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Elhai M, Sritharan N, Boubaya M, Balbir-Gurman A, Siegert E, Hachulla E, de Vries-Bouwstra J, Riemekasten G, Distler JHW, Rosato E, Del Galdo F, Mendoza FA, Furst DE, de la Puente C, Hoffmann-Vold AM, Gabrielli A, Distler O, Bloch-Queyrat C, Allanore Y. Stratification in systemic sclerosis according to autoantibody status versus skin involvement: a study of the prospective EUSTAR cohort. Lancet Rheumatol 2022; 4:e785-e794. [PMID: 38265945 DOI: 10.1016/s2665-9913(22)00217-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The current subclassification of systemic sclerosis into cutaneous subtypes does not fully capture the heterogeneity of the disease. We aimed to compare the performances of stratification into LeRoy's cutaneous subtypes versus stratification by autoantibody status in systemic sclerosis. METHODS For this cohort study, we assessed people with systemic sclerosis in the multicentre international European Scleroderma Trials and Research (EUSTAR) database. Individuals positive for systemic-sclerosis autoantibodies of two specificities were excluded, and remaining individuals were classified by cutaneous subtype, according to their systemic sclerosis-specific autoantibodies, or both. We assessed the performance of each model to predict overall survival, progression-free survival, disease progression, and different organ involvement. The three models were compared by use of the area under the curve (AUC) of the receiver operating characteristic and the net reclassification improvement (NRI). Missing data were imputed. FINDINGS We assessed the database on July 26, 2019. Of 16 939 patients assessed for eligibility, 10 711 patients were included: 1647 (15·4%) of 10 709 were male, 9062 (84·6%) were female, mean age was 54·4 (SD 13·8) years, and mean disease duration was 7·9 (SD 8·2) years. Information regarding cutaneous subtype was available for 10 176 participants and antibody data were available for 9643 participants. In the prognostic analysis, there was no difference in AUC for overall survival (0·82, 95% CI 0·81-0·84 for cutaneous only vs 0·84, 0·82-0·85 for antibody only vs 0·84, 0·83-0·86 for combined) or for progression-free survival (0·70, 0·69-0·71 vs 0·71, 0·70-0·72 vs 0·71, 0·70-0·72). However, at 4 years the NRI showed substantial improvement for the antibody-only model compared with the cutaneous-only model in prediction of overall survival (0·57, 0·46-0·71 for antibody only vs 0·29, 0·19-0·39 for cutaneous only) and disease progression (0·36, 0·29-0·46 vs 0·21, 0·14-0·28). The antibody-only model did better than the cutaneous-only model in predicting renal crisis (AUC 0·72, 0·70-0·74 for antibody only vs 0·66, 0·64-0·69 for cutaneous only) and lung fibrosis leading to restrictive lung function (AUC 0·76, 0·75-0·77 vs 0·71, 0·70-0·72). The combined model improved the prediction of digital ulcers and elevated systolic pulmonary artery pressure, but did poorly for cardiac involvement. INTERPRETATION The autoantibody-only model outperforms cutaneous-only subsetting for risk stratifying people with systemic sclerosis in the EUSTAR cohort. Physicians should be aware of these findings at the time of decision making for patient management. FUNDING World Scleroderma Foundation.
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Affiliation(s)
- Muriel Elhai
- INSERM U1016, Cochin Hospital, AP-HP, University of Paris, Paris, France; Department of Rheumatology, University Hospital Zürich, Zürich, Switzerland
| | - Nanthara Sritharan
- Department of Clinical Research, Paris Seine Saint Denis Hospital, AP-HP, Bobigny, France
| | - Marouane Boubaya
- Department of Clinical Research, Paris Seine Saint Denis Hospital, AP-HP, Bobigny, France
| | - Alexandra Balbir-Gurman
- B Shine Rheumatology Institute, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Elise Siegert
- Department of Rheumatology, Charité University Hospital, Berlin, Germany
| | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Rare Systemic Auto-immune Diseases North and North-West of France, Inserm, CHU Lille, U1286 - INFINITE, University of Lille, Lille, France
| | | | | | - Jörg H W Distler
- Department of Rheumatology and Hiller Research Unit, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Del Galdo
- Scleroderma Programme, Institute of Molecular Medicine, Division of Musculoskeletal Diseases, University of Leeds, Leeds, UK
| | - Fabian A Mendoza
- Thomas Jefferson Scleroderma Center Division of Rheumatology and Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel E Furst
- Arthritis Association of Southern California, Los Angeles, CA, USA
| | | | | | - Armando Gabrielli
- Università Politecnica delle Marche, Ancona, Italy; Azienda Ospedali Riuniti, Ancona, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zürich, Zürich, Switzerland
| | - Coralie Bloch-Queyrat
- Department of Clinical Research, Paris Seine Saint Denis Hospital, AP-HP, Bobigny, France
| | - Yannick Allanore
- INSERM U1016, Cochin Hospital, AP-HP, University of Paris, Paris, France.
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Abstract
PURPOSE OF REVIEW The majority of patients with systemic sclerosis (SSc) will experience involvement of their gastrointestinal over the course of their disease. Despite the high prevalence of gastrointestinal involvement in SSc, the strategies pertaining to the assessment and treatment for this clinical dimension of SSc have historically been limited. However, the present review highlights recent research contributions that enhance our understanding of SSc-GI patient subsets and provides updates on pathogenic mechanisms of disease, assessment and symptom-directed management. RECENT FINDINGS In the past few years, several studies have identified risk factors for more severe gastrointestinal disease in SSc and have provided insight to optimize diagnosis and management of SSc-GI symptoms. This article also provides a review of currently available investigations and therapies for individual SSc-GI disease manifestations and reflects on actively evolving areas of research, including our understanding the role of the gut microbiome in SSc. SUMMARY Here, we provide important updates pertaining to the risk stratification, assessment, diagnosis and management of SSc patients with gastrointestinal symptoms. These findings provide opportunities to enhance patient care and highlight exciting opportunities for future research.
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Affiliation(s)
- Elizabeth R. Volkmann
- Division of Rheumatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Zsuzsanna McMahan
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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53
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Gigante A, Leodori G, Pellicano C, Villa A, Rosato E. Assessment of kidney involvement in systemic sclerosis: From scleroderma renal crisis to subclinical renal vasculopathy. Am J Med Sci 2022; 364:529-537. [PMID: 35537505 DOI: 10.1016/j.amjms.2022.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 10/17/2021] [Accepted: 02/16/2022] [Indexed: 01/25/2023]
Abstract
The spectrum of kidney involvement in systemic sclerosis (SSc) includes scleroderma renal crisis, widely recognized as the most severe renal-vascular complication, but also several forms of chronic renal vasculopathy and reduced renal function are complications of scleroderma. Scleroderma renal crisis, myeloperoxidase-antineutrophil cytoplasmic antibody associated glomerulonephritis, penicillamine-associated renal disease, abnormal urinalysis, alteration of vascular endothelial markers, scleroderma associated-vasculopathy with abnormal renal resistance indices and cardiorenal syndromes type 5 were also reported in SSc patients. A frequent form of renal involvement in SSc patients is a subclinical renal vasculopathy, characterized by vascular damage and normal renal function. Indeed, asymptomatic renal changes, expressed by increase of intrarenal stiffness, are often non-progressive in SSc patients but can lead to a reduction in renal functional reserve. The purpose of this review is to provide an assessment of kidney involvement in SSc, from SRC to subclinical renal vasculopathy.
