Assessment of diaphragmatic function by ultrasonography in patients with systemic sclerosis and its relation to clinical parameters: A case-control study


Wiener Klinische Wochenschrift, vol.135, no.19-20, pp.528-537, 2023 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 135 Issue: 19-20
  • Publication Date: 2023
  • Doi Number: 10.1007/s00508-023-02163-x
  • Journal Name: Wiener Klinische Wochenschrift
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, CAB Abstracts, EMBASE, MEDLINE, MLA - Modern Language Association Database, Veterinary Science Database
  • Page Numbers: pp.528-537
  • Keywords: Diaphragm, Maximum respiratory pressures, Pulmonary function test, Systemic sclerosis, Thickening fraction
  • Dokuz Eylül University Affiliated: Yes


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.