Change in calcinosis over 1 year using the scleroderma clinical trials consortium radiologic scoring system for calcinosis of the hands in patients with systemic sclerosis

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dc.contributor.authorValenzuela, Antonia
dc.contributor.authorStevens, Kathryn
dc.contributor.authorChung, Melody P.
dc.contributor.authorRodriguez-Reyna, Tatiana S.
dc.contributor.authorProudman, Susanna
dc.contributor.authorBaron, Murray
dc.contributor.authorCastelino, Flavia, V
dc.contributor.authorHsu, Vivien
dc.contributor.authorGreen, Lorraine
dc.contributor.authorDel Galdo, Francesco
dc.contributor.authorLi, Shufeng
dc.contributor.authorFiorentino, David
dc.contributor.authorChung, Lorinda
dc.date.accessioned2025-01-20T21:04:52Z
dc.date.available2025-01-20T21:04:52Z
dc.date.issued2022
dc.description.abstractIntroduction: Calcinosis cutis is a debilitating complication of systemic sclerosis (SSc). We previously developed a radiographic scoring system to assess severity of calcinosis affecting the hands in patients with SSc. We sought to further validate our radiographic scoring system to assess for change over 1 year and to identify factors associated with improvement or progression.
dc.description.abstractMaterials and methods: Baseline and 1-year antero-posterior hand radiographs were obtained in 39 SSc patients with calcinosis prospectively enrolled at 6 centers within the US, Canada, Mexico and Australia. Two readers (one radiologist and one rheumatologist) scored all radiographs using the calcinosis scoring system and a 5-point Likert scale (1 = A lot better, 2 = A little better, 3 = No change, 4 = A little worse, 5 = A lot worse) on follow-up. By maximizing the Kappa coefficient of agreement between grouped Likert scale (better/no change/worse) and the percentage of change of calcinosis in the radiographic scoring system, we defined progressive calcinosis as >25% increase in score from baseline at 1-year, stable calcinosis as change in score between-25% to 25%, and improvement of calcinosis as decrease in score by >25%. Nineteen SSc patients from an independent cohort were used for validation.
dc.description.abstractResults: Inter-rater reliability of the calcinosis scoring system was high with intra-class correlation coefficient of 0.93 (0.89-0.95). The median percentage of change from baseline to 1 year was 12.8% (range-89.3 to 290.2%). Sixteen patients (41%) experienced progression of calcinosis over 1 year; 18 (46%) remained stable; and 5 (13%) had improvement. Patients with progressive calcinosis had lower T-score on bone densitometry (-3.3 vs-1.7, p = 0.044) and higher prevalence of loss of digital pulp on physical exam (56% vs 22%, p = 0.027), with a trend towards lower baseline modified Rodnan skin score (mRSS) (3.8 vs. 5.9, p = 0.057), than patients who did not progress. Patients who experienced improvement in calcinosis had lower prevalence of digital pitting scars (20% vs 71%, p = 0.047) than patients whose calcinosis did not improve. In multivariable analysis, loss of digital pulp remained a predictor of calcinosis progression (OR 5.8, p = 0.023, CI 1.27-26.36). In the validation cohort, 2 (11%) patients improved, 10 (53%) remained stable, and 7 (37%) progressed.
dc.description.abstractConclusions: We confirmed the excellent inter-rater reliability of our radiographic calcinosis scoring system and demonstrated its usefulness to detect change over time. Approximately 40% of patients experienced progression of calcinosis over 1 year. Loss of digital pulp was predictive of progressive calcinosis providing further evidence that digital ischemia contributes to the progression of calcinosis. Published by Elsevier Inc.
dc.fuente.origenWOS
dc.identifier.doi10.1016/j.semarthrit.2022.151980
dc.identifier.eissn1532-866X
dc.identifier.issn0049-0172
dc.identifier.urihttps://doi.org/10.1016/j.semarthrit.2022.151980
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/93265
dc.identifier.wosidWOS:000820186100015
dc.language.isoen
dc.revistaSeminars in arthritis and rheumatism
dc.rightsacceso restringido
dc.subjectCalcinosis
dc.subjectRadiography
dc.subjectHands
dc.subjectSystemic sclerosis
dc.subjectOutcome
dc.subjectValidation
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleChange in calcinosis over 1 year using the scleroderma clinical trials consortium radiologic scoring system for calcinosis of the hands in patients with systemic sclerosis
dc.typeartículo
dc.volumen53
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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