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Affiliation(s)
- Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giorgia Leodori
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Chiara Pellicano
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Annalisa Villa
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
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54
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Jerjen R, Nikpour M, Krieg T, Denton CP, Saracino AM. Systemic sclerosis in adults. Part I: Clinical features and pathogenesis. J Am Acad Dermatol 2022; 87:937-954. [PMID: 35131402 DOI: 10.1016/j.jaad.2021.10.065] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/06/2021] [Accepted: 10/21/2021] [Indexed: 11/27/2022]
Abstract
Systemic sclerosis (SSc), also referred to as systemic scleroderma or scleroderma, is a rare, complex immune-mediated connective tissue disease characterized by progressive skin fibrosis and other clinically heterogenous features. The etiopathogenesis of SSc involves vasculopathy and immune system dysregulation occurring on a permissive genetic and epigenetic background, ultimately leading to fibrosis. Recent developments in our understanding of disease-specific autoantibodies and bioinformatic analyses has led to a reconsideration of the purely clinical classification of diffuse and limited cutaneous SSc subgroups. Autoantibody profiles are predictive of skin and internal organ involvement and disease course. Early diagnosis of SSc, with commencement of disease-modifying treatment, has the potential to improve patient outcomes. In SSc, many of the clinical manifestations that present early signs of disease progression and activity are cutaneous, meaning dermatologists can and should play a key role in the diagnosis and management of this significant condition. The first article in this continuing medical education series discusses the epidemiology, clinical characteristics, and pathogenesis of SSc in adults, with an emphasis on skin manifestations, the important role of dermatologists in recognizing these, and their correlation with systemic features and disease course.
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Affiliation(s)
- Rebekka Jerjen
- Department of Dermatology, The Alfred Hospital, Melbourne, Australia
| | - Mandana Nikpour
- Department of Rheumatology, St Vincent's Hospital, Melbourne, Australia; Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Thomas Krieg
- Department Dermatology and Translational Matrix Biology, CMMC and CECAD, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Christopher P Denton
- Division of Medicine, Centre for Rheumatology and Connective Tissues Diseases, University College London, London, United Kingdom; Department of Rheumatology, Royal Free NHS Foundation Trust, London, United Kingdom
| | - Amanda M Saracino
- Department of Dermatology, The Alfred Hospital, Melbourne, Australia; Department of Medicine, Monash University, Melbourne, Australia.
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Cantanhede IG, Liu H, Liu H, Balbuena Rodriguez V, Shiwen X, Ong VH, Denton CP, Ponticos M, Xiong G, Lima-Filho JL, Abraham D, Abu-Hanna J, Taanman JW. Exploring metabolism in scleroderma reveals opportunities for pharmacological intervention for therapy in fibrosis. Front Immunol 2022; 13:1004949. [PMID: 36304460 PMCID: PMC9592691 DOI: 10.3389/fimmu.2022.1004949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/26/2022] [Indexed: 12/04/2022] Open
Abstract
Background Recent evidence has indicated that alterations in energy metabolism play a critical role in the pathogenesis of fibrotic diseases. Studies have suggested that ‘metabolic reprogramming’ involving the glycolysis and oxidative phosphorylation (OXPHOS) in cells lead to an enhanced generation of energy and biosynthesis. The aim of this study was to assess the molecular basis of changes in fibrotic metabolism in systemic sclerosis (Scleroderma; SSc) and highlight the most appropriate targets for anti-fibrotic therapies. Materials and methods Dermal fibroblasts were isolated from five SSc patients and five healthy donors. Cells were cultured in medium with/without TGF-β1 and with/without ALK5, pan-PIM or ATM kinase inhibitors. Extracellular flux analyses were performed to evaluate glycolytic and mitochondrial respiratory function. The mitochondrial network in TMRM-stained cells was visualized by confocal laser-scanning microscopy, followed by semi-automatic analysis on the ImageJ platform. Protein expression of ECM and fibroblast components, glycolytic enzymes, subunits of the five OXPHOS complexes, and dynamin-related GTPases and receptors involved in mitochondrial fission/fusion were assessed by western blotting. Results Enhanced mitochondrial respiration coupled to ATP production was observed in SSc fibroblasts at the expense of spare respiratory capacity. Although no difference was found in glycolysis when comparing SSc with healthy control fibroblasts, levels of phophofructokinase-1 isoform PFKM were significantly lower in SSc fibroblasts (P<0.05). Our results suggest that the number of respirasomes is decreased in the SSc mitochondria; however, the organelles formed a hyperfused network, which is thought to increase mitochondrial ATP production through complementation. The increased mitochondrial fusion correlated with a change in expression levels of regulators of mitochondrial morphology, including decreased levels of DRP1, increased levels of MIEF2 and changes in OPA1 isoform ratios. TGF-β1 treatment strongly stimulated glycolysis and mitochondrial respiration and induced the expression of fibrotic markers. The pan-PIM kinase inhibitor had no effect, whereas both ALK5 and ATM kinase inhibition abrogated TGF-β1-mediated fibroblast activation, and upregulation of glycolysis and respiration. Conclusions Our data provide evidence for a novel mechanism(s) by which SSc fibroblasts exhibit altered metabolic programs and highlight changes in respiration and dysregulated mitochondrial morphology and function, which can be selectively targeted by small molecule kinase inhibitors.
