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Wajid S, Shapiro L, Farrukh L, Hu K, Feustel PJ, Hongalgi K, Mehta S. Acute Kidney Injury in Systemic Sclerosis Beyond Scleroderma Renal Crisis: A Case-Control Study. J Clin Rheumatol 2024; 30:219-222. [PMID: 38980171 DOI: 10.1097/rhu.0000000000002108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
BACKGROUND AND OBJECTIVES Renal involvement in systemic sclerosis remains a significant concern with the focus often centered on scleroderma renal crisis (SRC). However, the broader spectrum of renal manifestations, beyond SRC, remains underrecognized. In our case-control analysis, we describe other causes, risk factors, and renal outcomes of acute kidney injury (AKI) in systemic sclerosis other than SRC. METHODS Patients diagnosed with SSC, with and without AKI, between 2017 and 2023 at Albany Medical Center, were included in the case-control study using International Classification of Diseases , 10th Revision codes and electronic medical records. Patients with SRC were carefully excluded. Data were collected and compared between AKI and non-AKI groups for patients' demographics, clinical characteristics, and baseline treatment. Additionally, data were collected for baseline, peak, and follow-up creatinine, etiology of AKI, treatment, and outcomes. Statistical analysis was performed using R (version 4.3.0) and Minitab (V19). Categorical variables were presented as frequencies/percentages, and continuous variables as means/standard deviations. Associations between categorical variables were assessed by χ 2 test and Fisher exact test. Odds ratios and 95% confidence intervals were calculated using binary logistic regression to separately assess the effect of each independent variable on the odds of AKI. Statistical significance was set at p < 0.05. RESULTS A total of 74 cases were identified. Out of these 74 cases, 27 had AKI and 47 did not have AKI. Out of the 27 AKI cases, 4 with SRC were excluded. Advanced age, chronic kidney disease, and heart failure were identified as risk factors for AKI development. The predominant cause of AKI was prerenal etiology, accounting for 47.8% (n = 11) of cases. This was followed by cardiorenal syndrome and acute tubular necrosis, accounting for 21.7% and 17.3% of the cases, respectively. Most of the cases with AKI had complete renal recovery 78% (n = 18), whereas 17% (n = 4) had progression of the underlying chronic kidney disease. One patient progressed to end-stage renal disease requiring hemodialysis. CONCLUSIONS This analysis highlights the risk factors and variable clinicopathological courses of renal involvement in patients with scleroderma. This may range from mild AKI with good prognosis to life-threatening SRC.
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Affiliation(s)
- Sumbal Wajid
- From the Department of Medicine, Albany Medical Center, Albany, NY
| | - Lee Shapiro
- From the Department of Medicine, Albany Medical Center, Albany, NY
| | - Larabe Farrukh
- From the Department of Medicine, Albany Medical Center, Albany, NY
| | - Kurt Hu
- Department of Pulmonary and Critical Care Medicine, Froedtert and the Medical College of Wisconsin, Milwaukee, WI
| | - Paul J Feustel
- Department of Research Affairs, Albany Medical College, Albany, NY
| | | | - Swati Mehta
- From the Department of Medicine, Albany Medical Center, Albany, NY
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Kidney Involvement in Systemic Sclerosis. J Pers Med 2022; 12:jpm12071123. [PMID: 35887620 PMCID: PMC9324204 DOI: 10.3390/jpm12071123] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Systemic sclerosis is a chronic multisystem autoimmune disease, characterized by diffuse fibrosis and abnormalities of microcirculation and small arterioles in the skin, joints and visceral organs. Material and Methods: We searched for the relevant articles on systemic sclerosis and kidney involvement in systemic sclerosis in the NIH library of medicine, transplant, rheumatologic and nephrological journals. Results: Half of patients with systemic sclerosis have clinical evidence of kidney involvement. Scleroderma renal crisis represents the most specific and serious renal event associated with this condition. It is characterized by an abrupt onset of moderate to marked hypertension and kidney failure. Early and aggressive treatment is mandatory to prevent irreversible organ damage and death. The advent of ACE-inhibitors revolutionized the management of scleroderma renal crisis. However, the outcomes of this serious complication are still poor, and between 20 to 50% of patients progress to end stage renal disease. Conclusions: Scleroderma renal crisis still represents a serious and life-threatening event. Thus, further studies on its prevention and on new therapeutic strategies should be encouraged.
