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We have read the interesting paper of Clements PJ et al (1) as well as their previous article “Cyclophosphamide versus placebo in scleroderma lung disease” (2).
We think the Authors should give information about the autoantibody status of the patients; the recent analysis of the very large EUSTAR cohort of scleroderma cases demonstrated that autoantibody specificity is more closely related to or...
We think the Authors should give information about the autoantibody status of the patients; the recent analysis of the very large EUSTAR cohort of scleroderma cases demonstrated that autoantibody specificity is more closely related to organ involvement than systemic sclerosis cutaneous subset (3). Concerning pulmonary evaluation this study (3) did not consider alveolitis, as in “Scleroderma lung study” (1, 2), but both pulmonary fibrosis and lung restrictive defect were about three times morefrequent in patients carrying anti-Scl70 antibody in comparison with anticentromere positive patients; comparing diffuse and limited cutaneous subsets of disease the difference in percentage of lung involvement was less pronounced. In particular we are interested in knowing how many patients affected by limited systemic sclerosis were anti-Scl70 autoantibody positive. In our experience, alveolitis rarely complicates
the course of patients with limited systemic sclerosis harbouring anticentromere antibody.
Moreover we would like to know the Authors opinion about the worse DLCO decline in patients with limited systemic sclerosis treated with cyclophosphamide in comparison with placebo group, as presented in table 3. The trend of this parameter was different in respect to the other pulmonary function tests: was the incidence of pulmonary hypertension similar in the two subgroups?
1) Clements PJ, Roth MD, Elashoff R, Tashkin PD, Goldin J, Silver RM,et al. Scleroderma Lung Study (SLS): Differences in the presentation and course of patients with limited versus diffuse systemic sclerosis. Ann
Rheum Dis 2007 May 7; [Epub ahead of print]
2) Tashkin PD, Elashoff R, Clements PJ, Goldin J, Roth MD, Furst DE, et al. Cyclophosphamide versus placebo in scleroderma lung disease. N EnglJ Med 2006;354:2655-66.
3) Walker UA, Tyndall A, czirjak L, Denton CP, Farge Baucel D, Kowal-Bielecka O, et al. Clinical risk assessment of organ manifestations in systemic sclerosis - a report from the EULAR Scleroderma Trials And Research (EUSTAR) group data base. Ann Rheum Dis 2007 Feb 1; [Epub ahead of print]