Score in Systemic Sclerosis Using Group-Based Trajectory Modelling

Emmanuel Ledoult^1,2, Vincent Sobanski^1,3,4,5, Luc Mouthon^6,7,8, Hélène Béhal⁹, Christian Agard¹⁰, Jean-Christophe Lega¹¹, Patrick Jego¹², Yves-Michel Frances¹³, Gilles Kaplanski^14,15, Jean-Robert Harle¹⁶, Sabine Berthier¹⁷, Boris Bienvenu¹⁸, Olivier Fain¹⁹, Arsene Mekinian²⁰, Elisabeth Diot²¹, Robin Dhote²², Alain Le Quellec²³, Zahir Amoura^24,25, Noemie Le Gouellec²⁶, Jean-Emmanuel Kahn²⁷, Nadine Magy²⁸, Marie-Hélène Balquet²⁹, Grégory Pugnet³⁰, Thomas Papo³¹, Pierre Kieffer³², Viviane Queyrel³³, Jean-Baptiste Gaultier³⁴, Denis Wahl³⁵, Francois Maurier³⁶, Emmanuel Chatelus³⁷, Jean-Louis Pennaforte³⁸, Olivier Aumaître³⁹, Olivier Lidove⁴⁰, Cristina Belizna⁴¹, Carine Boulon⁴², Marie-Elise Truchetet⁴³, Jacques Pouchot⁴⁴, Eric Auxenfants⁴⁵, Anne-Laure Fauchais⁴⁶, Bernard Imbert⁴⁷, Eric Hachulla^1,48,49,50, David Launay^3,4,5,51 and the French Autoimmune and Autoinflammatory Rare Diseases Network (FAI2R), ¹CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000 Lille, France, ²CHU Lille, Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), F-59000 Lille, France, ³CHU Lille, Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), F-59000 Lille, France, Lille, France, ⁴Inserm, U995, F-59000 Lille, France, Lille, France, ⁵Univ. Lille, U995, Lille Inflammation Research International Center (LIRIC), F-59000 Lille, France, Lille, France, ⁶Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, AP–HP, Université Paris Descartes, Paris, France, Paris, France, ⁷National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP–HP, Université Paris Descartes, Paris, France, ⁸INSERM U1016, Institut Cochin, Equipe Neutrophiles et Vascularites, Paris, France, ⁹Maison Régionale de la Recherche Clinique. CHU de Lille. F- 59000 Lille, France, Lille, France, ¹⁰Internal Medicine Department, Nantes University Hospital, Nantes, France, ¹¹Internal Medicine, Lyon Sud Hospital, Hospices Civils de Lyon, University of Lyon, Lyon, France, ¹²CHU de Rennes - Internal Medicine, Rennes, France, ¹³Médecine gériatrique - Hôpital Nord - F-13000 Marseilles, Marseilles, France, ¹⁴Aix-Marseille Université - Internal Medicine hopital conception - F-13000 Marseilles, Marseille, France, ¹⁵INSERM U608, Marseille, France, ¹⁶Service de médecine interne et immunologie clinique / Hôpital de la Timone, Marseilles, France, ¹⁷Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France, ¹⁸Caen University Hospital, Caen, France, ¹⁹Service de médecine interne. Hôpital Saint-Antoine., Paris, France, ²⁰Internal Medicine, DHUi2B Saint Antoine Hospital, paris, France, ²¹Pôle médecine interne et gériatrique, pneumologie CHRU de Tours - Hôpital Bretonneau, Tours, France, ²²Service de médecine interne. Hôpital Avicenne, Paris, France, ²³Division of internal Medicine, Hôpital Saint-Eloi, Centre Hospitalier Universitaire de Montpellier, Montpellier, Montpellier, France, ²⁴Internal Medecine - Centre de Référence National pour les Lupus et et le Syndrome des Antiphospholipides, Internal Medecine - Centre de Référence National pour les Lupus et et le Syndrome des Antiphospholipides, Pitié-Salpêtrière Hospital (AP-HP), Paris, France, ²⁵Department of Internal Medicine, Pitié-Salpêtrière Hospital, Paris, France, ²⁶Internal Medicine, Lille, France, ²⁷Internal Medicine, Foch Hospital, Suresnes, France, ²⁸Médecine Interne. CHU Besancon, Besancon, France, ²⁹Médecine Interne - CH Lens, Lens, France, ³⁰Department of Internal Medicine, Toulouse University Hospital, University of Toulouse, INSERM UMR 1027, Toulouse, France, ³¹Bichat University Hospital - Internal Medicine, Paris, France, ³²Hopital Emile Muller - Medecine Interne, Mulhouse Cedex 1, France, ³³Service de médecine interne - CHU de Nice. Hopital de l'Archet., Nice, France, ³⁴Pole de Gériatrie et Médecine interne - CHU Saint-Etienne, Saint-Etienne, France, ³⁵CHU de Nancy - Service de médecine interne - Unité de Médecine vasculaire Institut lorrain du coeur et des vaisseaux Louis Mathieu, Nancy, France, ³⁶Centre de Compétences des Maladies Systémiques Rares - CHU Metz, metz, France, ³⁷Department of Rheumatology, Strasbourg University Hospital, Strasbourg, France, ³⁸Service de médecine interne Pôle Médecines CHU de Reims - Hôpital Robert Debré, Reims, France, ³⁹CHU Pitié-Salpêtrière - Department of Internal Medicine 2. Referal center for SLE/APS, Paris, France, ⁴⁰Service de Médecine Interne-Rhumatologie Hôpital de la Croix St Simo, Paris, France, ⁴¹Angers University hospital - Internal Medicine, Angers, France, ⁴²Service de médecine interne et vasculaire - CHU Bordeaux, Bordeaux, France, ⁴³CHU de Bordeaux - Service de médecine interne, Bordeaux, France, ⁴⁴Internal Medicine Department, European Hospital Georges Pompidou, Paris, France, ⁴⁵CH Roubaix - Médecine interne, Roubaix, France, ⁴⁶Department of Internal Medicine, CHU de Limoges, Limoges, France, ⁴⁷CHU, Grenoble, Grenoble, France, ⁴⁸CHU Lille, Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), F-59000, France, ⁴⁹Univ. Lille, U995, Lille Inflammation Research International Center (LIRIC), F-59000 Lille, France, ⁵⁰Inserm, U995, F-59000 Lille, France, ⁵¹CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000 Lille, France, Lille, France