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Cao XY, Liu H, Xu D, Li MT, Wang Q, Jiang L, Hou Y, Zhu LX, Zeng XF. Patterns of renal pathology in Chinese patients with systemic sclerosis undergoing renal biopsy at a tertiary medical center. J Int Med Res 2020; 48:300060519894456. [PMID: 31878823 PMCID: PMC7783277 DOI: 10.1177/0300060519894456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 11/21/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We investigated renal injury characteristics in Chinese patients with systemic sclerosis (SSc) who had undergone renal biopsy. METHODS We searched the medical records of patients with SSc who were hospitalized at Peking Union Medical College Hospital between January 1990 and August 2019. We analyzed the clinical characteristics and pathological results of these patients. RESULTS We identified 25 patients who had undergone renal biopsy. Of these patients, 10 had scleroderma renal crisis (SRC); one underwent renal biopsy twice (for diffuse mesangial proliferative glomerulonephritis and for SRC); two had antineutrophil cytoplasmic antibody-associated glomerulonephritis; one had immunoglobulin M nephropathy; one had minimal change nephropathy; seven had lupus nephritis; one had scleroderma renal crisis with comorbid lupus nephritis; and two had drug-related kidney injury (caused by aristolochic acid in one and D-penicillamine in the other). Acute tubular necrosis was observed in the patient taking oral aristolochic acid, while minimal change nephropathy was observed in the patient with D-penicillamine-induced renal injury. CONCLUSIONS SRC was the most commonly encountered renal damage in patients with SSc. We recommend biopsy for patients undergoing treatment for SRC who have persistent renal injury with proteinuria, regardless of hematuria. Rheumatologists in Eastern countries should be aware of aristolochic acid nephropathy.
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Affiliation(s)
- Xiao-yu Cao
- Department of Rheumatology and
Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of
Medical Sciences & Peking Union Medical College, Graduate School of Peking
Union Medical College, Beijing, China
| | - He Liu
- Department of Ultrasound, Peking
Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking
Union Medical College, Beijing, China
| | - Dong Xu
- Department of Rheumatology and
Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of
Medical Sciences & Peking Union Medical College, Graduate School of Peking
Union Medical College, Beijing, China
| | - Meng-tao Li
- Department of Rheumatology and
Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of
Medical Sciences & Peking Union Medical College, Graduate School of Peking
Union Medical College, Beijing, China
| | - Qian Wang
- Department of Rheumatology and
Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of
Medical Sciences & Peking Union Medical College, Graduate School of Peking
Union Medical College, Beijing, China
| | - Li Jiang
- Department of Rheumatology and
Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of
Medical Sciences & Peking Union Medical College, Graduate School of Peking
Union Medical College, Beijing, China
| | - Yong Hou
- Department of Rheumatology and
Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of
Medical Sciences & Peking Union Medical College, Graduate School of Peking
Union Medical College, Beijing, China
| | - Li-xiu Zhu
- Department of Rheumatology, Ningde
Hospital Affiliated to Fujian Medical University, Ningde, Fujian Province,
China
| | - Xiao-feng Zeng
- Department of Rheumatology and
Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of
Medical Sciences & Peking Union Medical College, Graduate School of Peking
Union Medical College, Beijing, China
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Yatomi A, Mori S, Kawauchi H, Shono A, Shimoyama S, Tanaka H, Okano T, Inoue T, Jimbo N, Morinobu A, Hirata KI. Predominant Involvement of the Aortic Root in a Patient with Anti-neutrophil Cytoplasmic Antibody-associated Vasculitis: Congestive Heart Failure due to Subacute Severe Aortic Regurgitation and Reversible Conduction Disturbance. Intern Med 2020; 59:663-671. [PMID: 31708549 PMCID: PMC7086330 DOI: 10.2169/internalmedicine.3831-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A 72-year-old woman was referred to our institution with decompensated congestive heart failure owing to subacute severe aortic regurgitation and mitral regurgitation. Her blood sample tested positive for myeloperoxidase anti-neutrophil cytoplasmic antibody (ANCA). Cardiac computed tomography revealed abnormal thickening and shortening of the aortic valvar leaflets as well as wall thickening of the sinuses of Valsalva. Based on the diagnosis of ANCA-associated vasculitis, predominantly involving the aortic root, prednisolone administration was initiated, which failed to improve the valvar dysfunction. The patient underwent aortic root replacement and mitral annuloplasty. Histopathology confirmed severe inflammation involving both the aortic valvar sinuses and leaflets.
