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Response to: ‘Can we further SPARkle the SPAR model?’ by Kavadichanda et al
  1. Wanlong Wu1,2,
  2. Suzana Jordan1,
  3. Oliver Distler1
  1. 1 Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
  2. 2 Department of Rheumatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
  1. Correspondence to Dr Oliver Distler, Department of Rheumatology, University Hospital Zurich, Zürich 8091, Switzerland; oliver.distler{at}usz.ch

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Thank you very much for your interest in our article ‘Prediction of progression of interstitial lung disease in patients with systemic sclerosis: the SPAR model’1 and your precious questions ‘Can we further SPARkle the SPAR model’.2 We are glad to respond as below.

Ever having arthritis and progression of ILD

Musculoskeletal manifestations in scleroderma are commonly treated with methotrexate. The progress/worsening of ILD by methotrexate has been widely contested across various disease groups. Hence, could it be possible that the subset of patients with arthritis ended up receiving methotrexate, which in turn was responsible for ILD progression?

The causative role of methotrexate (MTX) in inducing or exacerbating interstitial lung disease (ILD) is quite controversial, especially in non-rheumatoid arthritis autoimmune diseases.3 Furthermore, Avouac et al 4 reported that the presence of joint synovitis was an independent predictor for disease progression in systemic sclerosis (SSc), suggesting that arthritis by itself is associated with organ manifestations independent …

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