Home monitoring detects decline in lung function in systemic sclerosis Measuring at home enables faster adjustment of treatment

A brief weekly home measurement detects deterioration in lung function in systemic sclerosis just as reliably and faster than the semi-annual hospital test. This makes it possible to adjust treatments more swiftly. These findings are reported by researchers led by rheumatologist Madelon Vonk of Radboud university medical center in The Lancet Rheumatology.

Systemic sclerosis is a rare condition in which the immune system causes damage to the body through inflammation and hardening of connective tissue. In the Netherlands, approximately 3,500 people are known to suffer from this disease, though many more may be undiagnosed. More than half of patients develop lung damage, known as pulmonary fibrosis, which is the primary cause of death in systemic sclerosis.

‘Nowadays, we’re able to treat pulmonary fibrosis more effectively’, says rheumatologist Madelon Vonk of Radboudumc. ‘But you only want to start or intensify treatment if it’s truly necessary. That’s why we need to identify who has pulmonary fibrosis and monitor those in whom it’s worsening.’ Currently, patients visit the hospital twice a year for a consult with a lung function test, and sometimes a CT scan is used to confirm disease progression.

Intensifying Treatment

Vonk and her team, in collaboration with Erasmus MC and LUMC, investigated whether home measurements might be a viable alternative to hospital tests. In this study, 43 people with systemic sclerosis conducted weekly home measurements. Participants answered five questions about their symptoms in an app and used a device called a spirometer. This simple tool reliably measures lung function and sends data to the app, accessible to both the patient and the physician of the study.

The study shows that home monitoring is not only reliable for detecting lung function decline, but also detects it sooner than hospital testing. Vonk: ‘This is a very positive result, because if we detect deterioration of pulmonary fibrosis earlier, we can start or intensify treatment sooner. This can include immunosuppressing drugs or medications that combat fibrosis.’

Accessible

This treatment aims to stabilize the disease, but it can also lead to improvements over time. ‘Stabilization, in particular, gives the body time to adapt’, Vonk explains. ‘If certain areas of the lungs function better than others, the body gradually directs more blood flow to these healthier parts of the lungs, which can alleviate symptoms.’

Participants in the study generally had a very positive experience and participated consistently. They appreciated being closely monitored. Due to these encouraging results, the researchers are eager to start a follow-up study. In this next phase, they will explore whether it’s feasible in the long term to replace hospital-based lung function tests and questionnaires entirely with accessible home monitoring.

About the publication

This study was published in The Lancet Rheumatology: Detection of decline in pulmonary function in patients with systemic sclerosis-associated interstitial lung disease using home monitoring in the Netherlands (DecreaSSc): a prospective, observational study. Arthiha Velauthapillai, Catharina C Moor, Jeska K de Vries-Bouwstra, Marlies S Wijsenbeek-Lourens, Cornelia H M van den Ende, Madelon C Vonk. DOI: 10.1016/S2665-9913(24)00236-4.

A study on patient experiences was published in Rheumatology Advances in Practice: Experiences of systemic sclerosis patients with home monitoring of their pulmonary function: a qualitative study. Arthiha Velauthapillai, Gwyn M M Schepers, Madelon C Vonk, Cornelia H M van den Ende. DOI: 10.1093/rap/rkae036.

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