title: Prevalence of Systemic Sclerosis in Primary Biliary Cholangitis Using the New ACR/EULAR Classification Criteria.
abstract: Systemic sclerosis (SSc) is a well-established disease associated with primary biliary cholangitis (PBC). However, the original 1980 American College of Rheumatology (ACR) criteria have poor sensitivity, especially for the detection of earlier SSc in previous studies. The objective was to evaluate the prevalence of SSc in patients with PBC using more sensitive 2001 LeRoy and Medsger criteria and the 2013 ACR/European League Against Rheumatism (EULAR) classification criteria. The secondary objective was to evaluate the frequency of individual clinical features.
  
  
  
  One hundred consecutive patients with PBC without previously diagnosed SSc were recruited between 2005 and 2007 from a tertiary care gastroenterology clinic. All patients underwent a complete clinical examination, determination of SSc-specific antibodies, and a nailfold capillary microscopy. Fulfillment of the 3 different criteria sets was analyzed, along with individual disease features.
  
  
  
  Of 100 patients with PBC, 1% met the ACR 1980 criteria, 22% met the 2001 LeRoy and Medsger criteria for early SSc, and 17% the 2013 ACR/EULAR criteria. Raynaud phenomenon, SSc-related antibodies, and SSc capillaroscopic patterns were the most prevalent findings, with the highest sensitivities to help guide future screening.
  
  
  
