Abstract

BackgroundThickened skin is a major clinical feature in patients with systemic sclerosis (SSc). We investigated changes of skin thickness in patients with SSc using both high frequency ultrasound (HFU) and the modified Rodnan skin score (mRSS) to evaluate the feasibility of application of HFU in skin involvement and the relationship between HFU and clinical profiles.MethodsWe recruited 31 consecutive patients with SSc and 31 age-matched and sex-matched healthy controls in this prospective, cross-sectional study. Skin thickness was measured by an 18-MHz ultrasonic probe at five different skin sites. Total skin thickness (TST) and skin thickness using categorical mRSS scores were recorded and compared to HFU. The European Scleroderma Trial and Research (EUSTAR) group Disease Activity Index (EUSTAR-DAI) and other clinical manifestations were assessed and analyzed.ResultsTST in patients with SSc was thicker than in healthy controls (P < 0.001), and correlated positively with total mRSS and the EUSTAR-DAI and correlated negatively with disease duration (P < 0.05). Patients with higher TST had higher EUSTAR-DAI, mRSS, C-reactive protein (CRP) and lower diffusing capacity of the lung for carbon monoxide (DLCO) (P < 0.05). Even in patients who on clinical assessment were assigned an mRSS that suggested the skin thickness was normal. This was also true to mRSS locally of 1 and 2 (P < 0.01). The area under the receiver operator characteristic (ROC) curve was 0.831 and yielded sensitivity of 77.4% and specificity of 87.1% at the predicted probability of 7.4 mm as the optimal cutoff point to access skin thickness.ConclusionsIn the study, HFU was able to measure skin thickness, it correlated quantitatively with a valid measure of SSc activity, and a minimal detectable difference was identified.

Highlights

  • Thickened skin is a major clinical feature in patients with systemic sclerosis (SSc)

  • Skin thickness assessed by high frequency ultrasound (HFU) We compared total skin thickness (TST) assessed by HFU in the patients with SSc with the total modified Rodnan skin score (mRSS) and found that both demonstrated that the skin was significantly thicker than in healthy controls (P < 0.001)

  • Localized skin thickness in the group scored as mRSS = 3 was thicker compared with controls, it was not statistically significant (P = 0.057), probably because there were only three skin sites among the total 155 sites

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Summary

Introduction

Thickened skin is a major clinical feature in patients with systemic sclerosis (SSc). We investigated changes of skin thickness in patients with SSc using both high frequency ultrasound (HFU) and the modified Rodnan skin score (mRSS) to evaluate the feasibility of application of HFU in skin involvement and the relationship between HFU and clinical profiles. Systemic sclerosis (SSc) is an autoimmune disorder of unknown etiology, characterized by thickening and hardening of the skin and variable involvement of internal organs, with fibrosis and vasculopathy being the major pathological changes [1]. The modified Rodnan skin score (mRSS) was established by Rodnan in 1979 and is a validated method to evaluate skin thickening in SSc worldwide [6,7,8]. Other techniques that are more sensitive, objective and reliable for assessment and evaluation are in development [11]

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