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Affiliation(s)
- Atsusuke Yatomi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Hirotaka Kawauchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Ayu Shono
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Shinsuke Shimoyama
- Department of Radiology, Kobe University Graduate School of Medicine, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Takaichi Okano
- Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Japan
| | - Takeshi Inoue
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Japan
| | - Naoe Jimbo
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Japan
| | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
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Felten R, Nespola B, Chatelus E, Arnaud L, Gottenberg JE, Canuet M, Prinz E, Goetz J, Sibilia J. Acute renal failure in systemic sclerosis revealing Goodpasture syndrome: "All that glitters is not scleroderma renal crisis". JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2020; 5:NP1-NP5. [PMID: 35382400 PMCID: PMC8922589 DOI: 10.1177/2397198319838131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/25/2019] [Indexed: 11/30/2023]
Abstract
The most common cause of acute renal failure in systemic sclerosis patients is scleroderma renal crisis but other etiologies have to be considered such as another autoimmune disease. We report the case of a 60-year-old male admitted to our hospital with a renal failure. His medical history included a diagnosis of systemic sclerosis 6 months ago. Antinuclear antibodies were positive at a titer of 1:1280 with positive anti-Scl-70 and anti-myeloperoxidase (34 U/mL) antibodies. Scleroderma renal crisis was suspected. However, antineutrophil cytoplasmic antibody-associated vasculitis could not be excluded and a renal biopsy was performed. Histopathology revealed crescentic glomerulonephritis and rupture of Bowman's capsule. Anti-glomerular basement membrane antibodies were detected in serum and the diagnosis of Goodpasture syndrome was confirmed by kidney's immunofluorescence analysis showing typical deposits. Only three other cases of systemic sclerosis associated with Goodpasture syndrome have been reported in the literature. Also, rapidly progressive glomerulonephritis with positivity of both antineutrophil cytoplasmic antibody and anti-glomerular basement membrane antibodies has been described. Several studies have suggested that antineutrophil cytoplasmic antibody positivity occurs first leading to damages of the glomerular basement membrane, to the release of alpha-3 NC1 antigen, and ultimately to anti-glomerular basement membrane antibody production. Although rare, antineutrophil cytoplasmic antibody-associated vasculitis and Goodpasture syndrome should be searched for in systemic sclerosis patients with acute renal failure.
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Affiliation(s)
- Renaud Felten
- Department of Rheumatology, National
Referral Center for Autoimmune Diseases, Strasbourg University Hospital, Strasbourg,
France
| | - Benoît Nespola
- Immunology Laboratory, National Referral
Center for Autoimmune Diseases, Strasbourg University Hospital, Strasbourg,
France
| | - Emmanuel Chatelus
- Department of Rheumatology, National
Referral Center for Autoimmune Diseases, Strasbourg University Hospital, Strasbourg,
France
| | - Laurent Arnaud
- Department of Rheumatology, National
Referral Center for Autoimmune Diseases, Strasbourg University Hospital, Strasbourg,
France
| | - Jacques-Eric Gottenberg
- Department of Rheumatology, National
Referral Center for Autoimmune Diseases, Strasbourg University Hospital, Strasbourg,
France
| | - Matthieu Canuet
- Department of Pneumology, Strasbourg
University Hospital, Strasbourg, France
| | - Eric Prinz
- Department of Nephrology, Strasbourg
University Hospital, Strasbourg, France
| | - Joëlle Goetz
- Immunology Laboratory, National Referral
Center for Autoimmune Diseases, Strasbourg University Hospital, Strasbourg,
France
| | - Jean Sibilia
- Department of Rheumatology, National
Referral Center for Autoimmune Diseases, Strasbourg University Hospital, Strasbourg,
France
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Montrief T, Koyfman A, Long B. Scleroderma renal crisis: a review for emergency physicians. Intern Emerg Med 2019; 14:561-570. [PMID: 31076978 DOI: 10.1007/s11739-019-02096-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/27/2019] [Indexed: 12/15/2022]
Abstract
Scleroderma renal crisis (SRC) remains a high-risk clinical presentation, and many patients require emergency department (ED) management for complications and stabilization. This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of SRC. While SRC remains a rare clinical presentation, surveillance data suggest an overall incidence between 4 and 6% of patients with scleroderma. The diagnostic criteria for SRC include a new onset blood pressure > 150/85 mm Hg OR increase ≥ 20 mm Hg from baseline systolic blood pressure, along with a decline in renal function, defined as an increase serum creatinine of ≥ 10% and supportive features. There are many risk factors for SRC, including diffuse and rapidly progressive skin thickening, palpable tendon friction rubs, and new anemia or cardiac events. Critical patients should be evaluated in the resuscitation bay, and consultation with the nephrology team for appropriate patients improves patient outcomes.
