Is modified clinical activity score an accurate indicator of diplopia progression in Graves&amp;rsquo; orbitopathy patients?

Kim, Ji Won; Woo, Young Sup; Yoon, Jin Sook

doi:10.1507/endocrj.ej16-0165

Cited by 23 publications

(13 citation statements)

References 24 publications

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“…Indicators for evaluating the activity and severity of thyroid ophthalmopathy have always been controversial. [32][33][34] CAS and the modified NOSPECS score have been challenged as reliable measures of disease status, as they sum the clinical features of the disease with equal weight. 34 For example, some features may worsen, whereas others may improve as the disease progresses.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal association of thyroid-stimulating immunoglobulin levels with clinical characteristics in thyroid eye disease

Kook

Yoon

et al. 2022

BMJ Open

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ObjectivesThe clinical course of thyroid eye disease (TED) is heterogeneous and predicting patients who may develop the severe sequelae of the disease is difficult. In this study, we evaluated the longitudinal association between changes in serum thyroid-stimulating hormone (TSH) receptor antibody (TRAb) levels and course of disease activity and severity over time.DesignThis was a multicentre, prospective, observational study.SettingFifteen tertiary care oculoplastic service centres in Korea.ParticipantsSeventy-six patients with newly diagnosed TED were included and followed up for 12 months.MethodsWe evaluated clinical characteristics and serum TRAb levels at baseline, 6 and 12 months of TED diagnosis. Additionally, we analysed longitudinal associations between the serum TRAb levels and clinical activity score (CAS), no signs or symptoms, only signs, soft tissue involvement, proptosis, extraocular muscle involvement, corneal involvement, sight loss (NOSPECS) score and proptosis.ResultsThyroid-stimulating immunoglobulin (TSI) and TSH-binding inhibitory immunoglobulin (TBII) levels decreased during the 1-year follow-up, whereas disease activity measured using CAS decreased mainly in the first 6 months. Disease severity measured using NOSPECS score and proptosis remained unchanged. Moreover, inter-person differences in TBII levels were associated with CAS, NOSPECS score and proptosis over time, whereas inter-person differences in TSI levels were associated with NOSPECS score. Subgroup analysis of patients with a baseline CAS≥4 demonstrated that within-person changes in TSI levels affected the CAS and NOSPECS score.ConclusionsFollow-up measurement of serum TSI and TBII levels may help evaluate TED prognosis and enable accurate clinical decision-making.

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Section: Discussionmentioning

confidence: 99%

Longitudinal association of thyroid-stimulating immunoglobulin levels with clinical characteristics in thyroid eye disease

Kook

Yoon

et al. 2022

BMJ Open

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“…In clinical settings, evaluation of inflammatory activity is crucial for management of GO but is often difficult and imprecise due to a lack of biomarkers available to diagnose the active inflammatory status, other than the clinical activity score. The clinical activity score does not always ref lect the inf lammatory status, can indicate an incorrect diagnosis of congestion, and can lead to ineffective anti-inflammatory treatment in patients with GO [13]. Our results showed that active chemokine production decreased during adipogenesis compared to before differentiation.…”

Section: Discussionmentioning

confidence: 66%

Chemokine Expression during Adipogenesis and Inflammation in Orbital Fibroblasts from Patients with Graves' Orbitopathy

Lee

Choi

Yoon

2020

Korean J Ophthalmol

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Graves' orbitopathy (GO) is an autoreactive inflammatory disease that causes expansion of orbital adipose tissue and edema of extraocular muscles within the orbit [1-3]. Generation of antibodies against self-antigens such as thyroid-stimulating hormone receptor and insulin-like growth factor-1 receptor, inflammatory infiltration, and accumula-Purpose: Chemokines are involved in the pathogenesis of various autoimmune diseases, including Graves' orbitopathy (GO), but comprehensive analyses of the dynamics of these cytokines and their receptors in such diseases remain lacking. In this study, we investigated the expressions of chemokines and their receptors during adipogenesis and inflammation in primary cultured orbital fibroblasts from patients with GO. Methods: The messenger RNA (mRNA) expression levels of chemokines were compared between GO (n = 6) and non-GO (n = 5) orbital tissues by real-time polymerase chain reaction. After adipogenesis was induced in primary cultured orbital fibroblasts from patients with GO (n =5) and following stimulation with interleukin (IL)-1β and tumor necrosis factor (TNF)-α, the mRNA expression levels of chemokines and their receptors were analyzed. Results: Chemokines were significantly downregulated in GO orbital tissues compared to non-GO orbital tissues (p < 0.05). Adipogenesis resulted in a strong increase in mRNA expression levels of chemokines and their receptors at an early stage (day 1); however, expression levels started to decrease thereafter and, eventually, decreased to below basal levels at the end of adipogenesis (day 10). Following stimulation with IL-1β and TNF-α, the mRNA expression levels of chemokines and their receptors increased, showing different responses to various proinflammatory cytokines. Conclusions: Chemokines were strongly upregulated in the early phase of adipogenesis before decreasing continuously until the end of adipogenesis. Also, overt mature GO tissues showed reduced mRNA expression of chemokines compared to controls, which might indicate the existence of a shorter window for effective medical inflammatory treatment. The heightened levels of chemokines and their receptors observed after stimulation with IL-1β and TNF-α suggest a crucial role of proinflammatory cytokines in the pathogenesis of GO and, further, support the idea that chemokines could be used as biomarkers of GO activity.

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“…The female-to-male ratio of patients with restrictive myopathy has been reported to be lower (1-1.74:1) than that of all patients with TED. [14][15][16] According to several studies, smoking is strongly associated with the development of TED and unfavorable clinical outcomes. Current smokers had more than twice the odds ratio or relative risk of TED development than those who had never smoked or past smokers.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors of Restrictive Myopathy in Thyroid Eye Disease

Choi

Noh

Kim

et al. 2021

Preprint

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To investigate the prognostic factors of extraocular muscle restriction in patients with thyroid eye disease (TED), sixty-five patients with TED and restrictive myopathy were evaluated. Demographics, clinical activity score (CAS), smoking status, thyroid disease status, thyroid hormone status, thyroid autoantibody status, orbital computed tomography (CT) scan at initial presentation, and treatment regimens were assessed. The movements of the most severely affected extraocular muscles were categorized into five grades. The patients were divided into the improved and the not-improved group based on the improvement in the limitation of the extraocular muscle excursion (LOM) throughout the follow-up, and the groups were compared using clinical factors. The mean LOM significantly improved from 2.3 ± 1.1 to 1.7 ± 1.2 after 1 year of follow-up. The excursion of the most restricted muscle improved in 32 patients but not in 33 patients during the follow-up. The initial concentration of the thyroid-stimulating antibody (TSAb) was significantly lower in the improved than in the not-improved group. Age, sex, smoking status, CAS, thyroid status, and muscle thickness on the CT scan did not significantly differ in the groups. This study showed that the initial concentration of TSAb is a factor affecting the recovery of restrictive myopathy.

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Is modified clinical activity score an accurate indicator of diplopia progression in Graves’ orbitopathy patients?

Cited by 23 publications

References 24 publications

Longitudinal association of thyroid-stimulating immunoglobulin levels with clinical characteristics in thyroid eye disease

Longitudinal association of thyroid-stimulating immunoglobulin levels with clinical characteristics in thyroid eye disease

Chemokine Expression during Adipogenesis and Inflammation in Orbital Fibroblasts from Patients with Graves' Orbitopathy

Prognostic Factors of Restrictive Myopathy in Thyroid Eye Disease

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