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Assessment of diaphragmatic function by ultrasonography in patients with systemic sclerosis and its relation to clinical parameters

A case-control study

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Summary

Background

Diaphragmatic function can be affected in many diseases and disorders. Although systemic sclerosis (SSc) is a serious connective tissue disease that affects not only the skin but also the pulmonary and musculoskeletal systems, there is insufficient information about diaphragm function.

Aims

To compare the diaphragmatic parameters by ultrasonography (USG) in patients with SSc and healthy individuals and examine the relationship between these parameters and clinical features in patients with SSc.

Methods

This study included 13 patients with SSc and 15 healthy individuals. Muscle thickness (in deep inspiration Tins and at the end of calm expiration Texp), changes in thickness (∆T), and thickening fraction at deep breathing were evaluated by USG. Skin thickness, pulmonary function tests, respiratory muscle strength, and the perception of dyspnea were measured as clinical features.

Results

The results of Texp, Tins, and ∆T were similar in both groups (p > 0.05), albeit patients in the SSc group had less thickening fraction compared to the control group (79.9 ± 36.7 cm and 103.8 ± 20.6 cm, respectively, p < 0.05). The Tins, ∆T, and thickening fraction of the diaphragm were associated with skin thickness, pulmonary function test parameters, and respiratory muscle strength (p < 0.05). Besides, there was significant correlation between muscle thickening fraction and perception of dyspnea (p < 0.05).

Conclusion

These results confirm that diaphragm thickness and contractility can be affected in patients with SSc. Therefore, ultrasonographic evaluation of the diaphragm can play a complementary role to pulmonary function test and respiratory muscle strength measurement in the diagnosis and follow-up of patients with SSc.

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Funding

This study did not receive any specific grant from funding agencies.

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Authors and Affiliations

  1. Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Buyukdere Meselik Campus, Eskisehir Osmangazi University, 26040, Eskisehir, Turkey

    Hazal Yakut PT, PhD

  2. Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey

    Gamze Yalcinkaya PT, PhD

  3. Faculty of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey

    Seher Ozyurek PT, PhD, Sevgi Ozalevli PT, PhD & Yesim Salik Sengul PT, PhD

  4. Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University, Izmir, Turkey

    Merih Birlik MD, PhD

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  1. Hazal Yakut PT, PhD
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Hazal Yakut, Gamze Yalcinkaya and Seher Ozyurek. The first draft of the manuscript was written by Hazal Yakut and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Hazal Yakut PT, PhD.

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Conflict of interest

H. Yakut, G. Yalcinkaya, S. Ozyurek, S. Ozalevli, Y. Salik Sengul and M. Birlik declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. The study was started after the necessary permissions were obtained from the Non-Invasive Research Ethics Committee of Dokuz Eylul University (No: 2021/28-06, date: 13 December 2021).

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Data available on request. The data underlying this article will be shared on reasonable request to the corresponding author. Participants only gave informed consent for anonymized patient-level data sharing with the research team and publications to include aggregate data.

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Yakut, H., Yalcinkaya, G., Ozyurek, S. et al. Assessment of diaphragmatic function by ultrasonography in patients with systemic sclerosis and its relation to clinical parameters. Wien Klin Wochenschr 135, 528–537 (2023). https://doi.org/10.1007/s00508-023-02163-x

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