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MESH Headings
- Angiotensin-Converting Enzyme Inhibitors/therapeutic use
- Antibodies, Antineutrophil Cytoplasmic/analysis
- Antibodies, Antineutrophil Cytoplasmic/blood
- Emergency Service, Hospital/organization & administration
- Humans
- Kidney Failure, Chronic/drug therapy
- Kidney Failure, Chronic/etiology
- Kidney Failure, Chronic/physiopathology
- Purpura, Thrombotic Thrombocytopenic/blood
- Purpura, Thrombotic Thrombocytopenic/diagnosis
- Purpura, Thrombotic Thrombocytopenic/physiopathology
- Renal Dialysis/methods
- Risk Factors
- Scleroderma, Systemic/blood
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/physiopathology
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Affiliation(s)
- Tim Montrief
- Department of Emergency Medicine, Jackson Memorial Hospital/Miller School of Medicine, University of Miami, 1611 N.W. 12th Avenue, Miami, FL, 33136, USA
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, TX, 78234, USA.
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7
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Moxey J, Huq M, Proudman S, Sahhar J, Ngian GS, Walker J, Strickland G, Wilson M, Ross L, Major G, Roddy J, Stevens W, Nikpour M. Significance of anti-neutrophil cytoplasmic antibodies in systemic sclerosis. Arthritis Res Ther 2019; 21:57. [PMID: 30764870 PMCID: PMC6376778 DOI: 10.1186/s13075-019-1839-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/01/2019] [Indexed: 11/26/2022] Open
Abstract
Background Up to 12% of patients with systemic sclerosis (SSc) have anti-neutrophil cytoplasmic antibodies (ANCA). However, the majority of these patients do not manifest ANCA-associated vasculitis (AAV) and the significance of ANCA in these patients is unclear. The aim of this study is to determine the prevalence of ANCA in a well-characterised SSc cohort and to examine the association between ANCA and SSc clinical characteristics, other autoantibodies, treatments and mortality. Methods Clinical data were obtained from 5 centres in the Australian Scleroderma Cohort Study (ASCS). ANCA positive was defined as the presence of any one or combination of cytoplasmic ANCA (c-ANCA), perinuclear ANCA (p-ANCA), atypical ANCA, anti-myeloperoxidase (anti-MPO) or anti-proteinase-3 (anti-PR3). Associations of demographic and clinical features with ANCA were investigated by logistic or linear regression. Survival analysis was performed using Kaplan-Meyer curves and Cox regression models. Results Of 1303 patients, 116 (8.9%) were ANCA positive. Anti-PR3 was more common than anti-MPO (13.8% and 11.2% of ANCA-positive patients, respectively). Only 3 ANCA-positive patients had AAV. Anti-Scl-70 was more common in ANCA positive vs ANCA negative (25% vs 12.8%, p < 0.001), anti-MPO positive vs anti-MPO negative (38.5% vs 13.6%, p = 0.006) and anti-PR3 positive vs anti-PR3 negative patients (44.4% vs 13.4%, p < 0.001). A higher prevalence of interstitial lung disease (ILD) was found in the ANCA positive (44.8% vs 21.8%, p < 0.001) and the anti-PR3 positive groups (50.0% vs 23.4%, p = 0.009). In multivariable analysis, ANCA-positive status remained associated with ILD after adjusting for anti-Scl-70 antibodies. Pulmonary embolism (PE) was more common in ANCA-positive patients (8.6% vs 3.0%, p = 0.002) and anti-PR3-positive patients (16.7% vs 3.3%, p = 0.022). ANCA-positive status remained associated with PE in a multivariable analysis adjusting for anti-phospholipid antibodies. Kaplan-Meier analysis revealed increased mortality in ANCA-positive patients (p = 0.006). In Cox regression analysis, ANCA was associated with increased mortality, after adjusting for age and sex. Conclusions ANCA is associated with increased prevalence of ILD and PE in SSc. ANCA should be tested in SSc, as it identifies individuals with worse prognosis who require close monitoring for adverse outcomes.
