Skin thickness score as a predictor and correlate of outcome in systemic sclerosis: High-dose versus low-dose penicillamine trial

Philip J. Clements, Eric L. Hurwitz, Weng Kee Wong, James R. Seibold, Maureen Mayes, Barbara White, Fredrick Wigley, Michael Weisman, Walter Barr, Larry Moreland, Thomas A. Medsger, Virginia D. Steen, Richard W. Martin, David Collier, Arthur Weinstein, Edward Lally, John Varga, Steven R. Weiner, Brian Andrews, Micha AbelesDaniel E. Furst

Research output: Contribution to journalArticle

Abstract

Objective. To study the clinical implications of a skin thickness score ≥26 at first visit and of softening of sclerodermatous skin in a cohort of systemic sclerosis (SSc) patients with diffuse cutaneous scleroderma. Methods. Skin and visceral involvement were assessed in 134 SSc patients with diffuse scleroderma (mean ± SD duration of SSc 16 ± 4 months) as they entered a multicenter drug trial and again at 2 years of followup. Advent of mortality and scleroderma renal crisis (SRC) were assessed during a followup of 4.0 ± 1.1 years (mean ± SD). Logistic and linear regression were used to examine the relationship of baseline skin score to morbidity, mortality, and visceral involvement and the relationship of changes in skin score to changes in physical examination, laboratory, and functional variables over 2 years. Results. A baseline skin score ≥20 was associated with heart involvement at baseline (odds ratio [OR] 3.10, 95% confidence interval [95% CI] 1.25-7.70) and was predictive of mortality (OR 3.59, 95% CI 1.23-10.55) and SRC (OR 10.00, 95% CI 2.21-4.5.91) over 4 years. Multivariate linear regression demonstrated that a model with skin score at baseline (P = 0.0078) and changes in large joint contractures (P = 0.0072), tender joint counts (P = 0.0119), handspread (P = 0.0242), and Health Assessment Questionnaire disability index (HAQ-DI) (P = 0.0244) explained the change in skin score over 2 years (R 2 = 0.567). Multivariate logistic regression demonstrated that the investigator's global assessment of improvement was best explained by a model with skin score and HAQ-DI (R 2 = 0.455). Conclusion. A baseline skin score ≥20 was associated with heart involvement at baseline and predicted mortality and SRC over the subsequent 4 years. Improvement in skin score in these patients with diffuse cutaneous scleroderma was associated with improvement in hand function, inflammatory indices, joint contractures, arthritis signs, overall functional ability, and the examining investigator's global assessment of improvement.

Original languageEnglish (US)
Pages (from-to)2445-2454
Number of pages10
JournalArthritis and Rheumatism
Volume43
Issue number11
DOIs
StatePublished - 2000

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Penicillamine
Systemic Scleroderma
Skin
Diffuse Scleroderma
Mortality
Joints
Odds Ratio
Contracture
Confidence Intervals
Kidney
Linear Models
Logistic Models
Research Personnel
Health
Multicenter Studies
Physical Examination
Arthritis

ASJC Scopus subject areas

  • Immunology
  • Rheumatology

Cite this

Skin thickness score as a predictor and correlate of outcome in systemic sclerosis : High-dose versus low-dose penicillamine trial. / Clements, Philip J.; Hurwitz, Eric L.; Wong, Weng Kee; Seibold, James R.; Mayes, Maureen; White, Barbara; Wigley, Fredrick; Weisman, Michael; Barr, Walter; Moreland, Larry; Medsger, Thomas A.; Steen, Virginia D.; Martin, Richard W.; Collier, David; Weinstein, Arthur; Lally, Edward; Varga, John; Weiner, Steven R.; Andrews, Brian; Abeles, Micha; Furst, Daniel E.

In: Arthritis and Rheumatism, Vol. 43, No. 11, 2000, p. 2445-2454.

