Date: Friday, November 6, 2020
Session Title: Systemic Sclerosis & Related Disorders – Clinical Poster I
Session Type: Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: The Very Early Diagnosis Of Systemic Sclerosis (VEDOSS) study has shown that more than 80% of patients with Raynaud’s Phenomenon, specific ANA positivity and scleroderma pattern at nailfold videocapillaroscopy will fulfill classification criteria within 5 years. This is suggesting that there is a subclinical window of opportunity to diagnose systemic sclerosis (SSc) before clinical manifestations occur. In this scenario, a non-invasive tool to diagnose SSc in clinically unaffected skin might improve the early detection of disease in at risk-patients. Optical coherence tomography (OCT) of the skin has been shown to be a sensitive and accurate biomarker of skin fibrosis in SSc. Here we aimed to assess the ability of skin OCT to “detect SSc” in clinically unaffected skin from a multicenter cohort.
Methods: Dorsal forearm skin of SSc patients and matched-healthy controls (HC) was evaluated using VivoSight scanner (Michelson Diagnostics). Mean A-scans (mean OCT signal plotted against depth-in-tissue) were derived as previously described. Minimum Optical Density (MinOD), Maximum OD (MaxOD) and OD at 300 micron-depth (OD300) were calculated. Clinical involvement was assessed by an operator blinded to OCT findings using the mRSS. Receiver-operating characteristic (ROC) curve analysis was carried out for MinOD, MaxOD, and OD300 to evaluate their ability to discriminate between SSc and HC. Statistical analysis was performed using GraphPad Prism software V.7.0.
Results: One hundred seventy four OCT images were collected from 87 subjects [43 SSc (39 Female, mean age 49.7 ± 9.1 years) and 44 gender/age-matched healthy controls (HC) (36 Female, mean age 50.2 ± 8.3 years)] in two different SSc centers. All patients fulfilled classification criteria for SSc. OCT measures demonstrated discriminative ability in SSc skin detection with any clinical skin involvement (0-3 at site of analysis) with an AUC of 0.73 (MinOD, 95%CI 0.64-0.81), 0.77 (MaxOD, 95%CI 0.7-0.85) and 0.82 (OD300, 95%CI 0.76-0.89); p< 0.0001 for all as previously indicated. Most importantly, all three measures showed comparable performance in detecting scleroderma also in clinically unaffected skin (mRss=0 at site of analysis), with an AUC of 0.7 (95%CI 0.6-0.81, p=0.001), 0.72 (95%CI 0.61-0.83, p=0.0003) and 0.72 (95%CI 0.61-0.83, p=0.0003) for MinOD, MaxOD and OD300 respectively.
Conclusion: Virtual biopsy by OCT recognises clinically unaffected skin of SSc patients from the HC skin. This is in line with gene array data showing that scleroderma specific signatures are consistent in affected and clinically unaffected skin. These results inform future studies on at risk patients with clinically unaffected skin which may define a role for OCT in detecting subclinical SSc.
To cite this abstract in AMA style:Abignano G, Temiz Karadag D, Gundogdu O, Lettieri G, Padula M, Padula A, Emery P, D'Angelo S, Del Galdo F. Optical Coherence Tomography of the Skin Detects Scleroderma Changes in Clinically Unaffected Skin: An Opportunity for Early Detection of Systemic Sclerosis [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/optical-coherence-tomography-of-the-skin-detects-scleroderma-changes-in-clinically-unaffected-skin-an-opportunity-for-early-detection-of-systemic-sclerosis/. Accessed November 26, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/optical-coherence-tomography-of-the-skin-detects-scleroderma-changes-in-clinically-unaffected-skin-an-opportunity-for-early-detection-of-systemic-sclerosis/