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Affiliation(s)
- Jayne Moxey
- The University of Melbourne, 41 Victoria Parade Fitzroy, Melbourne, Victoria, 3065, Australia.,St. Vincent's Hospital Melbourne, 41 Victoria Parade Fitzroy, Melbourne, Victoria, 3065, Australia
| | - Molla Huq
- The University of Melbourne, 41 Victoria Parade Fitzroy, Melbourne, Victoria, 3065, Australia
| | - Susanna Proudman
- University of Adelaide, Adelaide, South Australia, Australia.,Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joanne Sahhar
- Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Gene-Siew Ngian
- Monash Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Jenny Walker
- Flinders Medical Centre, Adelaide, South Australia, Australia
| | | | - Michelle Wilson
- St. Vincent's Hospital Melbourne, 41 Victoria Parade Fitzroy, Melbourne, Victoria, 3065, Australia
| | - Laura Ross
- The University of Melbourne, 41 Victoria Parade Fitzroy, Melbourne, Victoria, 3065, Australia.,St. Vincent's Hospital Melbourne, 41 Victoria Parade Fitzroy, Melbourne, Victoria, 3065, Australia
| | - Gabor Major
- Royal Newcastle Centre John Hunter Hospital, Newcastle, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia
| | - Janet Roddy
- Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Wendy Stevens
- St. Vincent's Hospital Melbourne, 41 Victoria Parade Fitzroy, Melbourne, Victoria, 3065, Australia
| | - Mandana Nikpour
- The University of Melbourne, 41 Victoria Parade Fitzroy, Melbourne, Victoria, 3065, Australia. .,St. Vincent's Hospital Melbourne, 41 Victoria Parade Fitzroy, Melbourne, Victoria, 3065, Australia.
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8
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Neuman R, Wabbijn M, Guillen S, Dees A. Blue toe syndrome as a first sign of systemic sclerosis. BMJ Case Rep 2018; 2018:bcr-2017-221613. [PMID: 29305361 DOI: 10.1136/bcr-2017-221613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We describe an unusual case of blue toe syndrome as the primary and solitary manifestation of systemic sclerosis. The possible cause was long-term occupational exposure in construction work. Blue toe syndrome is a small vessel disease, characterised by the sudden development of painful, blue discolouration in one or more toes. The most common aetiology is atheroembolic disease; however, it can also appear in several conditions ranging from hypercoagulability disorders to underlying systemic diseases such as vasculitis or autoimmune diseases. Here, we describe the case of a 57-year-old man who presented with blue toe syndrome without underlying atheroembolic disease. He was found to have positive anticentromere antibodies, which indicated that systemic sclerosis was the likely primary underlying cause. An extensive systemic evaluation and a thorough physical examination revealed no other symptoms associated with systemic sclerosis. He was prescribed nifedipin and rosuvastatin, and showed complete resolution of symptoms after 3 months.
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Affiliation(s)
- Rugina Neuman
- Department of Internal Medicine, Ikazia Hospital, Rotterdam, The Netherlands
| | - Marike Wabbijn
- Department of Internal Medicine, Ikazia Hospital, Rotterdam, The Netherlands
| | - Samara Guillen
- Department of Internal Medicine, Ikazia Hospital, Rotterdam, The Netherlands
| | - Adriaan Dees
- Department of Internal Medicine, Ikazia Hospital, Rotterdam, The Netherlands
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Maciel M, Sa A, Zimmermann A, Pereira I, Fialho S, Neves F. ASSOCIAÇÃO ENTRE ESCLEROSE SISTÊMICA E GRANULOMATOSE COM POLIANGEÍTE. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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10
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Zakharova EV. ANCA-Associated Vasculitis in Patient with CREST-Syndrome - Case Report. ACTA ACUST UNITED AC 2016. [DOI: 10.17352/acn.000015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Scleroderma renal crisis (SRC) is a rare, potentially life-threatening complication that affects 2-15% of patients with systemic sclerosis (SSc, also known as scleroderma). SRC typically presents in patients with early, rapidly progressive, diffuse cutaneous SSc within the first 3-5 years after the onset of a non-Raynaud sign or symptom. SRC is characterized by an acute, usually symptomatic increase in blood pressure, a rise in serum creatinine levels, oliguria and thrombotic microangiopathy in about 50% of patients. The prognosis of SRC substantially improved in the 1980s with the introduction of angiotensin-converting-enzyme inhibitors for rapid blood pressure control, with additional antihypertensive agents as required. However, the survival of patients with SRC can still be improved. Current patient survival is 70-82% at 1 year, but decreases to 50-60% at 5 years despite dialysis support. Patients with SRC who show no signs of renal functional recovery despite timely blood pressure control are candidates for transplantation. In this Review, we discuss progress made in the identification and proactive management of patients at risk of SRC and make recommendations aimed at optimizing management for those who progress to chronic kidney failure.