Research output: Contribution to journalArticle

Clements, PJ, Hurwitz, EL, Wong, WK, Seibold, JR, Mayes, M, White, B, Wigley, F, Weisman, M, Barr, W, Moreland, L, Medsger, TA, Steen, VD, Martin, RW, Collier, D, Weinstein, A, Lally, E, Varga, J, Weiner, SR, Andrews, B, Abeles, M & Furst, DE 2000, 'Skin thickness score as a predictor and correlate of outcome in systemic sclerosis: High-dose versus low-dose penicillamine trial', Arthritis and Rheumatism, vol. 43, no. 11, pp. 2445-2454. https://doi.org/10.1002/1529-0131(200011)43:11<2445::AID-ANR11>3.0.CO;2-Q
Clements, Philip J. ; Hurwitz, Eric L. ; Wong, Weng Kee ; Seibold, James R. ; Mayes, Maureen ; White, Barbara ; Wigley, Fredrick ; Weisman, Michael ; Barr, Walter ; Moreland, Larry ; Medsger, Thomas A. ; Steen, Virginia D. ; Martin, Richard W. ; Collier, David ; Weinstein, Arthur ; Lally, Edward ; Varga, John ; Weiner, Steven R. ; Andrews, Brian ; Abeles, Micha ; Furst, Daniel E. / Skin thickness score as a predictor and correlate of outcome in systemic sclerosis : High-dose versus low-dose penicillamine trial. In: Arthritis and Rheumatism. 2000 ; Vol. 43, No. 11. pp. 2445-2454.
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title = "Skin thickness score as a predictor and correlate of outcome in systemic sclerosis: High-dose versus low-dose penicillamine trial",
abstract = "Objective. To study the clinical implications of a skin thickness score ≥26 at first visit and of softening of sclerodermatous skin in a cohort of systemic sclerosis (SSc) patients with diffuse cutaneous scleroderma. Methods. Skin and visceral involvement were assessed in 134 SSc patients with diffuse scleroderma (mean ± SD duration of SSc 16 ± 4 months) as they entered a multicenter drug trial and again at 2 years of followup. Advent of mortality and scleroderma renal crisis (SRC) were assessed during a followup of 4.0 ± 1.1 years (mean ± SD). Logistic and linear regression were used to examine the relationship of baseline skin score to morbidity, mortality, and visceral involvement and the relationship of changes in skin score to changes in physical examination, laboratory, and functional variables over 2 years. Results. A baseline skin score ≥20 was associated with heart involvement at baseline (odds ratio [OR] 3.10, 95{\%} confidence interval [95{\%} CI] 1.25-7.70) and was predictive of mortality (OR 3.59, 95{\%} CI 1.23-10.55) and SRC (OR 10.00, 95{\%} CI 2.21-4.5.91) over 4 years. Multivariate linear regression demonstrated that a model with skin score at baseline (P = 0.0078) and changes in large joint contractures (P = 0.0072), tender joint counts (P = 0.0119), handspread (P = 0.0242), and Health Assessment Questionnaire disability index (HAQ-DI) (P = 0.0244) explained the change in skin score over 2 years (R 2 = 0.567). Multivariate logistic regression demonstrated that the investigator's global assessment of improvement was best explained by a model with skin score and HAQ-DI (R 2 = 0.455). Conclusion. A baseline skin score ≥20 was associated with heart involvement at baseline and predicted mortality and SRC over the subsequent 4 years. Improvement in skin score in these patients with diffuse cutaneous scleroderma was associated with improvement in hand function, inflammatory indices, joint contractures, arthritis signs, overall functional ability, and the examining investigator's global assessment of improvement.",
author = "Clements, {Philip J.} and Hurwitz, {Eric L.} and Wong, {Weng Kee} and Seibold, {James R.} and Maureen Mayes and Barbara White and Fredrick Wigley and Michael Weisman and Walter Barr and Larry Moreland and Medsger, {Thomas A.} and Steen, {Virginia D.} and Martin, {Richard W.} and David Collier and Arthur Weinstein and Edward Lally and John Varga and Weiner, {Steven R.} and Brian Andrews and Micha Abeles and Furst, {Daniel E.}",
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TY - JOUR

T1 - Skin thickness score as a predictor and correlate of outcome in systemic sclerosis

T2 - High-dose versus low-dose penicillamine trial

AU - Clements, Philip J.

AU - Hurwitz, Eric L.

AU - Wong, Weng Kee

AU - Seibold, James R.

AU - Mayes, Maureen

AU - White, Barbara

AU - Wigley, Fredrick

AU - Weisman, Michael

AU - Barr, Walter

AU - Moreland, Larry

AU - Medsger, Thomas A.

