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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ESystemic sclerosis (SSc) is characterized by increased dermal thickness; the severity and extent of skin involvement are used to establish the diagnosis and subclassify the disease. The modified Rodnan skin score is a validated method to evaluate skin involvement in SSc, and it is based on manual palpation of 17 areas of the skin. This article discusses detection of subclinical diffuse dermal involvement by high-frequency ultrasound in patients with limited cutaneous SSc.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatological Autoimmune Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatological Autoimmune Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ESystemic sclerosis (SSc) is characterized by increased dermal thickness (DT); the severity and extent of skin involvement are used to establish the diagnosis and subclassify the disease. The modified Rodnan skin score (mRSS) is a validated method to evaluate skin involvement in SSc, and it is based on manual palpation of 17 areas of the skin. Alberto Sulli, MD, University of Genova, Genoa, Italy, discussed detection of subclinical diffuse dermal involvement by high-frequency ultrasound (US) in patients with limited cutaneous SSc (lcSSc) and presented a poster on the correlation among 3 different methods: mRSS, high-frequency ultrasound (US; a 18-MHz probe), and a plicometer skin test (plicometry) to evaluate skin involvement in patients with SSc [Ruaro B et al. EULAR 2014 (poster SAT0304)].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EIn patients with lcSSc, areas of skin that were normal according to mRSS were evaluated by high-frequency US. The aim of the study of mRSS, high-frequency US, and plicometry in patients with SSc was to identify possible correlations among these techniques to evaluate DT.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EProf. Sulli presented the results of a study in which 50 patients with lcSSc diagnosed by mRSS (a 5-year median duration of disease) were compared with 50 healthy subjects. DT was evaluated in the 17 standard skin areas (cheeks, fingers, dorsum of hands, forearms, arms, chest, abdomen, thighs, legs, and feet) in patients and healthy control subjects by both mRSS and high-frequency US. He then highlighted a comparative technique study by Ruaro and colleagues [EULAR 2014 (poster SAT0304)], in which the DT of 70 patients with SSc was compared with that of 63 healthy subjects using mRSS, high-frequency US, and plicometry on the standard 17 skin areas. The 3 techniques were performed on the same day for each subject and repeated by 2 blind operators to evaluate interobserver and intraobserver variability.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EIn patients with lcSSc, DT measured by high-frequency US was significantly higher than DT in healthy subjects for all skin areas (p\u0026lt;0.0001) except the thighs. DT was significantly higher in patients with lcSSc than in healthy subjects in 4 out of 6 skin areas (the arms, chest, and abdomen) in which the mRSS was normal, in agreement with the diagnosis of lcSSc.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EIn the comparative study, a significant positive correlation was found among the 3 methods used to evaluate DT in patients with SSc (mRSS vs US r=0.53, p\u0026lt;0.0001; mRSS vs plicometry r=0.98, p\u0026lt;0.0001; and US vs plicometry r=0.53, p\u0026lt;0.0001). DT in patients with SSc, including limited and diffuse SSc, was significantly higher (p=0.0001) than that of controls. Interobserver and intraobserver variability was small; variability and execution times for the 3 techniques are shown in \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14598\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14598\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14598\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EInterobserver and Intraobserver Variability and Execution Time for Dermal Thickness Assessment\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EThese studies show that subclinical diffuse dermal involvement may be detectable by high-frequency US in patients with lcSSc. This may be useful in future disease subclassification and may explain the similar degree of organ involvement in patients with lcSSc and diffuse cutaneous SSc that has been seen in clinical studies. In nearly all 17 skin areas analyzed by high-frequency US, patients with SSc have a significantly higher DT than controls. The 3 techniques of mRSS, high-frequency US, and plicometry used to measure DT in patients with SSc show a high degree of correlation.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/17\/20.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp3o1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzp3o1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}