• Enrico De Lorenzis, Francesco Del Galdo, Gerlando Natalello, Francesco Varone, Stefano Di Donato, Lucrezia Verardi, Lucio Calandriello, Vishal Kakkar, Pier Giacomo Cerasuolo, LariciAnna RitaAR0000-0002-1882-6244Catholic University of the Sacred Heart, Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy., Maria Antonietta D'Agostino, Silvia Laura Bosello, and Luca Richeldi.
• Catholic University of the Sacred Heart, Division of Rheumatology - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
• Am. J. Respir. Crit. Care Med. 2024 Jul 30.

RationaleInterstitial lung disease (ILD) in systemic sclerosis (SSc) is a common complication that has varied progression rate and prognosis. Different progression definitions are available: include minimal clinically important worsening of forced vital capacity (FVC MCIW), EUSTAR (EUropean Scleroderma Trials and Research group) progression, OMERACT (Outcome Measures in Rheumatology Clinical Trials) progression, and Erice ILD working group progression. Pulmonary function and symptoms changes may act as specific confounding factors applying these definitions in SSc.ObjectiveTo assess the concordance and prognostic value of four different definitions in SSc-ILD patients overall and specific clinical groups.MethodsProgression status in consecutive SSc-ILD patients was assessed over 24 months, 60-month disease-related mortality risk was compared between progressors and non-progressors using the four definitions.ResultsAmong 245 patients, 26 SSc-related deaths were reported. Mortality was linked to progression for FVC MCIW (HR 2.27, 95% CI 1.03-4.97), OMERACT (HR 2.90, 95% CI 1.28-6.57), and Erice definitions (HR 11.02, 95% CI 2.38-51.08). The association between progression and mortality was poor in patients with disease duration ≥3 years, mild functional impairment, and pulmonary artery systolic pressure (PASP)≥40 mmHg. Erice criteria appeared superior in patients with duration ≥3 years, limited cutaneous variant, and PASP<40 mmHg. OMERACT criteria performed better in diffuse cutaneous variant patients with severe functional impairment.ConclusionsThe four evaluated definitions of progression in SSc-ILD are not interchangeable, resulting in up to a third of cases being classified differently based on the adopted criteria, and presenting different prognostic values, particularly within specific clinical groups.

4 keywords...

hide…