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Affiliation(s)
- Isabella Gomes Cantanhede
- Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London, London, United Kingdom
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, Brazil
| | - Huan Liu
- Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London, London, United Kingdom
- Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Huan Liu
- Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London, London, United Kingdom
| | - Vestaen Balbuena Rodriguez
- Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London, London, United Kingdom
| | - Xu Shiwen
- Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London, London, United Kingdom
| | - Voo H. Ong
- Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London, London, United Kingdom
| | - Christopher P. Denton
- Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London, London, United Kingdom
| | - Markella Ponticos
- Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London, London, United Kingdom
| | - Guo Xiong
- Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - José Luiz Lima-Filho
- Laboratory of Immunopathology Keizo Asami, Federal University of Pernambuco, Recife, Brazil
| | - David Abraham
- Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London, London, United Kingdom
- *Correspondence: David Abraham, ; Jan-Willem Taanman,
| | - Jeries Abu-Hanna
- Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London, London, United Kingdom
| | - Jan-Willem Taanman
- Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, University College London, London, United Kingdom
- *Correspondence: David Abraham, ; Jan-Willem Taanman,
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56
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Liem SIE, Boonstra M, le Cessie S, Riccardi A, Airo P, Distler O, Matucci-Cerinic M, Caimmi C, Siegert E, Allanore Y, Huizinga TWJ, Toes REM, Scherer HU, de Vries-Bouwstra JK. Sex-specific risk of anti-topoisomerase antibodies on mortality and disease severity in systemic sclerosis: 10-year analysis of the Leiden CCISS and EUSTAR cohorts. Lancet Rheumatol 2022; 4:e699-e709. [PMID: 38265968 DOI: 10.1016/s2665-9913(22)00224-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 01/26/2024]
Abstract
BACKGROUND We aimed to evaluate sex-specific risk of anti-topoisomerase I antibodies (ATA) on mortality, diffuse cutaneous systemic sclerosis, interstitial lung disease, and pulmonary hypertension in two cohorts of people with systemic sclerosis. METHODS This study was a 10-year analysis of the prospective Leiden Combined Care in Systemic Sclerosis (CCISS) cohort in the Netherlands and the international European Scleroderma Trials and Research (EUSTAR) cohort. We included participants with systemic sclerosis according to the 2013 American College of Rheumatology-European League Against Rheumatism (ACR-EULAR) classification criteria; available autoantibody status; available skin subtyping; at least one available radiographic assessment of interstitial lung disease; and with a known date of disease onset. People with systemic sclerosis were categorised in six risk groups by sex and autoantibody status (anti-centromere antibody [ACA]-positive female, ACA-positive male, ACA and ATA-negative female, ACA and ATA-negative male, ATA-positive female, and ATA-positive male). We constructed Kaplan-Meier curves and Cox proportional hazard models, accounting for left-truncated survival to prevent bias because the date of disease onset (first non-Raynaud's symptom) preceded the date of cohort entry for all patients. The primary outcome was all-cause mortality and the secondary outcomes were diffuse cutaneous systemic sclerosis, interstitial lung disease, and pulmonary hypertension. FINDINGS 445 (63%) of 708 participants between April 1, 2009, and Jan 1, 2022, in CCISS (101 [23%] male and 344 [77%] female) and 4263 (50%) of 8590 between June 1, 2004, and March 28, 2018, in EUSTAR (783 [18%] male and 3480 [82%] female) were eligible for this study. In both cohorts, ATA expression occurred significantly more often in males than in females (39 [39%] of 101 males vs 67 [19%] of 344 females in CCISS; p<0·0001 and 381 [49%] of 783 males vs 1323 [38%] of 3480 females in EUSTAR; p<0·0001). According to estimated survival rates, 30% of ATA-positive males versus 12% of ATA-positive females died in the CCISS cohort and 33% versus 15% died in the EUSTAR cohort within 10 years. After adjustment for age, race, and autoantibody status, male sex remained the most important risk factor for all-cause mortality (HR 2·9 [95% CI 1·5-5·5] in CCISS, p=0·0018; and HR 2·6 [2·0-3·4] in EUSTAR, p<0·0001). INTERPRETATION We show that the association between male sex and increased mortality in systemic sclerosis cannot be explained by higher ATA prevalence. However, additional research on the effect of sex-specific characteristics on people with systemic sclerosis is required. FUNDING None.
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Affiliation(s)
- Sophie I E Liem
- Department of Rheumatology, University Medical Center, Leiden, Netherlands.
| | - Maaike Boonstra
- Department of Rheumatology, University Medical Center, Leiden, Netherlands
| | - Saskia le Cessie
- Department of Clinical Epidemiology, University Medical Center, Leiden, Netherlands; Department of Biomedical Data Sciences, University Medical Center, Leiden, Netherlands
| | - Antonella Riccardi
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Paolo Airo
- Division of Rheumatology and Clinical Immunology, Civil Hospital Brescia, Brescia, Italy
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Elise Siegert
- Department of Rheumatology, Berlin Institute of Health, Berlin, Germany
| | | | - Tom W J Huizinga
- Department of Rheumatology, University Medical Center, Leiden, Netherlands
| | - René E M Toes
- Department of Rheumatology, University Medical Center, Leiden, Netherlands
| | - Hans U Scherer
- Department of Rheumatology, University Medical Center, Leiden, Netherlands
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Lam BH, Assassi S, Charles J, Taherian R, Lyons MA, Jandali B, Mayes MD, Skaug B. False positive anti-Topoisomerase I (Scl-70) antibody results in clinical practice: A case series from a scleroderma referral center. Semin Arthritis Rheum 2022; 56:152052. [PMID: 35753143 PMCID: PMC10061056 DOI: 10.1016/j.semarthrit.2022.152052] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/31/2022] [Accepted: 06/14/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine if some patients who tested positive for anti-Scl-70 antibody in clinical practice, but did not have classifiable systemic sclerosis, were negative for anti-Scl-70 antibody by the more specific immunodiffusion method of testing. METHODS Patients evaluated by a rheumatologist at a Scleroderma referral center who had tested positive for anti-Scl-70 antibody prior to referral, but did not have classifiable SSc based on clinical criteria, were invited to undergo testing for anti-Scl-70 antibody by immunodiffusion. Patient demographics and clinical features were recorded at the time of their evaluation, and diagnostic testing results were reviewed using the medical records. RESULTS 52 patients were enrolled over an 8-year period, with 48 (92.3%) testing negative and 4 (7.7%) testing positive for anti-Scl-70 antibody by immunodiffusion. Of the 48 patients who tested negative, 18 (37.5%) tested negative for ANA by indirect immunofluorescence, 33 (68.8%) did not have Raynaud's phenomenon, and 43 (89.6%) had ≤1 clinical criteria items based on the 2013 ACR/EULAR SSc classification criteria. Nevertheless, 21 (43.8%) patients who were negative for anti-Scl-70 antibody by immunodiffusion had undergone a chest CT and 14 (29.2%) had undergone an echocardiogram. A total of 23 patients had at least one follow up clinic visit. 3 out of 4 patients who were positive for anti-Scl-70 antibody by immunodiffusion, but none of the 19 patients who tested negative by immunodiffusion, developed sufficient criteria during follow up to be classified as SSc. CONCLUSION Assays for anti-Scl-70 antibody in commercial laboratories that are commonly utilized in clinical practice can produce false positive results. These results can lead to angst for patients, as well as unnecessary referrals and diagnostic evaluations.
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Affiliation(s)
- Brian H Lam
- Division of Rheumatology, University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin St., MSB 5.266, Houston, TX 77030, United States
| | - Shervin Assassi
- Division of Rheumatology, University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin St., MSB 5.266, Houston, TX 77030, United States
| | - Julio Charles
- Division of Rheumatology, University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin St., MSB 5.266, Houston, TX 77030, United States
| | - Rana Taherian
- Division of Rheumatology, University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin St., MSB 5.266, Houston, TX 77030, United States
| | - Marka A Lyons
- Division of Rheumatology, University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin St., MSB 5.266, Houston, TX 77030, United States
| | - Bochra Jandali
- Division of Rheumatology, University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin St., MSB 5.266, Houston, TX 77030, United States
| | - Maureen D Mayes
- Division of Rheumatology, University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin St., MSB 5.266, Houston, TX 77030, United States
| | - Brian Skaug
- Division of Rheumatology, University of Texas Health Science Center at Houston, McGovern Medical School, 6431 Fannin St., MSB 5.266, Houston, TX 77030, United States.
