Functional Exercise Tests in Patients With Systemic Sclerosis

• Conditions: Scleroderma, Systemic; Pulmonary Arterial Hypertension; Acroosteolysis; Lung Diseases, Interstitial
• Interventions: Diagnostic Test: 6-minute walk test part one; Diagnostic Test: 6-minute walk test part two; Diagnostic Test: 1-minute sit-to-stand test; Diagnostic Test: 4-meters gait speed test; Diagnostic Test: Nailfold videocapillaroscopy; Diagnostic Test: HR-pQCT; Diagnostic Test: Hand x-ray; Diagnostic Test: DEXA

• Registration Number: NCT04650659
• Lead Sponsor: University of Aarhus

Brief Summary

The aim of the study is to examine the validity of peripheral oxygen saturation measurement during the 6-minute walk test in patients with Systemic Sclerosis (SSc) and to examine the utility of two other functional tests as markers of pulmonary involvement in patients with SSc.

Detailed Description

Systemic Sclerosis (SSc) is a connective tissue disease characterized by progressive organ fibrosis and vascular dysfunction. The leading causes of disease related morbidity and mortality are interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH). The 6-minute walk test (6MWT) is a submaximal functional exercise test used to evaluate ILD and PAH in patients with SSc. Desaturations during the 6MWT have been considered suggestive of ILD and PAH. Still, the optimal method to measure peripheral oxygen saturation during the 6MWT in patients with SSc remains unclear. Furthermore, other functional exercise tests may also be useful in patients with SSc.

Patients with SSc will perform three functional exercise tests, and approximately half of the patients will be invited to repeat the tests 1 week later to determine test-retest reliability. Additionally, nailfold videocapillaroscopy (NVC) will be performed on every patient to assess the capillary density of the nailfold of the fingers. Furthermore, to study the effect of SSc on bone, a high resolution peripheral quantitative computed tomography (HRpQCT) scan of radius and distal interphalangeal joints (DIP)/distal phalanges will be performed.

During the 6MWT, the peripheral oxygen saturation (SpO2) will be measured continuously on three anatomical locations. An arterial line will be placed, and blood will be drawn at baseline and after ended 6MWT and analysed for arterial oxygen saturation (SaO2). The correlation between the capillary density of the nailfold and the SpO2 measured on the finger will be assessed. The correlation between capillary density of the nailfold and bone status in the fingers and distal radius assessed with HRpQCT will be evaluated, and HRpQCT images will be compared with conventional radiography and DEXA. Bland-Altman plot will be used to display the agreement between SaO2 and SpO2 and between the two 6MWT. Further, the association between pulmonary variables and 6MWT results will be examined.

Two alternative functional exercise tests will be investigated and compared to results in the 6MWT: The 1-minute sit-to-stand test (1STST) and the 4-meter gait speed test (4MGS). The association between the three functional exercise tests and clinical parameters in patients with SSc will be examined.

Study Timeline

• Study First Submitted: 2020-11-23
• Study First Submitted QC: 2020-12-01
• Study First Posted: 2020-12-03
• Study Start: 2021-07-27
• Status Verified: 2022-05
• Last Update Submitted: 2022-05-19
• Last Update Posted: 2022-05-20
• Primary Completion: 2023-01-31
• Study Completion: 2023-01-31

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 83

Inclusion Criteria

• Diagnosed with Systemic Sclerosis according to the ACR/EULAR 2013 criteria
• Provided written informed consent

Exclusion Criteria

• Overlap syndrome (except for rheumatoid arthritis and Sjögren syndrome)
• Recent or ongoing lung infection
• Other major comorbidities that could affect the functional exercise tests.
• Pregnancy
• Unable to understand the patient information

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Part one of the project	1-minute sit-to-stand test	83 patients with Systemic Sclerosis will perform three functional exercise tests on the same day. All 83 patients will be examined with NVC. Moreover, HRpQCT will be performed on all patients at baseline and after 1 year.
Part one of the project	6-minute walk test part one	83 patients with Systemic Sclerosis will perform three functional exercise tests on the same day. All 83 patients will be examined with NVC. Moreover, HRpQCT will be performed on all patients at baseline and after 1 year.
Part one of the project	DEXA	83 patients with Systemic Sclerosis will perform three functional exercise tests on the same day. All 83 patients will be examined with NVC. Moreover, HRpQCT will be performed on all patients at baseline and after 1 year.
Part one of the project	HR-pQCT	83 patients with Systemic Sclerosis will perform three functional exercise tests on the same day. All 83 patients will be examined with NVC. Moreover, HRpQCT will be performed on all patients at baseline and after 1 year.
Part two of the project	4-meters gait speed test	Half of the patients from part one of the project will be invited to repeat the three functional exercise tests approximately one week later in reverse order to determine test-retest reliability.
Part one of the project	Hand x-ray	83 patients with Systemic Sclerosis will perform three functional exercise tests on the same day. All 83 patients will be examined with NVC. Moreover, HRpQCT will be performed on all patients at baseline and after 1 year.
Part one of the project	Nailfold videocapillaroscopy	83 patients with Systemic Sclerosis will perform three functional exercise tests on the same day. All 83 patients will be examined with NVC. Moreover, HRpQCT will be performed on all patients at baseline and after 1 year.
Part one of the project	4-meters gait speed test	83 patients with Systemic Sclerosis will perform three functional exercise tests on the same day. All 83 patients will be examined with NVC. Moreover, HRpQCT will be performed on all patients at baseline and after 1 year.
Part two of the project	6-minute walk test part two	Half of the patients from part one of the project will be invited to repeat the three functional exercise tests approximately one week later in reverse order to determine test-retest reliability.
Part two of the project	1-minute sit-to-stand test	Half of the patients from part one of the project will be invited to repeat the three functional exercise tests approximately one week later in reverse order to determine test-retest reliability.

Primary Outcome Measures

Name	Time	Method
Examine the validity of peripheral oxygen saturation measurement during 6-minute walk test in patients with Systemic Sclerosis.	1 hour	The agreement between the peripheral oxygen saturation measured on the forehead, finger and earlobe and the arterial oxygen saturation from the blood gas analysis will be examined.

Secondary Outcome Measures

Name	Time	Method
Examine the correlation between the 6-minute walk test, the 1-minute sit-to-stand test, and the 4-meter gait speed test in patients with Systemic Sclerosis.	1 hour	The agreement between the 6-minute walk test, the 1-minute sit-to-stand test, and the 4-meter gait speed test in patients with Systemic Sclerosis.
Investigate the correlation between functional exercise tests and the severity of pulmonary involvement in patients with Systemic Sclerosis.	1 hour	The agreement between functional exercise tests and the severity of pulmonary involvement in patients with Systemic Sclerosis.

Trial Locations

Locations (1)

The Department of Rheumatology, Aarhus University Hospital; 🇩🇰 Aarhus, Denmark