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: skin fibrosis and systemic sclerosis

Session Information

Date: Monday, November 14, 2016

Title: Systemic Sclerosis, Fibrosing Syndromes, and Raynaud's – Clinical Aspects and Therapeutics - Poster II

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: The modified Rodnan skin score (mRSS) is a clinical evaluation score of the extent of cutaneous fibrosis in systemic sclerosis (SSc). mRSS has been associated with morbi-mortality in several studies. This study aimed to delineate different trajectories of mRSS changes overtime in a large database of patients and to compare patients’ characteristics in clusters of patients identified. In this report, the results for non-treated patients are presented.

Methods: From a large French multi-center database of 2098 SSc patients, we included patients fulfilling the 1980 ACR criteria with at least two available records of mRSS. Treatment status was defined as steroids or immunosuppressive intake. Group-based modelling was used to cluster similar mRSS patterns into trajectories. Then variables of clusters obtained were compared using the SAS software.

Results: 818 patients were included: 306 had never received treatment, 403 had been treated and treatment status was unavailable for 109. Treated patients were more severe than non-treated patients with a higher frequency of diffuse cutaneous (dc) SSc, anti-topoisomerase I antibodies, muscular and joint involvements, interstitial lung disease (p<0.0001), and mortality (p=0.003). Two subgroups of similar trajectory among untreated patients were identified (p<0.001, figure 1). The analysis of tendencies showed that patients in cluster 1 had a low baseline mRSS (mean mRSS: 4.15±3.66) that did not change significantly during the follow-up (mean mRSS: 4.11±4.00, mean follow-up: 3.50±2.78 years; p=0.78). Patients in cluster 2 had a higher mRSS at baseline (mean mRSS: 21.23±6.96) with a significant decrease during the follow-up (mean mRSS: 17.62±8.5, mean follow-up: 2.98±3.04 years; p<0.0001). Patients in cluster 2 had a higher frequency of dcSSc (77% vs. 7%, p<0.0001), anti-topoisomerase I antibodies (52% vs. 17%, p<0.0001), muscle involvements (23% vs. 6%, p=0.008), digital ulcers (56% vs. 34%, p=0.026), gastrointestinal tract involvements (42% vs. 20%, p=0.0079) and interstitial lung disease (25% vs. 1%, p<0.0001). There was no significant difference between the two clusters concerning heart involvement, pulmonary arterial hypertension and mortality.

Conclusion: This work led to the identification of two different clusters among non-treated patients from a French multicenter database, based on similar mRSS trajectories. Interestingly, mRSS of cluster 2 significantly decreased overtime whereas the patients received no immunosuppressive treatment. Nevertheless, they remained exposed to more severe complications than cluster 1. The analysis of the entire database and comparisons between treated and untreated patients might provide new insights into the natural history of this disease. EL and VS have contributed equally to this work.

Disclosure: E. Ledoult, None; V. Sobanski, None; L. Mouthon, None; H. Béhal, None; C. Agard, None; J. C. Lega, None; P. Jego, None; Y. M. Frances, None; G. Kaplanski, None; J. R. Harle, None; S. Berthier, None; B. Bienvenu, None; O. Fain, None; A. Mekinian, None; E. Diot, None; R. Dhote, None; A. Le Quellec, None; Z. Amoura, None; N. Le Gouellec, None; J. E. Kahn, None; N. Magy, None; M. H. Balquet, None; G. Pugnet, None; T. Papo, None; P. Kieffer, None; V. Queyrel, None; J. B. Gaultier, None; D. Wahl, None; F. Maurier, None; E. Chatelus, None; J. L. Pennaforte, None; O. Aumaître, None; O. Lidove, None; C. Belizna, None; C. Boulon, None; M. E. Truchetet, None; J. Pouchot, None; E. Auxenfants, None; A. L. Fauchais, None; B. Imbert, None; E. Hachulla, None; D. Launay, None.

To cite this abstract in AMA style:

Ledoult E, Sobanski V, Mouthon L, Béhal H, Agard C, Lega JC, Jego P, Frances YM, Kaplanski G, Harle JR, Berthier S, Bienvenu B, Fain O, Mekinian A, Diot E, Dhote R, Le Quellec A, Amoura Z, Le Gouellec N, Kahn JE, Magy N, Balquet MH, Pugnet G, Papo T, Kieffer P, Queyrel V, Gaultier JB, Wahl D, Maurier F, Chatelus E, Pennaforte JL, Aumaître O, Lidove O, Belizna C, Boulon C, Truchetet ME, Pouchot J, Auxenfants E, Fauchais AL, Imbert B, Hachulla E, Launay D. Longitudinal Analysis of Modified Rodnan Skin Score in Systemic Sclerosis Using Group-Based Trajectory Modelling [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/longitudinal-analysis-of-modified-rodnan-skin-score-in-systemic-sclerosis-using-group-based-trajectory-modelling/. Accessed .

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/longitudinal-analysis-of-modified-rodnan-skin-score-in-systemic-sclerosis-using-group-based-trajectory-modelling/