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Jazia RB, Ayachi J, Ghzel R, Kacem A, Limem IB, Faidi A, Braiek DB, Chatbouri F, Maatallah A. Atypical emphysema formation in a never-smoker with scleroderma-related interstitial pneumonia: a case report. Pan Afr Med J 2022; 42:295. [PMID: 36415340 PMCID: PMC9643793 DOI: 10.11604/pamj.2022.42.295.29442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 03/18/2022] [Indexed: 06/16/2023] Open
Abstract
Scleroderma is an autoimmune connective tissue disorder which is characterized by fibrosis of visceral organs, blood vessels and skin. The most common manifestations of lung disease in systemic sclerosis are interstitial lung disease and pulmonary hypertension and, together, are the leading cause of mortality in systemic sclerosis. Recently, we notice a new pattern called Combined-pulmonary emphysema and lung fibrosis. Most patients with this entity are male smokers or ex-smokers. This entity is characterized by the coexistence of both centro-lobular and para-septal emphysema in the upper lobes and interstitial lung disease in the lower lobes. Here, we present a case of a nonsmoker adult woman with systemic sclerosis, in which High Resolution Computed Tomography of lung showed combined fibrosis and emphysema with atypical radiological presentation and unusual distribution. This case outlines the importance of recognizing the presence of combined fibrosis and emphysema in patient with systemic sclerosis even without smoking history.
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Affiliation(s)
- Rahma Ben Jazia
- Pulmonology Department, Ibn El Jazzar University Hospital, Kairouan, Tunisia
| | - Jihene Ayachi
- Medical Intensive Care Unit, Ibn El Jazzar University Hospital, Kairouan, Tunisia
| | - Raja Ghzel
- Emergency Department, Ibn El Jazzar University Hospital, Kairouan, Tunisia
| | - Ameni Kacem
- Pulmonology Department, Ibn El Jazzar University Hospital, Kairouan, Tunisia
| | - Iteb Ben Limem
- Pulmonology Department, Ibn El Jazzar University Hospital, Kairouan, Tunisia
| | - Amira Faidi
- Pulmonology Department, Ibn El Jazzar University Hospital, Kairouan, Tunisia
| | - Dhouha Ben Braiek
- Medical Intensive Care Unit, Ibn El Jazzar University Hospital, Kairouan, Tunisia
| | - Farouk Chatbouri
- Emergency Department, Ibn El Jazzar University Hospital, Kairouan, Tunisia
| | - Anis Maatallah
- Pulmonology Department, Ibn El Jazzar University Hospital, Kairouan, Tunisia
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Azoulay LD, Mathian A, Hekimian G, Schmidt M, Luyt CE, Amoura Z, Combes A, Pineton de Chambrun M. Scleroderma cardiac crisis and scleroderma renal crisis: Two sides of the same coin? Clin Exp Rheumatol 2022; 21:103179. [PMID: 35977660 DOI: 10.1016/j.autrev.2022.103179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Levi-Dan Azoulay
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares, Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Alexis Mathian
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares, Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Guillaume Hekimian
- Sorbonne Université, APHP, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, 75013 Paris, France; Sorbonne Université, INSERM, UMRS_1166-ICAN, ICAN, Paris, France
| | - Matthieu Schmidt
- Sorbonne Université, APHP, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, 75013 Paris, France; Sorbonne Université, INSERM, UMRS_1166-ICAN, ICAN, Paris, France
| | - Charles-Edouard Luyt
- Sorbonne Université, APHP, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, 75013 Paris, France; Sorbonne Université, INSERM, UMRS_1166-ICAN, ICAN, Paris, France
| | - Zahir Amoura
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares, Hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - Alain Combes
- Sorbonne Université, APHP, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, 75013 Paris, France; Sorbonne Université, INSERM, UMRS_1166-ICAN, ICAN, Paris, France
| | - Marc Pineton de Chambrun
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares, Hôpital Pitié-Salpêtrière, 75013 Paris, France; Sorbonne Université, APHP, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, 75013 Paris, France; Sorbonne Université, INSERM, UMRS_1166-ICAN, ICAN, Paris, France..
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Maritati F, Provenzano M, Lerario S, Corradetti V, Bini C, Busutti M, Grandinetti V, Cuna V, La Manna G, Comai G. Kidney transplantation in systemic sclerosis: Advances in graft, disease, and patient outcome. Front Immunol 2022; 13:878736. [PMID: 35958558 PMCID: PMC9360313 DOI: 10.3389/fimmu.2022.878736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
Systemic sclerosis (SSc) is an immune-mediated rheumatic disease characterized by vascular abnormalities, tissue fibrosis, and inflammation. Renal disease occurring in patients with SSc may have a variable clinicopathological picture. However, the most specific renal condition associated with this disease is the scleroderma renal crisis (SRC), characterized by acute onset of renal failure and severe hypertension. SRC develops in about 20% of cases of SSc, especially in those patients with diffuse cutaneous disease. The prognosis of this condition is often negative, with a rapid progression to end-stage renal disease (ESRD). The advent of the antihypertensive angiotensin-converting enzyme inhibitors in 1980 was associated with a significant improvement in patients’ survival and recovery of renal function. However, the prognosis of these patients can still be improved. The dialytic condition is associated with early death, and mortality is significantly higher than among patients undergoing renal replacement therapy (RRT) due to other conditions. Patients with SRC who show no signs of renal functional recovery despite timely blood pressure control are candidates for kidney transplantation (KT). In this review, we reported the most recent advances in KT in patients with ESRD due to SSc, with a particular overview of the risk of disease recurrence after transplantation and the evolution of other disease manifestations.
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Clark KEN, Campochiaro C, Host LV, Sari A, Harvey J, Denton CP, Ong VH. Combinations of scleroderma hallmark autoantibodies associate with distinct clinical phenotypes. Sci Rep 2022; 12:11212. [PMID: 35780179 PMCID: PMC9250530 DOI: 10.1038/s41598-022-15062-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/17/2022] [Indexed: 11/09/2022] Open
Abstract
Systemic sclerosis (SSc) is characterized by the presence of SSc-specific or SSc-associated antibodies (SSc-Abs): anti-topoisomerase I (ATA), anti-centromere (ACA), anti-RNA polymerase III (ARA), anti-U3RNP (U3RNP), anti-U1RNP (U1RNP), anti-PmScl (PmScl), anti-Ku (Ku) and anti-Th/To (Th/To), each being associated with specific clinical features and prognosis. The detection of more than one SSc-Abs in SSc patients is rare and only few data about these patients' clinical phenotype is available. The aim of our study was to evaluate the frequency and the disease's features associated with the presence of > 1 SSc-Abs positivity in a large cohort of SSc patients. The autoantibody profiles of 2799 SSc patients from February 2001 to June 2017 were retrospectively reviewed. Patients with > 1 SSc-Abs were identified. Clinical features were collected and compared to a large historical cohort of SSc patients with single SSc-Ab positivity. SSc patients were excluded if previously treated with rituximab, intravenous immunoglobulins or stem cell transplantation. Non-parametric tests were used for statistical analysis. Nearly 5% of SSc patients from our cohort had ≥ 2 autoantibody positivity, and 2.3% (n = 72) had ≥ 2 SSc-Abs positivity. Th e most common combination was U1RNP and ATA (35%). These patients were younger than patients with single autoantibody positivity and showed more commonly a diffuse cutaneous SSc form. They also had higher rates of overlap features compared to ATA patients. Other combinations included U1RNP and ACA (13%), ATA and ACA (7%) and U1RNP and PmScl (5%). In our study we observed that, while infrequently, SSc patients can present with a combination of two SSc-Abs and that the double positivity can influence their clinical phenotype compared to patients with single SSc-Ab positivity. The importance of re-testing SSc-Abs in patients with changing clinical phenotypes was also highlighted, as this may confer a differing risk stratification.