  Our data show a high prevalence of SSc in patients with PBC with probable underestimation by previous studies using the original ACR criteria. Comorbid SSc should be actively searched for based on newly described criteria to improve detection and increase benefits of earlier treatment.
authors.affiliation: From the Department of Internal Medicine, University of Montreal Hospital Center (CHUM), Hôpital Notre-Dame, Montreal, Quebec; the Department of Hepatology, CHUM, Hôpital St. Luc, Montreal, Quebec; the Department of Rheumatology, CHUM, Hôpital Notre-Dame, Montreal, Quebec; and the Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada. boyangz123@hotmail.com.|B. Zheng, MD, Department of Internal Medicine, CHUM, Hôpital Notre-Dame; C. Vincent, MD, Department of Hepatology, CHUM, Hôpital St. Luc; M.J. Fritzler, MD, PhD, Faculty of Medicine, University of Calgary; J.L. Senécal, MD, Department of Rheumatology, CHUM, Hôpital Notre-Dame; M. Koenig, MD, MSc, Department of Internal Medicine, CHUM, Hôpital Notre-Dame; F. Joyal, MD, MSc, Department of Internal Medicine, CHUM, Hôpital Notre-Dame. boyangz123@hotmail.com.
authors.forename: Boyang
authors.initials: B
authors.lastname: Zheng
authors.affiliation: From the Department of Internal Medicine, University of Montreal Hospital Center (CHUM), Hôpital Notre-Dame, Montreal, Quebec; the Department of Hepatology, CHUM, Hôpital St. Luc, Montreal, Quebec; the Department of Rheumatology, CHUM, Hôpital Notre-Dame, Montreal, Quebec; and the Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.|B. Zheng, MD, Department of Internal Medicine, CHUM, Hôpital Notre-Dame; C. Vincent, MD, Department of Hepatology, CHUM, Hôpital St. Luc; M.J. Fritzler, MD, PhD, Faculty of Medicine, University of Calgary; J.L. Senécal, MD, Department of Rheumatology, CHUM, Hôpital Notre-Dame; M. Koenig, MD, MSc, Department of Internal Medicine, CHUM, Hôpital Notre-Dame; F. Joyal, MD, MSc, Department of Internal Medicine, CHUM, Hôpital Notre-Dame.
authors.forename: Catherine
authors.initials: C
authors.lastname: Vincent
authors.affiliation: From the Department of Internal Medicine, University of Montreal Hospital Center (CHUM), Hôpital Notre-Dame, Montreal, Quebec; the Department of Hepatology, CHUM, Hôpital St. Luc, Montreal, Quebec; the Department of Rheumatology, CHUM, Hôpital Notre-Dame, Montreal, Quebec; and the Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.|B. Zheng, MD, Department of Internal Medicine, CHUM, Hôpital Notre-Dame; C. Vincent, MD, Department of Hepatology, CHUM, Hôpital St. Luc; M.J. Fritzler, MD, PhD, Faculty of Medicine, University of Calgary; J.L. Senécal, MD, Department of Rheumatology, CHUM, Hôpital Notre-Dame; M. Koenig, MD, MSc, Department of Internal Medicine, CHUM, Hôpital Notre-Dame; F. Joyal, MD, MSc, Department of Internal Medicine, CHUM, Hôpital Notre-Dame.
authors.forename: Marvin J
authors.initials: MJ
authors.lastname: Fritzler
authors.affiliation: From the Department of Internal Medicine, University of Montreal Hospital Center (CHUM), Hôpital Notre-Dame, Montreal, Quebec; the Department of Hepatology, CHUM, Hôpital St. Luc, Montreal, Quebec; the Department of Rheumatology, CHUM, Hôpital Notre-Dame, Montreal, Quebec; and the Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.|B. Zheng, MD, Department of Internal Medicine, CHUM, Hôpital Notre-Dame; C. Vincent, MD, Department of Hepatology, CHUM, Hôpital St. Luc; M.J. Fritzler, MD, PhD, Faculty of Medicine, University of Calgary; J.L. Senécal, MD, Department of Rheumatology, CHUM, Hôpital Notre-Dame; M. Koenig, MD, MSc, Department of Internal Medicine, CHUM, Hôpital Notre-Dame; F. Joyal, MD, MSc, Department of Internal Medicine, CHUM, Hôpital Notre-Dame.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Senécal
authors.affiliation: From the Department of Internal Medicine, University of Montreal Hospital Center (CHUM), Hôpital Notre-Dame, Montreal, Quebec; the Department of Hepatology, CHUM, Hôpital St. Luc, Montreal, Quebec; the Department of Rheumatology, CHUM, Hôpital Notre-Dame, Montreal, Quebec; and the Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.|B. Zheng, MD, Department of Internal Medicine, CHUM, Hôpital Notre-Dame; C. Vincent, MD, Department of Hepatology, CHUM, Hôpital St. Luc; M.J. Fritzler, MD, PhD, Faculty of Medicine, University of Calgary; J.L. Senécal, MD, Department of Rheumatology, CHUM, Hôpital Notre-Dame; M. Koenig, MD, MSc, Department of Internal Medicine, CHUM, Hôpital Notre-Dame; F. Joyal, MD, MSc, Department of Internal Medicine, CHUM, Hôpital Notre-Dame.
authors.forename: Martial
authors.initials: M
authors.lastname: Koenig
authors.affiliation: From the Department of Internal Medicine, University of Montreal Hospital Center (CHUM), Hôpital Notre-Dame, Montreal, Quebec; the Department of Hepatology, CHUM, Hôpital St. Luc, Montreal, Quebec; the Department of Rheumatology, CHUM, Hôpital Notre-Dame, Montreal, Quebec; and the Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.|B. Zheng, MD, Department of Internal Medicine, CHUM, Hôpital Notre-Dame; C. Vincent, MD, Department of Hepatology, CHUM, Hôpital St. Luc; M.J. Fritzler, MD, PhD, Faculty of Medicine, University of Calgary; J.L. Senécal, MD, Department of Rheumatology, CHUM, Hôpital Notre-Dame; M. Koenig, MD, MSc, Department of Internal Medicine, CHUM, Hôpital Notre-Dame; F. Joyal, MD, MSc, Department of Internal Medicine, CHUM, Hôpital Notre-Dame.
authors.forename: France
authors.initials: F
authors.lastname: Joyal
mesh_terms: D000368:Aged; D002761:Cholangitis / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D020678:Microscopic Angioscopy; D008875:Middle Aged; D015995:Prevalence; D011928:Raynaud Disease / Q000175:diagnosis / Q000453:epidemiology*; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000453:epidemiology*
keywords: AUTOIMMUNE DISEASE; PRIMARY BILIARY CHOLANGITIS; PRIMARY BILIARY CIRRHOSIS; SYSTEMIC SCLEROSIS