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Curtiss P, Svigos K, Schwager Z, Lo Sicco K, Franks AG. Part I: Epidemiology, pathophysiology, and clinical considerations of primary and secondary Raynaud's phenomenon. J Am Acad Dermatol 2024; 90:223-234. [PMID: 35809798 DOI: 10.1016/j.jaad.2022.06.1199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/24/2022]
Abstract
Raynaud's phenomenon (RP) is a relatively common disease with both primary and secondary forms. It is well understood as a vasospastic condition affecting the acral and digital arteries, resulting in characteristic, well-demarcated color changes typically in the hands and feet in response to cold or stress. Secondary RP (SRP) has been described in association with a variety of rheumatologic and nonrheumatologic diseases, environmental exposures, and/or medications. While both primary RP and SRP may impact the quality of life, SRP may lead to permanent and potentially devastating tissue destruction when undiagnosed and untreated. It is therefore crucial for dermatologists to distinguish between primary and secondary disease forms early in clinical evaluation, investigate potential underlying causes, and risk stratify SRP patients for the development of associated autoimmune connective tissue disease. The epidemiology, pathogenesis, and clinical presentation and diagnosis of both forms of RP are described in detail in this review article.
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Affiliation(s)
- Paul Curtiss
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Katerina Svigos
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Zachary Schwager
- Department of Dermatology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Kristen Lo Sicco
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York.
| | - Andrew G Franks
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York; Department of Internal Medicine, Division of Rheumatology, New York University School of Medicine, New York, New York
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Qiu M, Nian X, Pang L, Yu P, Zou S. Prevalence and risk factors of systemic sclerosis-associated interstitial lung disease in East Asia: A systematic review and meta-analysis. Int J Rheum Dis 2021; 24:1449-1459. [PMID: 34418313 PMCID: PMC9292335 DOI: 10.1111/1756-185x.14206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
Objective Interstitial lung disease (ILD) is a common and potentially life‐threatening complication for individuals with systemic sclerosis (SSc). The purpose of this study was to complete a systematic review and meta‐analysis on prevalence and risk factors of SSc‐ILD in East Asia. Methods Medline, EMBASE, and Cochrane Library were searched up to January 22, 2021. The Reporting of Observational Studies in Epidemiology (STROBE) statement was applied to access the methodological quality of the eligible studies. Study characteristics and magnitude of effect sizes were extracted. Then, we calculated the pooled prevalence, weighted mean differences (WMDs), pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs), and performed subgroup analysis, sensitivity analysis, and publication bias with Egger's test. Results Twenty‐seven of 1584 articles were eligible and a total of 5250 patients with SSc were selected in the meta‐analysis. The pooled prevalence of SSc‐ILD in East Asia was 56% (95% CI 49%‐63%). The SSc‐ILD prevalence was higher in China (72%) than in Japan (46%) and Korea (51%). Longer disease duration (WMD = 1.97, 95% CI 0.55‐3.38), diffuse SSc (OR = 2.84, 95% CI 1.91‐4.21), positive anti‐topoisomerase I antibody (ATA) (OR = 4.92, 95% CI 2.74‐8.84), positive anti‐centromere body antibody (ACA) (OR = 0.14, 95% CI 0.08‐0.25), positive anti‐U3 ribonucleoprotein (RNP) antibody (OR = 0.17, 95% CI 0.04‐0.66), and higher erythrocyte sedimentation rate (ESR) (WMD = 6.62, 95% CI 1.19‐12.05) were associated with SSc‐ILD in East Asia. Conclusion Through this systematic review and meta‐analysis, we found that ILD occurs in up to approximately 56% of patients with SSc in East Asia. Longer disease duration, diffuse SSc, positive ATA, negative ACA, negative anti‐U3 RNP antibody, and higher ESR were risk factors for SSc‐ILD.
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Affiliation(s)
- Meihua Qiu
- Department of Respiratory and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated with the Medical College of Qingdao, Yantai, China
| | - Xueyuan Nian
- Department of Gastroenterology, Yantai Yuhuangding Hospital, Affiliated with the Medical College of Qingdao, Yantai, China
| | - Lingling Pang
- Department of Respiratory and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated with the Medical College of Qingdao, Yantai, China
| | - Pengfei Yu
- Department of Respiratory and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated with the Medical College of Qingdao, Yantai, China
| | - Shenchun Zou
- Department of Respiratory and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated with the Medical College of Qingdao, Yantai, China
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Curtiss P, Schwager Z, Lo Sicco K, Franks AG. The clinical effects of l-arginine and asymmetric dimethylarginine: implications for treatment in secondary Raynaud's phenomenon. J Eur Acad Dermatol Venereol 2018; 33:497-503. [PMID: 30004597 PMCID: PMC6916181 DOI: 10.1111/jdv.15180] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/06/2018] [Indexed: 01/18/2023]
Abstract
Secondary Raynaud's phenomenon (RP) is often the sentinel clinical finding in systemic sclerosis and may precede systemic disease by several years. Altered nitric oxide metabolism plays a critical role in both fibrosis and severe secondary RP phenotypes in these patients. Increased flux through inducible nitric oxide synthase (iNOS) drives cutaneous fibrosis. Failure of flux through endothelial nitric oxide synthase (eNOS) contributes to increased vasoconstriction and decreased vasorelaxation. The underproduction of nitric oxide by eNOS is in part due to increased levels of asymmetric dimethylarginine (ADMA), an endogenous competitive inhibitor of nitric oxide synthase. The inhibitory effects of increased ADMA levels may be counteracted increasing serum l‐arginine, which is often an effective treatment strategy in these patients. As such, l‐arginine‐based therapies should be considered in managing secondary RP, particularly given their favourable safety and tolerability profile. While there is no established dosing regimen, studies of oral l‐arginine in secondary RP suggest that divided dosing may begin at 1–2 g/day and may be titrated up to 10 g/day. Conversely, primary RP is not associated with increased ADMA production which likely accounts for the failure of l‐arginine trials to show benefit in primary RP.