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Affiliation(s)
- Kristina E N Clark
- Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London, London, UK
| | - Corrado Campochiaro
- Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London, London, UK
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Lauren V Host
- Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London, London, UK
| | - Alper Sari
- Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London, London, UK
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Jennifer Harvey
- Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London, London, UK
| | - Christopher P Denton
- Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London, London, UK
| | - Voon H Ong
- Centre for Rheumatology and Connective Tissue Diseases, Division of Medicine, University College London, London, UK.
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Abstract
BACKGROUND Raynaud phenomenon, with and without scleroderma, is a common vasospastic condition that manifests with extremity pain and skin discoloration. When conservative management fails, complications such as ischemia, ulceration, and gangrene may warrant surgical intervention. The purpose of this study was to determine the risk factors and use of surgical intervention in this population. METHODS A national insurance claims-based database with patient records from the Centers for Medicare and Medicaid Services was used for data collection. Patients with first diagnoses of Raynaud phenomenon, scleroderma, or both between 2005 and 2014 were identified. Primary outcomes included the presence of upper extremity amputation or vascular procedure, and history of amputation within 5 years of a vascular procedure. Secondary outcomes included hospital admissions, upper extremity wounds, and amputation within 1 year of diagnosis. RESULTS The Raynaud phenomenon, scleroderma, and Raynaud phenomenon with scleroderma cohorts consisted of 161,300, 117,564, and 25,096 patients, respectively. A diagnosis of both Raynaud phenomenon and scleroderma increased the odds of upper extremity amputation by 5.4-fold, vascular procedure by 4.8-fold, and amputation within 5 years of a vascular procedure by 1.5-fold. Patients with Raynaud phenomenon or scleroderma alone were 3.1 and 5.6 times less likely to undergo amputation within 5 years of a vascular procedure, respectively. CONCLUSIONS Patients with both Raynaud phenomenon and scleroderma have higher likelihoods of having upper extremity amputations, vascular procedures, and amputations following vascular procedures compared to each diagnosis alone. Vascular procedures are rarely being performed. Further research is necessary to establish a standard of care and determine whether early and more frequent intervention with vascular procedures can decrease amputation rates in this patient population. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Affiliation(s)
- Lee M Hakami
- From the Department of Plastic Surgery, the School of Medicine, and the Claude Moore Health Sciences Library, University of Virginia
| | - Grace L Forster
- From the Department of Plastic Surgery, the School of Medicine, and the Claude Moore Health Sciences Library, University of Virginia
| | - Marieke K Jones
- From the Department of Plastic Surgery, the School of Medicine, and the Claude Moore Health Sciences Library, University of Virginia
| | - Brent R DeGeorge
- From the Department of Plastic Surgery, the School of Medicine, and the Claude Moore Health Sciences Library, University of Virginia
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63
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Sookaromdee P, Wiwanitkit V. Morphea and COVID-19 mRNA vaccine. Int J Dermatol 2022; 61:e162. [PMID: 35230704 PMCID: PMC9111283 DOI: 10.1111/ijd.16156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/07/2022] [Indexed: 11/27/2022]
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64
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Ma J, Li W, Cao R, Gao D, Zhang Q, Li X, Li B, Lv L, Li M, Jiang J, Wang Y, Li J, Wu Z, Zhu Y, Zhong W, Zhang S, Leng L. Application of an iPSC-Derived Organoid Model for Localized Scleroderma Therapy. Adv Sci (Weinh) 2022; 9:e2106075. [PMID: 35315234 PMCID: PMC9165518 DOI: 10.1002/advs.202106075] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/24/2022] [Indexed: 06/14/2023]
Abstract
Localized scleroderma (LoS) is a rare chronic disease with extensive tissue fibrosis, inflammatory infiltration, microvascular alterations, and epidermal appendage lesions. However, a deeper understanding of the pathogenesis and treatment strategies of LoS is currently limited. In the present work, a proteome map of LoS skin is established, and the pathological features of LoS skin are characterized. Most importantly, a human-induced pluripotent stem cell-derived epithelial and mesenchymal (EM) organoids model in a 3D culture system for LoS therapy is established. According to the findings, the application of EM organoids on scleroderma skin can significantly reduce the degree of skin fibrosis. In particular, EM organoids enhance the activity of epidermal stem cells in the LoS skin and promotes the regeneration of sweat glands and blood vessels. These results highlight the potential application of organoids for promoting the recovery of scleroderma associated phenotypes and skin-associated functions. Furthermore, it can provide a new therapeutic alternative for patients suffering from disfigurement and skin function defects caused by LoS.
