title: Joint and tendon involvement predict disease progression in systemic sclerosis: a EUSTAR prospective study.
abstract: OBJECTIVE
  To determine whether joint synovitis and tendon friction rubs (TFRs) can predict the progression of systemic sclerosis (SSc) over time.
  
  
  METHODS
  We performed a prospective cohort study that included 1301 patients with SSc from the EUSTAR database with disease duration ≤3 years at inclusion and with a follow-up of at least 2 years. Presence or absence at clinical examination of synovitis and TFRs was extracted at baseline. Outcomes were skin, cardiovascular, renal and lung progression. Overall disease progression was defined according to the occurrence of at least one organ progression.
  
  
  RESULTS
  Joint synovitis (HR: 1.26, 95% CI 1.01 to 1.59) and TFRs (HR: 1.32, 95% CI 1.03 to 1.70) were independently predictive of overall disease progression, as were also the diffuse cutaneous subset (HR: 1.30, 95% CI 1.05 to 1.61) and positive antitopoisomerase-I antibodies (HR: 1.25, 95% CI 1.02 to 1.53). Regarding skin progression, joint synovitis (HR: 1.67, 95% CI 1.06 to 2.64) and TFRs (HR: 1.69, 95% CI 1.02 to 2.77) were also independently predictive of worsening of the modified Rodnan skin score. For cardiovascular progression, joint synovitis was predictive of the occurrence of new digital ulcer(s) (HR: 1.45, 95% CI 1.08 to 1.96) and decreased left ventricular ejection fraction (HR: 2.20, 95% CI 1.06 to 4.57); TFRs were confirmed to be an independent predictor of scleroderma renal crisis (HR: 2.33, 95% CI 1.03 to 6.19).
  
  
  CONCLUSIONS
  Joint synovitis and TFRs are independent predictive factors for disease progression in patients with early SSc. These easily detected clinical markers may be useful for the risk stratification of patients with SSc.
authors.affiliation: Rheumatology A Department, Paris Descartes University, Cochin Hospital, Paris, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Avouac
authors.affiliation: Department of Rheumatology, Basel University, Basel, Switzerland.
authors.forename: Ulrich A
authors.initials: UA
authors.lastname: Walker
authors.affiliation: Department of Internal Medicine, Université Lille Nord de France, IMPRT IFR 114, Hôpital Claude-Huriez, and Centre Hospitalier Régional Universitaire de Lille, Lille, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Hachulla
authors.affiliation: Department of Rheumatology, Clinical Immunology, German Rheumatism Research Centre, a Leibniz institute, Charité-University Medicine, Berlin, Germany.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Riemekasten
authors.affiliation: Rheumatology Section, Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Cuomo
authors.affiliation: Rheumatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Patricia E
authors.initials: PE
authors.lastname: Carreira
authors.affiliation: Rheumatology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italia.
authors.forename: Paola
authors.initials: P
authors.lastname: Caramaschi
authors.affiliation: Institute of Rheumatology, Russian Academy of Medical Science, Moscow, Russia.
authors.forename: Lidia P
authors.initials: LP
authors.lastname: Ananieva
authors.affiliation: Section of Rheumatology, Department of Medicine, University of Florence, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Matucci-Cerinic
authors.affiliation: Department of Rheumatology and Immunology, University of Pecs, Pecs, Hungary.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Czirjak
authors.affiliation: Centre for Rheumatology, Royal Free and University College London Medical School, London, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Denton
authors.affiliation: Department of Internal Medicine and Rheumatology, Justus-Liebig-University of Giessen, Kerckhoff-Klinik, Bad Nauheim, Germany.
authors.forename: Ulf Müller
authors.initials: UM
authors.lastname: Ladner
authors.affiliation: Rheumatology A Department, Paris Descartes University, Cochin Hospital, Paris, France.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Allanore
mesh_terms: D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood; D004264:DNA Topoisomerases, Type I / Q000276:immunology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D017276:Friction / Q000502:physiology*; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology / Q000503:physiopathology; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011658:Pulmonary Fibrosis / Q000209:etiology / Q000503:physiopathology; D011859:Radiography; D012595:Scleroderma, Systemic / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D012883:Skin Ulcer / Q000209:etiology; D013585:Synovitis / Q000503:physiopathology*; D013710:Tendons / Q000503:physiopathology*; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology
chemical_list: D000906:Antibodies; D004264:DNA Topoisomerases, Type I; C528909:TOP1 protein, human
keywords: Outcomes research; Synovitis; Systemic Sclerosis