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12
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Patel FB, Couch KS, McNish S, Miller JD, Siegel R, Easley S, Shanmugam VK. A 66-Year-Old Woman With Hemoptysis. Arthritis Care Res (Hoboken) 2015; 69:439-448. [PMID: 26714016 DOI: 10.1002/acr.22820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 12/02/2015] [Accepted: 12/15/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Falin B Patel
- The George Washington University, School of Medicine and Health Sciences, Washington, DC
| | - Kara S Couch
- The George Washington University, School of Medicine and Health Sciences, Washington, DC
| | - Sean McNish
- The George Washington University, School of Medicine and Health Sciences, Washington, DC
| | - Jonathan D Miller
- The George Washington University, School of Medicine and Health Sciences, Washington, DC
| | - Robert Siegel
- The George Washington University, School of Medicine and Health Sciences, Washington, DC
| | - Samantha Easley
- The George Washington University, School of Medicine and Health Sciences, Washington, DC
| | - Victoria K Shanmugam
- The George Washington University, School of Medicine and Health Sciences, Washington, DC
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13
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14
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Pieroni M, De Santis M, Zizzo G, Bosello S, Smaldone C, Campioni M, De Luca G, Laria A, Meduri A, Bellocci F, Bonomo L, Crea F, Ferraccioli G. Recognizing and treating myocarditis in recent-onset systemic sclerosis heart disease: potential utility of immunosuppressive therapy in cardiac damage progression. Semin Arthritis Rheum 2013; 43:526-35. [PMID: 23932313 DOI: 10.1016/j.semarthrit.2013.07.006] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/14/2013] [Accepted: 07/08/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Scleroderma heart disease is a major risk of death in systemic sclerosis (SSc). Mechanisms underlying myocardial damage are still unclear. We performed an extensive study of SSc patients with recent-onset symptoms for heart disease and examined the efficacy of immunosuppressive therapy. METHODS A cohort of 181 SSc patients was enrolled. Of these, 7 patients newly developed clinical symptoms of heart disease (heart failure, chest pain, and palpitation); all of them showed mild but persistent increase in cardiac enzymes. These patients underwent Holter ECG, 2D-echocardiography, perfusional scintigraphy, delayed-enhancement-cardiac magnetic resonance (DE-CMR), coronary angiography, and endomyocardial biopsy. Patients were treated for at least 12 months and followed-up for 5 years. RESULTS Ventricular ectopic beats (VEBs) were found in 4 patients, wall motion abnormalities in 3, pericardial effusion in 6, and DE in CMR in 6 with T2-hyperintensity in 2. In all patients, histology showed upregulation of endothelium adhesion molecules and infiltration of activated T lymphocytes, with (acute/active myocarditis in 6) or without (chronic/borderline myocarditis in 1) myocyte necrosis. Parvovirus B19 genome was detected in 3. None showed occlusion of coronary arteries or microvessels. Compared with SSc controls, these patients more often had early disease, skeletal myositis, c-ANCA/anti-PR3 positivity, VEBs, pericardial effusion, and systolic and/or diastolic dysfunction. Immunosuppressive therapy improved symptoms and led to cardiac enzyme negativization; however, 2 patients died of sudden death during follow-up. CONCLUSIONS Myocarditis is a common finding in SSc patients with recent-onset cardiac involvement. Its early detection allowed to timely start an immunosuppressive treatment, preventing cardiac damage progression in most cases.
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Affiliation(s)
- Maurizio Pieroni
- Division of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Maria De Santis
- Division of Rheumatology, Institute of Rheumatology and Affine Sciences, Catholic University of the Sacred Heart, CIC-Via Moscati 31, Rome 00168, Italy
| | - Gaetano Zizzo
- Division of Rheumatology, Institute of Rheumatology and Affine Sciences, Catholic University of the Sacred Heart, CIC-Via Moscati 31, Rome 00168, Italy
| | - Silvia Bosello
- Division of Rheumatology, Institute of Rheumatology and Affine Sciences, Catholic University of the Sacred Heart, CIC-Via Moscati 31, Rome 00168, Italy
| | - Costantino Smaldone
- Division of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Mara Campioni
- Division of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giacomo De Luca
- Division of Rheumatology, Institute of Rheumatology and Affine Sciences, Catholic University of the Sacred Heart, CIC-Via Moscati 31, Rome 00168, Italy
| | - Antonella Laria
- Division of Rheumatology, Institute of Rheumatology and Affine Sciences, Catholic University of the Sacred Heart, CIC-Via Moscati 31, Rome 00168, Italy
| | - Agostino Meduri
- Division of Rheumatology, Institute of Rheumatology and Affine Sciences, Catholic University of the Sacred Heart, CIC-Via Moscati 31, Rome 00168, Italy
| | - Fulvio Bellocci
- Division of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Lorenzo Bonomo
- Institute of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Crea
- Division of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Gianfranco Ferraccioli
- Division of Rheumatology, Institute of Rheumatology and Affine Sciences, Catholic University of the Sacred Heart, CIC-Via Moscati 31, Rome 00168, Italy.