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Affiliation(s)
- Jie Ma
- State Key Laboratory of ProteomicsBeijing Proteome Research CenterNational Center for Protein Sciences (Beijing)Beijing Institute of LifeomicsBeijing102206China
| | - Wei Li
- National Engineering Research Center for the Emergency DrugBeijing Institute of Pharmacology and ToxicologyBeijing100850China
| | - Ruiyuan Cao
- National Engineering Research Center for the Emergency DrugBeijing Institute of Pharmacology and ToxicologyBeijing100850China
| | - Dunqin Gao
- Stem Cell and Regenerative Medicine LabDepartment of Medical Science Research CenterState Key Laboratory of Complex Severe and Rare DiseasesTranslational Medicine CenterPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730China
| | - Qiyu Zhang
- Department of Dermatology and VenereologyPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730China
| | - Xiao Li
- State Key Laboratory of ProteomicsBeijing Proteome Research CenterNational Center for Protein Sciences (Beijing)Beijing Institute of LifeomicsBeijing102206China
| | - Biyou Li
- State Key Laboratory of ProteomicsBeijing Proteome Research CenterNational Center for Protein Sciences (Beijing)Beijing Institute of LifeomicsBeijing102206China
- Basic Medical SchoolAnhui Medical UniversityAnhui230032China
| | - Luye Lv
- Institute of NBC DefenseBeijing102205China
| | - Mansheng Li
- State Key Laboratory of ProteomicsBeijing Proteome Research CenterNational Center for Protein Sciences (Beijing)Beijing Institute of LifeomicsBeijing102206China
| | - Junyi Jiang
- State Key Laboratory of ProteomicsBeijing Proteome Research CenterNational Center for Protein Sciences (Beijing)Beijing Institute of LifeomicsBeijing102206China
| | - Yujie Wang
- Stem Cell and Regenerative Medicine LabDepartment of Medical Science Research CenterState Key Laboratory of Complex Severe and Rare DiseasesTranslational Medicine CenterPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730China
| | - Jun Li
- Department of Dermatology and VenereologyPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730China
| | - Zhihong Wu
- Stem Cell and Regenerative Medicine LabDepartment of Medical Science Research CenterState Key Laboratory of Complex Severe and Rare DiseasesTranslational Medicine CenterPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730China
| | - Yunping Zhu
- State Key Laboratory of ProteomicsBeijing Proteome Research CenterNational Center for Protein Sciences (Beijing)Beijing Institute of LifeomicsBeijing102206China
- Basic Medical SchoolAnhui Medical UniversityAnhui230032China
| | - Wu Zhong
- National Engineering Research Center for the Emergency DrugBeijing Institute of Pharmacology and ToxicologyBeijing100850China
| | - Shuyang Zhang
- Department of CardiologyPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730China
| | - Ling Leng
- Stem Cell and Regenerative Medicine LabDepartment of Medical Science Research CenterState Key Laboratory of Complex Severe and Rare DiseasesTranslational Medicine CenterPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730China
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Aliyeva A, Adrovic A, Ocak S, Batur Ş, Yıldız M, Haşlak F, Köker O, Şahin S, Barut K, Kasapçopur Ö. A case of juvenile systemic sclerosis and congenital pulmonary airway malformation related mucinous adenocarcinoma of the lung: paraneoplastic syndrome or just a coincidence? Turk J Pediatr 2022; 64:394-399. [PMID: 35611431 DOI: 10.24953/turkjped.2020.2997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ayten Aliyeva
- Departments of Pediatric Rheumatology, İstanbul Cerrahpaşa University Faculty of Medicine, İstanbul, Turkey
| | - Amra Adrovic
- Departments of Pediatric Rheumatology, İstanbul Cerrahpaşa University Faculty of Medicine, İstanbul, Turkey
| | - Süheyla Ocak
- Departments of Pediatric Hematology and Oncology, İstanbul Cerrahpaşa University Faculty of Medicine, İstanbul, Turkey
| | - Şebnem Batur
- Departments of Pathology, İstanbul Cerrahpaşa University Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Yıldız
- Departments of Pediatric Rheumatology, İstanbul Cerrahpaşa University Faculty of Medicine, İstanbul, Turkey
| | - Fatih Haşlak
- Departments of Pediatric Rheumatology, İstanbul Cerrahpaşa University Faculty of Medicine, İstanbul, Turkey
| | - Oya Köker
- Departments of Pediatric Rheumatology, İstanbul Cerrahpaşa University Faculty of Medicine, İstanbul, Turkey
| | - Sezgin Şahin
- Departments of Pediatric Rheumatology, İstanbul Cerrahpaşa University Faculty of Medicine, İstanbul, Turkey
| | - Kenan Barut
- Departments of Pediatric Rheumatology, İstanbul Cerrahpaşa University Faculty of Medicine, İstanbul, Turkey
| | - Özgür Kasapçopur
- Departments of Pediatric Rheumatology, İstanbul Cerrahpaşa University Faculty of Medicine, İstanbul, Turkey
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Fa'ak F, Al-Bahadili H, Shah N, Julka K. Posterior Reversible Encephalopathy Syndrome Induced by Scleroderma Renal Crisis in a Patient With Undiagnosed Scleroderma. J Clin Rheumatol 2021; 27:S825-S826. [PMID: 32511145 DOI: 10.1097/rhu.0000000000001435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Faisal Fa'ak
- From the Department of Internal Medicine, Piedmont Athens Regional Medical Center
| | - Huda Al-Bahadili
- From the Department of Internal Medicine, Piedmont Athens Regional Medical Center
| | - Nirvi Shah
- From the Department of Internal Medicine, Piedmont Athens Regional Medical Center
| | - Karan Julka
- Athens Pulmonary and Sleep Medicine, Athens, GA
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Ghosh S, Bajad S, Tanna D, Sharma L, Bajaj R, Gupta R. Not Only Skin Deep-A Rare Case of Porphyria Cutanea Tarda With Corneal Opacity Presenting Along With Scleroderma With Interstitial Lung Disease. J Clin Rheumatol 2021; 27:S804-S805. [PMID: 35073640 DOI: 10.1097/rhu.0000000000001457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Shounak Ghosh
- From the Department of Rheumatology & Clinical Immunology, Medanta-The Medicity, Gurgaon, Haryana, India
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Moradi S, Shokraee K, Sharifi A, Zojaji M, Masoumi M. Emergent Scleroderma in a Celiac Patient After 10 Years-A Coincidence? J Clin Rheumatol 2021; 27:S787. [PMID: 32826652 DOI: 10.1097/rhu.0000000000001469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Kamyar Shokraee
- Minimally Invasive Surgeries Research Centers, Iran University of Medical Sciences, Tehran
| | | | | | - Maryam Masoumi
- Clinical Research Development Center, Qom University of Medical Sciences and Health Services, Qom, Iran
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Abstract
Juvenile-onset systemic sclerosis (jSSc) is a complex multisystem inflammatory-driven disease of fibrosis, requiring multifaceted treatment including pharmacologic therapy, supportive care, and lifestyle modification. Most regimens are adapted from adult SSc treatment given the rarity of the disease. Landmark trials over the past decade in adult SSc have led to 2 Food and Drug Administration-approved therapies for SSc-associated interstitial lung disease, and several ongoing trials of other biological agents are underway. Resetting the immune system with autologous stem cell transplant to halt this disease earlier in its course, especially in pediatric onset where disease burden can accumulate, is on the horizon.
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Affiliation(s)
- Kathryn S Torok
- Division of Pediatric Rheumatology, UPMC & University of Pittsburgh Scleroderma Center; Pediatric Scleroderma Clinic, University of Pittsburgh |UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224, USA.
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Happle R, Haneke E. More about Zlotnikov, the Man Who Explained Blaschko's Lines to be a Mosaic. Acta Derm Venereol 2021; 101:adv00521. [PMID: 34263329 PMCID: PMC9413650 DOI: 10.2340/00015555-3880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Rudolf Happle
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, DE-79106 Freiburg, Germany. E-mail:
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71
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Heymann WR. Morphing concepts of morphea. J Am Acad Dermatol 2021; 85:36-37. [PMID: 33940100 DOI: 10.1016/j.jaad.2021.04.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 04/20/2021] [Accepted: 04/27/2021] [Indexed: 11/18/2022]
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Arif T, Fatima R, Sami M. Parry-Romberg syndrome: a mini review. Acta Dermatovenerol Alp Pannonica Adriat 2020; 29:193-199. [PMID: 33348939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Parry-Romberg syndrome (PRS) is a rare disorder of uncertain etiology that is characterized by progressive atrophy of the soft and hard tissues of face, typically occurring in the first 2 decades of life. It is more commonly seen in females. The disease progresses slowly with gradual atrophy, frequently associated with neurological, ophthalmological, and other system involvement, resulting in secondary complications. The severity of deformity varies depending on the age of onset of disease. Those in whom the disease starts at an earlier age will have more severe deformity. Due to the visible facial deformity, such patients usually suffer from social and psychological trauma. Management is mainly cosmetic, which is carried out after disease progression has stopped and stabilized. This brief review describes PRS in detail and compares it with linear morphea en coup de sabre (ECDS), its close differential, which is likely to be a milder variant sharing the same spectrum of disease.
