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• Our response to questions raised by Drs Ugurlu and Seyahi
  Robyn T Domsic
  Published on: 28 March 2011
• Skin thickness progression rate: a predictor of mortality and early internal organ involvement in diffuse scleroderma. Comment on the article by Domsic et al.
  Serdal Ugurlu
  Published on: 28 March 2011

• Published on: 28 March 2011

  Our response to questions raised by Drs Ugurlu and Seyahi

  • Robyn T Domsic
  • Other Contributors:
    • Thomas A Medsger

  We thank Drs Ugurlu and Seyahi for their comments and request for clarification regarding the development of the skin thickness progression rate. For the purpose of this study, we included only patients with early diffuse scleroderma at the time of the first Pittsburgh evaluation (<2 years duration). We defined diffuse cutaneous disease as skin thickening proximal to the elbows or knees (upper arms, thighs or trunk) o...

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  We thank Drs Ugurlu and Seyahi for their comments and request for clarification regarding the development of the skin thickness progression rate. For the purpose of this study, we included only patients with early diffuse scleroderma at the time of the first Pittsburgh evaluation (<2 years duration). We defined diffuse cutaneous disease as skin thickening proximal to the elbows or knees (upper arms, thighs or trunk) on physical examination at the time of the first Pittsburgh evalutions.

  In our model building process we assessed for correlations and interactions between al variables significant at a p-value of 0.20 in the bivariate model, and performed stepwise multivariable logistic regression. By using a larger critical value we intended to included all potentially useful variables and thus hoped to have a better predictive model.

  We agree that in the Table 2 the 95% confidence interval for the prediction of mortality by anti-RNA polymerase III antibody should not be 0.40 - 1.94. Instead, it should be 0.40 - 0.94. We apologize for this error.

  While we collected information on the patient's referral area and assessed its potential impact on the model (section entitled clinical information), all US systemic sclerosis patients were included regardless of their residence location.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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• Published on: 28 March 2011

  Skin thickness progression rate: a predictor of mortality and early internal organ involvement in diffuse scleroderma. Comment on the article by Domsic et al.

  • Serdal Ugurlu, Associate Professor
  • Other Contributors:
    • Emire Seyahi, MD

  To the editor, We read with interest the article by Domsic et al (1) in which they report that skin thickness progression rate (STPR) could predict mortality and early internal organ involvement in diffuse scleroderma (dSSc). There are few points that we would like to address: 1)Authors included only patients with diffuse skin involvement at the time of initial evaluation and measured STPR prospectively in 826 patients wit...

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  To the editor, We read with interest the article by Domsic et al (1) in which they report that skin thickness progression rate (STPR) could predict mortality and early internal organ involvement in diffuse scleroderma (dSSc). There are few points that we would like to address: 1)Authors included only patients with diffuse skin involvement at the time of initial evaluation and measured STPR prospectively in 826 patients with dSSc followed between 1980 and 2005. However, they do not tell us how they defined the degree and the extent of skin involvement used as inclusion criteria. This information would be useful in interpretation of the STPR. 2)They used variables that were significant at the level of p < 0.2 in the univariate analysis for stepwise multivariable logistic regression. It is rather obvious that a variable with a low statistical significance would be even less significant when used in a logistic regression. 3)In Table 4, the p value for anti-RNA polymerase III antibody in predicting mortality was found to be 0.02. However the 95 % confidence intervals were calculated as 0.40 - 1.94. We think that there might be an error in this calculation. 4)The authors report that multivariable regression model was not affected by patients' referral area whether greater or less than 100 miles from Pittsburgh. However at the Methods they state that they only included patients who were living within 100 miles of Pittsburgh. This point should be clarified.

  Reference 1) Domsic RT, Rodriguez-Reyna T, Lucas M, Fertig N, Medsger TA Jr. Skin thickness progression rate: a predictor of mortality and early internal organ involvement in diffuse scleroderma. Ann Rheum Dis. 2011;70:104-9.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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