AB0812 Ultrasonography for the assessment of skin in systemic sclerosis: a systematic review
Authors: T. Santiago, M. Santiago, B. Ruaro, M.J. Salvador, M. Cutolo, J.A. Pereira da Silva
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Skin involvement is the clinical hallmark of systemic sclerosis (SSc). A palpation-based semi-quantitative tool, the modified Rodnan skin score, is the current gold standard for the assessment of skin involvement. However, this method has significant limitations, with emphasis on low sensitivity to change and a high inter-observer variability. Ultrasound has been explored, in the past decades, as a basis for more objective, sensitivity and reproducible measure of skin involvement. <h3>Objectives</h3> To identify and synthesise the best available evidence on the use of ultrasound as a source of skin outcome measures in patients with SSc. <h3>Methods</h3> Two independent reviewers systematically searched Pubmed MEDLINE and Embase (up to December 2017). A study was eligible if it included at least one defined group of patients with SSc, and reported a structured evaluation of the skin with ultrasound and/or ultrasound elastography. This search was augmented by review of bibliographic references from the included studies. The same two reviewers independently extracted the data and classified the quality of evidence of the included studies by the Effective Public Health Practice Project system. <h3>Results</h3> A total of 30 studies (21 observational cross-sectional and 9 longitudinal) were included. They enrolled a total of 1171 SSc patients, mostly middle-aged, female and with a limited form of SSc (59.0%). The most common ultrasound outcome measure used was skin thickness (in 28 studies), although the definition of this parameter was a highly heterogeneous. Other outcome measures were echogenicity (in 7), and/or stiffness (in 6) and/or vascularity (in 1). There was a substantial discordance in the number and exact location of skin sites examined. The main comparator was global and site specific mRSS. There was a lack of construct and criterion validity (only 1 study assessed the correspondence between ultrasound measures and histological findings). Few studies reported information about inter- and intra-rater reproducibility, but when reported, it showed excellent results. Data regarding evidence for responsiveness to change and feasibility were also scarce. <h3>Conclusions</h3> This systematic review highlights a remarkable literature heterogeneity and limited quality of most reported studies. This hinders the evidence currently supporting the use of skin ultrasound evaluation in clinical practice, but the very promising data (e.g good reliability and early detection of skin involvement) support its use in clinical research. Further well-designed and dimensioned studies are needed to support the role of skin ultrasound assessment in the early diagnosis and monitoring SSc patients. These may be crucial to improve our understanding the disease process and to foster the development of much-needed new intervention strategies. <h3>References</h3> [1-] Clements PJ, et al. Arthritis Rheum. 2000;43(11):2445–54. [2] Kaldas M, et al. Rheumatology (Oxford). 2009;48(9):1143–6. [3] Moore TL, et al. Rheumatology (Oxford). 2003;42:1559–63. [4] Sulli A, et al. Ann Rheum Dis. 2014;73(1):247–51. <h3>Disclosure of Interest</h3> None declared