AU - Steen, Virginia D.

AU - Martin, Richard W.

AU - Collier, David

AU - Weinstein, Arthur

AU - Lally, Edward

AU - Varga, John

AU - Weiner, Steven R.

AU - Andrews, Brian

AU - Abeles, Micha

AU - Furst, Daniel E.

PY - 2000

Y1 - 2000

N2 - Objective. To study the clinical implications of a skin thickness score ≥26 at first visit and of softening of sclerodermatous skin in a cohort of systemic sclerosis (SSc) patients with diffuse cutaneous scleroderma. Methods. Skin and visceral involvement were assessed in 134 SSc patients with diffuse scleroderma (mean ± SD duration of SSc 16 ± 4 months) as they entered a multicenter drug trial and again at 2 years of followup. Advent of mortality and scleroderma renal crisis (SRC) were assessed during a followup of 4.0 ± 1.1 years (mean ± SD). Logistic and linear regression were used to examine the relationship of baseline skin score to morbidity, mortality, and visceral involvement and the relationship of changes in skin score to changes in physical examination, laboratory, and functional variables over 2 years. Results. A baseline skin score ≥20 was associated with heart involvement at baseline (odds ratio [OR] 3.10, 95% confidence interval [95% CI] 1.25-7.70) and was predictive of mortality (OR 3.59, 95% CI 1.23-10.55) and SRC (OR 10.00, 95% CI 2.21-4.5.91) over 4 years. Multivariate linear regression demonstrated that a model with skin score at baseline (P = 0.0078) and changes in large joint contractures (P = 0.0072), tender joint counts (P = 0.0119), handspread (P = 0.0242), and Health Assessment Questionnaire disability index (HAQ-DI) (P = 0.0244) explained the change in skin score over 2 years (R 2 = 0.567). Multivariate logistic regression demonstrated that the investigator's global assessment of improvement was best explained by a model with skin score and HAQ-DI (R 2 = 0.455). Conclusion. A baseline skin score ≥20 was associated with heart involvement at baseline and predicted mortality and SRC over the subsequent 4 years. Improvement in skin score in these patients with diffuse cutaneous scleroderma was associated with improvement in hand function, inflammatory indices, joint contractures, arthritis signs, overall functional ability, and the examining investigator's global assessment of improvement.

AB - Objective. To study the clinical implications of a skin thickness score ≥26 at first visit and of softening of sclerodermatous skin in a cohort of systemic sclerosis (SSc) patients with diffuse cutaneous scleroderma. Methods. Skin and visceral involvement were assessed in 134 SSc patients with diffuse scleroderma (mean ± SD duration of SSc 16 ± 4 months) as they entered a multicenter drug trial and again at 2 years of followup. Advent of mortality and scleroderma renal crisis (SRC) were assessed during a followup of 4.0 ± 1.1 years (mean ± SD). Logistic and linear regression were used to examine the relationship of baseline skin score to morbidity, mortality, and visceral involvement and the relationship of changes in skin score to changes in physical examination, laboratory, and functional variables over 2 years. Results. A baseline skin score ≥20 was associated with heart involvement at baseline (odds ratio [OR] 3.10, 95% confidence interval [95% CI] 1.25-7.70) and was predictive of mortality (OR 3.59, 95% CI 1.23-10.55) and SRC (OR 10.00, 95% CI 2.21-4.5.91) over 4 years. Multivariate linear regression demonstrated that a model with skin score at baseline (P = 0.0078) and changes in large joint contractures (P = 0.0072), tender joint counts (P = 0.0119), handspread (P = 0.0242), and Health Assessment Questionnaire disability index (HAQ-DI) (P = 0.0244) explained the change in skin score over 2 years (R 2 = 0.567). Multivariate logistic regression demonstrated that the investigator's global assessment of improvement was best explained by a model with skin score and HAQ-DI (R 2 = 0.455). Conclusion. A baseline skin score ≥20 was associated with heart involvement at baseline and predicted mortality and SRC over the subsequent 4 years. Improvement in skin score in these patients with diffuse cutaneous scleroderma was associated with improvement in hand function, inflammatory indices, joint contractures, arthritis signs, overall functional ability, and the examining investigator's global assessment of improvement.

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