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15
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Tahiat A, Djidjik R, Abdessmed A, Mellal Y, Nebbab A, Gharnaout M, Ghaffor M, Ladjouze A. Clinical relevance of antineutrophil cytoplasmic antibodies in Algerian scleroderma patients. Joint Bone Spine 2013; 80:547-8. [PMID: 23541846 DOI: 10.1016/j.jbspin.2013.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 02/08/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Azzeddine Tahiat
- Department of Immunology, Beni Messous teaching hospital, Algiers, Algeria
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16
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Mehra S, Walker J, Patterson K, Fritzler MJ. Autoantibodies in systemic sclerosis. Autoimmun Rev 2013; 12:340-54. [DOI: 10.1016/j.autrev.2012.05.011] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 05/15/2012] [Indexed: 01/06/2023]
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17
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Zurita Prada PA, Martín Rodríguez S, Urrego Laurín CL, Heras Benito M, Molina Ordas A, Saiz Gonzalez A. ANCA vasculitis in a patient with systemic sclerosis. ACTA ACUST UNITED AC 2012; 9:72-3. [PMID: 22951331 DOI: 10.1016/j.reuma.2012.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 06/07/2012] [Accepted: 06/08/2012] [Indexed: 10/26/2022]
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18
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ANCA-associated vasculitis in systemic sclerosis report of 3 cases. Rheumatol Int 2012; 33:139-43. [PMID: 22238029 DOI: 10.1007/s00296-011-2359-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 12/22/2011] [Indexed: 02/06/2023]
Abstract
The aim of the study was to describe the occurrence of anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) in systemic sclerosis (SSc) patients. SSc patients who developed biopsy-proven AAV were identified. Their clinical manifestations, autoantibodies, presentation with vasculitis, treatment and outcome were described and compared with previously reported patients with these two conditions. Of 985 patients, 3 were identified. All patients had interstitial lung disease, and all presented with acute renal failure, proteinuria and hematuria, and were P-ANCA- and anti-Scl-70-positive. One required hemodialysis. Two were hypertensive; additionally, one patient had sinusitis, and another had monoarthritis and a macular rash. All were treated with high-dose corticosteroids and responded to therapy and attained remission at 6 months. At 1 year, one patient died of pneumonia. ANCA-associated vasculitis is a rare but serious finding in SSc patients. Positive anti-Scl-70 antibody is found commonly in these patients. Different treatment modalities are effective. Serious infections can complicate therapy and lead to death.
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19
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Almeida I, Faria R, Vita P, Vasconcelos C. Systemic sclerosis refractory disease: from the skin to the heart. Autoimmun Rev 2011; 10:693-701. [PMID: 21575745 DOI: 10.1016/j.autrev.2011.04.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Systemic sclerosis or scleroderma (SSc) is an heterogeneous disease involving the connective tissue and the microvasculature with fibrosis and vascular occlusion. It is difficult to define refractory SSc once it is itself a paradigm of a refractory condition: there is no evidence of when to act to stop the progression to fibrosis and irreversible microvascular damage. There is no definition of refractory disease in SSc and to propose a definition we used mainly the Medsger severity index and the EULAR 2009 treatment recommendations from the skin to the heart through peripheral vascular, musculoskeletal, gastrointestinal, renal, pulmonary hypertension and interstitial lung disease. We used some clinical setting reflecting the different reasoning when there is probable refractory disease and finally we briefly pointed out some available treatment options to refractory disease. With this reflection, we would like to open paths to a broader discussion.
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Affiliation(s)
- Isabel Almeida
- Unidade de Imunologia Clínica, Hospital de Santo António, Centro Hospitalar do Porto, Portugal.
