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Fibrosis biomarkers in isolated Raynaud’s phenomenon: too little, too soon? Raynaud’s phenomenon (RP) can be the first manifestation or may be present before the development of an overt systemic sclerosis (SSc).1 Enhanced liver fibrosis (ELF) test, an algorithm combining tissue inhibitors of matrix metalloproteinases (TIMP-1), hyaluronic acid (HA) and aminoterminal propeptide of type III procollagen (PIIINP), has been related to several measures of fibrosis in SSc patients.2–4 We evaluated whether these biomarkers could discriminate between primary and secondary RP. Consecutive adult patients with RP at the first rheumatologic evaluation were recruited from February 2011 to May 2012 with ethics committee approval. Exclusion criteria were history of any fibrosing disorder, organ transplantation, hepatocellular carcinoma or treatment with interferon. One patient was excluded for interferon treatment. Fifteen limited cutaneous SSc and 15 diffuse cutaneous (dc) SSc were studied.5 All patients provided a written informed consent. All subjects underwent clinical evaluation and capillaroscopy.6 Sera were tested for anti-nuclear antibodies (ANA) on HEp2 cells; anti-dsDNA by ELISA; anti-extractable nuclear antigens Table 1

(anti-ENA) by ELISA (Phadia, Freiburg, Germany) and DotBlot (EUROIMMUN AG Luebeck, Germany). ELF score was determined blindly (iQur Limited, London, UK).7 Patients were classified as primary RP ( pRP),8 RP secondary to suspected SSc (ie, capillaroscopy or ANA positive with or without anti-ENA positivity and without any symptoms suggestive for SSc) and very early SSc.9 Demographic features of the 109 enrolled subjects are shown in table 1. Our cohort of patients is consistent with published series10 showing a higher female prevalence, similar percentage of ANA and anti-ENA positivities and abnormal capillaroscopy. A significant increasing trend was observed with one-way analysis of variance (ANOVA) in rank transformation from pRP to dcSSc for ELF test, HA and PIIINP ( p

Fibrosis biomarkers in isolated Raynaud's phenomenon: too little, too soon?

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