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Affiliation(s)
- Tasleem Arif
- Ellahi Medicare Clinic, Srinagar, Kashmir, India
| | - Rafiya Fatima
- Department of Dermatology, Tadawi General Hospital, Dammaam, Saudi Arabia
| | - Marwa Sami
- Ellahi Medicare Clinic, Srinagar, Kashmir, India
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Hernández-Molina G, Ávila-Casado C, Hernández-Hernández C, Recillas-Gispert C, Sánchez-Guerrero J. Performance of the 2016 ACR/EULAR SS classification criteria in patients with secondary Sjögren's syndrome. Clin Exp Rheumatol 2020; 38 Suppl 126:130-133. [PMID: 31994479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/07/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate the performance of the 2016 ACR-EULAR classification Sjögren's syndrome (SS) criteria for classifying patients with secondary SS. METHODS We randomly selected 300 patients with systemic lupus erythematosus, rheumatoid arthritis and scleroderma, as well as 50 with primary SS. SS diagnosis was established by two independent rheumatologists and was based on the combination of symptoms, signs, diagnostic tests and medical chart review. We evaluated the fulfillment of the 2002 AECG, 2012 ACR and 2016 ACR/EULAR criteria, and their performance using as the gold standard the clinical diagnosis. RESULTS We identified 154 patients with a clinical (definitive/probable) SS diagnosis, 95 patients (61.7%) fulfilled the AECG, 96 patients (62.3%) the ACR and 90 (58.4%) the 2016 ACR/EULAR criteria. Among the subset with definitive SS clinical diagnosis (n=99), 83 patients (83.8%) fulfilled the AECG, 77 (77.7%) the ACR and 79 (79.7%) the 2016 ACR/EULAR criteria. The concordance rate between the clinical diagnosis (definitive/probable) and the AECG, ACR and 2016 ACR/ EULAR criteria was κ=0.58, κ=0.55 and κ=0.60, respectively. The 2016 ACR/EULAR criteria showed the best AUCs results (0.87 definitive/probable diagnosis, 0.90 definitive diagnosis), followed by the AECG (0.82 definitive/probable diagnosis, 0.85 definitive diagnosis) and ACR (0.80 definitive/probable diagnosis, 0.79 definitive diagnosis) criteria. As a sensitivity analysis, the results were similar when excluding patients with primary SS. CONCLUSIONS Our study provides further evidence that the 2016 ACR/EULAR criteria are applicable in the setting of secondary SS.
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Affiliation(s)
- Gabriela Hernández-Molina
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carmen Ávila-Casado
- Department of Pathology, University Health Network, Toronto General Hospital, Canada
| | - Carlos Hernández-Hernández
- Dental Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Claudia Recillas-Gispert
- Ophthalmology Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jorge Sánchez-Guerrero
- Division of Rheumatology, Mount Sinai Hospital and University Health Network, University of Toronto, Canada.
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de Saint Riquier M, Ballerie A, Robin F, Belhomme N, Cazalets C, Droitcourt C, Perdriger A, Yelnik CM, Hachulla E, Sobanski V, Jégo P, Coiffier G, Lescoat A. Hand ultrasound for the diagnosis of scleroderma: a scoring strategy including US items and items from the EULAR/ACR classification. Clin Exp Rheumatol 2020; 38 Suppl 125:140-147. [PMID: 32865172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate the diagnostic value of hand ultrasound (US) in systemic sclerosis (SSc) and to explore its relevance within a combined diagnostic approach. METHODS 224 patients with suspected SSc were consecutively included. They all had US evaluation assessing the presence of fibrotic tenosynovitis (fibrotic TS) and ulnar artery occlusion (UAO). The final diagnosis of SSc was based on the clinical evaluation of a board of experts independently of any pre-established classification criteria. RESULTS 166 patients were finally diagnosed as SSc according to the experts as reference standard. 62 SSc and 8 non-SSc patients had UAO (uni or bilateral) (p=0.001). 23 SSc patients and 1 non-SSc patient had US fibrotic TS (p=0.007). A US SSc-pattern (presence of UAO and/or fibrotic TS) was reported in 73 SSc patients and 9 non-SSc patients (p<0.001). UAO had an area under ROC curve (AUC) for the diagnosis of SSc of 0.618 (95%CI 0.539- 0.697); with Se=0.373 (0.304-0.449) and Sp=0.862 (0.751-0.928). Fibrotic TS had an AUC of 0.561 (0.480-0.643); with Se=0.139 (0.094-0.199) and Sp=0.983 (0.909-0.997). The US-SSc pattern had a AUC of 0.641 (0.563- 0.695), with Se=0.440 (0.367-0.516) and Sp=0.845 (0.731-0.916). A scoring system including these US parameters and items from ACR/EULAR classification criteria had an AUC of 0.979 (0.962-0.996)) and allows the substitution of capillaroscopy by US parameters with similar performances. CONCLUSIONS The use of hand US parameters may help to refine the diagnostic strategy of SSc and their inclusion in a combined diagnostic approach could be discussed.
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Affiliation(s)
| | - Alice Ballerie
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, Université de Rennes; and Université de Rennes, CHU Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - François Robin
- Department of Rheumatology, CHU Rennes, Université de Rennes; and Inserm U 1241, Université de Rennes, France
| | - Nicolas Belhomme
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, Université de Rennes, France
| | - Claire Cazalets
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, Université de Rennes, France
| | - Catherine Droitcourt
- Université de Rennes; CHU Rennes, Department of Dermatology; INSERM, CIC 1414, Rennes; REPERES Pharmacoepidemiology and access to Health Care, University Rennes 1 and French School of Public Health, UPRES EA 7449, Rennes, France
| | - Aleth Perdriger
- Department of Rheumatology, CHU Rennes, Université de Rennes, France
| | - Cécile Marie Yelnik
- Université de Lille, U995, Lille Inflammation Research International Centre; and CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
| | - Eric Hachulla
- Université de Lille, U995, Lille Inflammation Research International Centre; CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille; Inserm, Lille; and Centre National de Référence Maladies Systémiques et Auto-Immunes Rares du Nord et Nord-Ouest de France, Lille, France
| | - Vincent Sobanski
- Université de Lille, U995, Lille Inflammation Research International Centre; CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille; Inserm, Lille; and Centre National de Référence Maladies Systémiques et Auto-Immunes Rares du Nord et Nord-Ouest de France, Lille, France
| | - Patrick Jégo
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, Université de Rennes; and Université de Rennes, CHU Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Guillaume Coiffier
- Department of Rheumatology, CHU Rennes, Université de Rennes; and Inserm U 1241, Université de Rennes, France
| | - Alain Lescoat
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, Université de Rennes; and Université de Rennes, CHU Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France.
