控制系统性硬化症中的指端溃疡疾病与手部功能改善相关。

Controlling the digital ulcerative disease in systemic sclerosis is associated with improved hand function.

作者信息

Mouthon Luc, Carpentier Patrick H, Lok Catherine, Clerson Pierre, Gressin Virginie, Hachulla Eric, Bérezné Alice, Diot Elisabeth, Van Kien Aurélie Khau, Jego Patrick, Agard Christian, Duval-Modeste Anne-Bénédicte, Sparsa Agnès, Puzenat Eve, Richard Marie-Aleth

机构信息

Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Cochin Hospital, Paris Descartes University, 27, Rue du Faubourg Saint-Jacques, 75679 Paris, France.

Department of Vascular Medicine, University Hospital Grenoble, Grenoble, France.

出版信息

Semin Arthritis Rheum. 2017 Jun;46(6):759-766. doi: 10.1016/j.semarthrit.2017.01.001. Epub 2017 Jan 13.

DOI:10.1016/j.semarthrit.2017.01.001

PMID:28214014

Abstract

OBJECTIVES

Ischemic digital ulcers (DU) represent a major complication of systemic sclerosis (SSc). We investigated the impact of controlling the ulcerative disease on disability, pain, and quality of life in SSc patients receiving bosentan.

METHODS

ECLIPSE (Study AC-052-517) is a 2-year prospective, multicenter, and observational study. Patients with SSc who experienced at least 1 DU in the previous year and received bosentan were included between October 2009 and March 2011. Disability scores [Cochin Hand Function Scale (CHFS) and Health Assessment Questionnaire Disability Index (HAQ-DI)], pain scores (visual analog scale), and quality-of-life scores (SF-36) were collected at inclusion and 1 year later (primary endpoint). A controlled ulcerative disease was defined by the absence of ongoing/new DU episode between inclusion and 1-year follow-up.

RESULTS

Data were available at 1 year for 120 patients out of 190 included. During follow-up, 46 (38.3%) patients experienced a new DU episode. The number of DU per patient decreased from 1.4 ± 1.8 at inclusion to 0.6 ± 1.6 (p < 0.0001) at 1 year. Disability scores decreased from 1.0 ± 0.7 to 0.9 ± 0.7 (p = 0.04) for the HAQ-DI and from 29 ± 20 to 25 ± 20 (p = 0.005) for the CHFS; the pain score decreased from 4.3 ± 3.1 to 2.9 ± 2.8 (p < 0.0001). This improvement was attributed to patients with a controlled ulcerative disease (48.3%), who significantly improved HAQ-DI (p = 0.04), CHFS (p = 0.04), and pain score (p = 0.046).

CONCLUSIONS

In patients with SSc, control of the ulcerative disease for 1 year was associated with significant attenuation of hand disability.

摘要

目的

缺血性指端溃疡（DU）是系统性硬化症（SSc）的主要并发症。我们研究了控制溃疡性疾病对接受波生坦治疗的SSc患者的残疾、疼痛和生活质量的影响。

方法

ECLIPSE（研究AC - 052 - 517）是一项为期2年的前瞻性、多中心观察性研究。2009年10月至2011年3月期间纳入了前一年至少经历过1次DU且接受波生坦治疗的SSc患者。在纳入时和1年后（主要终点）收集残疾评分[科钦手功能量表（CHFS）和健康评估问卷残疾指数（HAQ - DI）]、疼痛评分（视觉模拟量表）和生活质量评分（SF - 36）。溃疡性疾病得到控制定义为从纳入到1年随访期间无持续/新发DU发作。

结果

纳入的190例患者中有120例在1年时可获得数据。随访期间，46例（38.3%）患者出现新的DU发作。每位患者的DU数量从纳入时的1.4±1.8降至1年时的0.6±1.6（p<0.0001）。HAQ - DI的残疾评分从1.0±0.7降至0.9±0.7（p = 0.04），CHFS的残疾评分从29±20降至25±20（p = 0.005）；疼痛评分从4.3±3.1降至2.9±2.8（p<0.0001）。这种改善归因于溃疡性疾病得到控制的患者（48.3%），他们的HAQ - DI（p = 0.04）、CHFS（p = 0.04）和疼痛评分（p = 0.046）有显著改善。