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20
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ISHIGATSUBO Y, SAMUKAWA S. Behcet's disease from the aspect of autoinflammatory disease. ACTA ACUST UNITED AC 2011; 34:408-19. [DOI: 10.2177/jsci.34.408] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yoshiaki ISHIGATSUBO
- Department of Internal Medicine and Clinical Immunology, Yokohama City University
| | - Sei SAMUKAWA
- Department of Internal Medicine and Clinical Immunology, Yokohama City University
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21
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Abstract
Systemic sclerosis (SSc) is a multiorgan connective tissue disease characterized by autoantibody production and fibroproliferative stenosis of the microvasculature. The vascoluopathy associated with SSc is considered to be noninflammatory, yet frank vasculitis can complicate SSc, posing diagnostic and therapeutic challenges. Here, we have reviewed the literature for reports of small-, medium-, and large-vessel vasculitis occurring in SSc. Amongst 88 reported cases of vasculitis in SSc, patients with ANCA-associated vasculitis appear to present a unique subclass in that they combined typical features of SSc with the renal manifestation of ANCA-associated glomerulonephritis. Other vasculitic syndromes, including large-vessel vasculitis, Behcet's disease, cryoglobulinemia, and polyarteritis nodosa, are rarely encountered in SSc patients. ANCA-associated vasculitis needs to be considered as a differential diagnosis in SSc patients presenting with renal insufficiency, as renal manifestations may result from distinct disease processes and require appropriate diagnostic testing and treatment.
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22
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McMahan ZH, Wigley FM. Raynaud’s phenomenon and digital ischemia: a practical approach to risk stratification, diagnosis and management. ACTA ACUST UNITED AC 2010; 5:355-370. [DOI: 10.2217/ijr.10.17] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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23
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Vega Stieb J, Goecke Saavedra H, Méndez Olivieri G. Fever of unknown origin secondary to type I crescentic glomerulonephritis and anti-SCl 70 antibodies without clinical manifestations of systemic sclerosis. Clin Exp Nephrol 2008; 12:388-392. [PMID: 18491030 DOI: 10.1007/s10157-008-0057-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2007] [Accepted: 03/25/2008] [Indexed: 11/24/2022]
Abstract
A 57-year-old woman presented with fever and cellulitis of the right leg. Urinalysis and kidney function were normal on admission. Cellulitis remitted but fever persisted for six weeks. X-ray imaging, cultures, serological assays for viruses and autoimmunity did not reveal the cause of fever. Unexpectedly anti-Scl 70 (anti-topoisomerase I) antibodies were positive. A skin biopsy ruled out scleroderma. On the fifth hospitalization week kidney function declined in association with hematuria, leucocyturia, and proteinuria. Prednisone was administered due to clinical suspicion of drug-induced interstitial nephritis. Fever declined in 24 h, but renal failure became rapidly worse requiring hemodialysis. Kidney biopsy revealed extensive crescentic glomerulonephritis (CGN), with much glomerular destruction, with an IgG-positive linear pattern on immunofluorescence microscopy. No overtly active microangiopathy or vasculitis were present. There was no pulmonary involvement and anti-glomerular basement membrane antibodies were not detected in the serum. After one year anti-Scl 70 antibodies were still positive without scleroderma manifestations and 17 months later the patient received a kidney transplant with excellent results. Presentation of type 1 CGN as a fever of unknown origin (FUO) is exceptional. Anti-Scl 70 antibodies are highly specific for scleroderma and are seldom present in other diseases. As far as we are aware there are no published cases of the association of type 1 CGN with anti-Scl 70 antibodies.
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Affiliation(s)
- Jorge Vega Stieb
- Department of Nephrology, Dialysis and Transplantation, Navy Hospital A. Nef, Viña del Mar, Chile. .,Department of Medicine, Nephrology Section, School of Medicine, University of Valparaíso, Valparaíso, Chile. .,, 5 North 1035, Viña del Mar, Chile.
| | - Helmuth Goecke Saavedra
- Department of Nephrology, Dialysis and Transplantation, Navy Hospital A. Nef, Viña del Mar, Chile.,Department of Medicine, Nephrology Section, School of Medicine, University of Valparaíso, Valparaíso, Chile
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25
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Bibliography. Current world literature. Myositis and myopathies. Curr Opin Rheumatol 2007; 19:651-3. [PMID: 17917548 DOI: 10.1097/bor.0b013e3282f20347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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26
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Bibliography. Current world literature. Vasculitis syndromes. Curr Opin Rheumatol 2006; 19:81-5. [PMID: 17143101 DOI: 10.1097/bor.0b013e32801437a8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Abstract
Vasculitis associated with connective tissue disorders is an important cause of secondary vasculitis about which little is written. When vasculitis occurs in the setting of a preexisting connective tissue disorder, it often correlates with disease severity and portends a poorer prognosis. It may involve virtually any organ system and present in a myriad of ways. Prompt recognition and treatment of vasculitis can dramatically improve the outcome for the patient. This review focuses on recent insights into the clinical presentation and pathogenic mechanisms that may be involved.
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Affiliation(s)
- Mittie K Doyle
- Centocor Research & Development, 200 Great Valley Parkway, Malvern, PA 19355, USA.
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