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Kaur G, Banka S, Meena B, Kulkarni A, Prajapat R, Dhaka J. Sine Scleroderma. J Assoc Physicians India 2020; 68:68-70. [PMID: 32610852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Systemic sclerosis (SSc) is a connective tissue disorder of unknown aetiology. A small subset (10%) of patients with limited systemic sclerosis have all other features of the disease without any skin involvement and is known as systemic sclerosis sine scleroderma (ssSSc). Severe Critical Limb Ischaemia is rare in sine scleroderma.The present case showed severe critical limb ischaemia with severe PAH,Esophageal dysmotility,Glomerulonephritis(a rare association) with hypertension. Although skin thickening is considered as a hallmark of systemic sclerosis, there should be a high index of clinical suspicion in patients presenting with possible manifestations of systemic sclerosis without sclerodermatous cutaneous involvement because early diagnosis and treatment can reduce the morbidity and mortality in it.
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Affiliation(s)
- Gurdeep Kaur
- Professor and Unit Head General Medicine, RNT Medical College Udaipur, Rajasthan
| | - Sweta Banka
- Junior Resident, RNT Medical College Udaipur, Rajasthan
| | - Baldev Meena
- Asst. Professor, RNT Medical College Udaipur, Rajasthan
| | | | | | - Jeevraj Dhaka
- Junior Resident, RNT Medical College Udaipur, Rajasthan
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Zeng C, Kahlenberg JM, Gudjonsson JE. IL-17A Softens the Skin: Antifibrotic Properties of IL-17A in Systemic Sclerosis. J Invest Dermatol 2020; 140:13-14. [PMID: 31864428 DOI: 10.1016/j.jid.2019.07.678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 11/15/2022]
Abstract
IL-17A is abundant in scleroderma skin, but its pathologic role has remained unclear. In the Journal of Investigative Dermatology, Dufour et al. (2020) demonstrate a new role for IL-17A as an antifibrotic agent in scleroderma through modulation of keratinocyte responses to transforming growth factor-β and shifting of fibroblast responses from profibrotic to antifibrotic.
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Affiliation(s)
- Chang Zeng
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - J Michelle Kahlenberg
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Jain M. Esophageal Scleroderma- Changes in Esophageal Manometry. J Assoc Physicians India 2019; 67:85. [PMID: 31304715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Mayank Jain
- Choithram Hospital and Research Centre, Indore, Madhya Pradesh
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Montgomery K. The use of qualitative methods to understand the experience of facial morphea. Br J Dermatol 2018; 179:245-246. [PMID: 30141563 DOI: 10.1111/bjd.16804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- K Montgomery
- Department of Psychology, University of Sheffield, Sheffield, S1 2LT, U.K
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McCoy SS, Reed TJ, Berthier CC, Tsou PS, Liu J, Gudjonsson JE, Khanna D, Kahlenberg JM. Scleroderma keratinocytes promote fibroblast activation independent of transforming growth factor beta. Rheumatology (Oxford) 2017; 56:1970-1981. [PMID: 28968684 DOI: 10.1093/rheumatology/kex280] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Indexed: 01/06/2023] Open
Abstract
Objectives SSc is a devastating disease that results in fibrosis of the skin and other organs. Fibroblasts are a key driver of the fibrotic process through deposition of extracellular matrix. The mechanisms by which fibroblasts are induced to become pro-fibrotic remain unclear. Thus, we examined the ability of SSc keratinocytes to promote fibroblast activation and the source of this effect. Methods Keratinocytes were isolated from skin biopsies of 9 lcSSc, 10 dcSSc and 13 control patients. Conditioned media was saved from the cultures. Normal fresh primary fibroblasts were exposed to healthy control and SSc keratinocyte conditioned media in the presence or absence of neutralizing antibodies for TGF-β. Gene expression was assessed by microarrays and real-time PCR. Immunocytochemistry was performed for α-smooth muscle actin (α-SMA), collagen type 1 (COL1A1) and CCL5 expression. Results SSc keratinocyte conditioned media promoted fibroblast activation, characterized by increased α-SMA and COL1A1 mRNA and protein expression. This effect was independent of TGF-β. Microarray analysis identified upregulation of nuclear factor κB (NF-κB) and downregulation of peroxisome proliferator-activated receptor γ (PPAR-γ) pathways in both SSc subtypes. Scleroderma keratinocytes exhibited increased expression of NF-κB-regulated cytokines and chemokines and lesional skin staining confirmed upregulation of CCL5 in basal keratinocytes. Conclusion Scleroderma keratinocytes promote the activation of fibroblasts in a TGF-β-independent manner and demonstrate an imbalance in NF-κB1 and PPAR-γ expression leading to increased cytokine and CCL5 production. Further study of keratinocyte mediators of fibrosis, including CCL5, may provide novel targets for skin fibrosis therapy.
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Affiliation(s)
- Sara S McCoy
- Department of Internal Medicine, Division of Rheumatology, University of Wisconsin, Madison, WI
| | - Tamra J Reed
- Department of Internal Medicine, Division of Rheumatology
| | | | - Pei-Suen Tsou
- Department of Internal Medicine, Division of Rheumatology
| | - Jianhua Liu
- Department of Internal Medicine, Division of Rheumatology
| | | | - Dinesh Khanna
- Department of Internal Medicine, Division of Rheumatology
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Loureiro M, Sousa S, Santos MJ. [Juvenile Systemic Sclerosis]. ACTA MEDICA PORT 2015; 28:785. [PMID: 26849767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 07/21/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Marta Loureiro
- Serviço de Pediatria. Hospital Garcia de Orta. Almada. Portugal
| | - Sandra Sousa
- Serviço de Reumatologia. Hospital Garcia de Orta. Almada. Portugal
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Stirling A. Don a pair of gloves to raise awareness of scleroderma. Nurs Stand 2013; 27:32. [PMID: 23987717 DOI: 10.7748/ns2013.06.27.43.32.s50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Arndt K. Ask the doctor. My wife has morphea spots on many areas of her body. We are currently treating them with Dovonex cream, which seems to help a little but is very expensive. Do you have a better way to treat this disease? We have been told that very little is known about how to treat it. Harv Health Lett 2011; 37:8. [PMID: 27024295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Affiliation(s)
- Navdeep Tangri
- Department of Medicine, McGill University, Montréal, Que
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PAGEL W, TREIP CS. Viscero-cutaneous collagenosis; a study of the intermediate forms of dermatomyositis, scleroderma, and disseminated lupus erythematosus. J Clin Pathol 2003; 8:1-18. [PMID: 14354022 PMCID: PMC1023716 DOI: 10.1136/jcp.8.1.1] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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