Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Arthritis Res Ther. 2020 Mar 18;22(1):50. doi: 10.1186/s13075-020-02150-x.
Measurement of skin involvement is essential for the diagnosis and assessment of prognosis and disease progression in systemic sclerosis (SSc). The modified Rodnan skin score (mRSS) is the gold standard measure of skin thickness, but it has been criticised for the lack of objectivity, poor inter-observer reproducibility and lack of sensitivity to change. Recently, shear-wave elastography (SWE) emerged as a promising tool for the objective and quantitative assessment of the skin in SSc patients. However, no studies have evaluated its sensitivity to change over time.
To assess changes in skin stiffness in SSc patients using SWE during a 5-year follow-up.
Skin stiffness [i.e. shear-wave velocity values (SWV) in metres per second] was assessed by SWE ultrasound (using virtual touch image quantification) at the 17 sites of the mRSS, in each participant, at baseline and follow-up. mRSS was performed at both time points. Differences between groups were analysed using the related-samples Wilcoxon signed-rank test and the Mann-Whitney U test.
We included 21 patients [85.7% females; mean age 56.3 (10.4) years at baseline, 57.1% with limited SSc] and 15 healthy controls [73.3% females; mean age 53.6 (14.1) years)]. The median follow-up was 4.9 (0.4) years. Skin stiffness decreased significantly at all Rodnan sites (p ≤ 0.001) (except in the fingers), in SSc patients, over time. The same phenomenon occurred in controls, but to a lesser degree, in terms of percentage change. The percentage reduction in skin stiffness varied in the different Rodnan sites and in different phases of the disease. In addition, SWV values also decreased significantly in 15/16 skin sites with local normal Rodnan at baseline, whereas local Rodnan skin score only changed significantly in the upper arm (p = 0.046) and forearm (p = 0.026).
This study provides first-time evidence suggesting that skin SWV values are more sensitive to change over time than mRSS and reduce significantly over time in SSc and normal controls.
皮肤受累的测量对于系统性硬化症（SSc）的诊断、预后评估和疾病进展至关重要。改良的罗德纳皮肤评分（mRSS）是测量皮肤厚度的金标准，但它因缺乏客观性、观察者间重现性差和对变化不敏感而受到批评。最近，剪切波弹性成像（SWE）作为一种客观、定量评估 SSc 患者皮肤的工具而出现。然而，尚无研究评估其随时间变化的敏感性。
在 5 年的随访中，使用 SWE 评估 SSc 患者的皮肤硬度变化。
使用 SWE 超声（使用虚拟触摸图像量化）在 mRSS 的 17 个部位评估每个参与者的皮肤硬度[即剪切波速度值（SWV）以米/秒为单位]，在基线和随访时进行。在两个时间点均进行 mRSS。使用相关样本 Wilcoxon 符号秩检验和 Mann-Whitney U 检验分析组间差异。
我们纳入了 21 名患者[85.7%为女性；基线时的平均年龄为 56.3（10.4）岁，57.1%为局限型 SSc]和 15 名健康对照[73.3%为女性；平均年龄为 53.6（14.1）岁]。中位随访时间为 4.9（0.4）年。随着时间的推移，SSc 患者所有罗德纳部位的皮肤硬度（p≤0.001）（手指除外）均显著降低。在对照组中也观察到了同样的现象，但在百分比变化方面程度较小。不同罗德纳部位和疾病不同阶段的皮肤硬度降低百分比不同。此外，在基线时局部罗德纳皮肤评分正常的 16 个皮肤部位中的 15 个，SWV 值也显著降低，而只有在上臂（p=0.046）和前臂（p=0.026）的局部罗德纳皮肤评分显著改变。
本研究首次提供证据表明，皮肤 SWV 值比 mRSS 更敏感，随时间变化更明显，在 SSc 和正常对照组中随时间显著降低。