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Affiliation(s)
- P Curtiss
- Skin Lupus & Autoimmune Connective Tissue Section, The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Z Schwager
- Skin Lupus & Autoimmune Connective Tissue Section, The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - K Lo Sicco
- Skin Lupus & Autoimmune Connective Tissue Section, The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - A G Franks
- Skin Lupus & Autoimmune Connective Tissue Section, The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA.,Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York, NY, USA
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Clifton HL, Machin DR, Groot HJ, Frech TM, Donato AJ, Richardson RS, Wray DW. Attenuated nitric oxide bioavailability in systemic sclerosis: Evidence from the novel assessment of passive leg movement. Exp Physiol 2018; 103:1412-1424. [PMID: 29790215 DOI: 10.1113/ep086991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/15/2018] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Do systemic sclerosis patients exhibit impaired nitric oxide-mediated vascular function of the lower limb and are these decrements correlated with plasma biomarkers for inflammation and oxidative stress? What is the main finding and its importance? Findings indicate impaired nitric oxide-mediated vascular function, linked to the incidence of digital ulcers and a milieu of inflammation and oxidative stress. However, the absence of significant correlations between individual biomarkers and blood flow responses suggests that the vasculopathy observed in systemic sclerosis may not be solely the result of derangements in the redox balance or inflammatory signalling. ABSTRACT Systemic sclerosis (SSc) is an autoimmune disease characterized by vasculopathy, which may be the consequence of inflammation and oxidative stress that ultimately leads to a reduced nitric oxide (NO) bioavailability. Passive leg movement (PLM) is a novel methodology for assessing lower limb vascular function that is predominantly NO dependent. We combined this vascular assessment with a comprehensive panel of plasma biomarkers to assess the axis of inflammation, oxidative stress and NO in SSc patients (n = 12; 62 ± 11 years of age) compared with healthy control subjects (n = 17; 60 ± 16 years of age). The PLM-induced changes in leg blood flow (LBF; 191 ± 104 versus 327 ± 217 ml min-1 ) and LBF area under the curve (39 ± 104 versus 125 ± 131 ml) were reduced in SSc compared with control subjects. Stratification of patients according to history of digital ulcer (DU) formation revealed a further reduction in LBF area under the curve in DU (-13 ± 83 ml) versus non-DU (91 ± 102 ml) patients. Biomarkers of inflammation (C-reactive protein) and oxidative stress (malondialdehyde and protein carbonyl) were all elevated in SSc (C-reactive protein, 3299 ± 2372 versus 984 ± 565 ng ml-1 ; malondialdehyde, 3.2 ± 1.1 versus 1.1 ± 0.7 μm; and protein carbonyl, 0.15 ± 0.05 versus 0.12 ± 0.03 nmol mg-1 ), and C-reactive protein was further elevated in patients with a history of DU (4551 ± 2752 versus 2047 ± 1019 ng ml-1 ) compared with non-DU, although these were not individually correlated with changes in LBF. These findings of impaired NO-mediated vascular function, linked to DU and a milieu of inflammation and oxidative stress, suggest that redox balance plays an important, but not necessarily deterministic, role in the vascular pathophysiology of SSc.
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Affiliation(s)
- Heather L Clifton
- Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, UT, USA.,Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT, USA
| | - Daniel R Machin
- Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, UT, USA.,Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT, USA
| | - H Jonathan Groot
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT, USA
| | - Tracy M Frech
- Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, UT, USA.,Department of Internal Medicine, Division of Rheumatology, University of Utah, Salt Lake City, UT, USA
| | - Anthony J Donato
- Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, UT, USA.,Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT, USA.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA.,Department of Biochemistry, University of Utah, Salt Lake City, UT, USA
| | - Russell S Richardson
- Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, UT, USA.,Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT, USA.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA.,Center on Aging, University of Utah, Salt Lake City, UT, USA
| | - D Walter Wray
- Geriatric Research, Education, and Clinical Center, George E. Wahlen VA Medical Center, Salt Lake City, UT, USA.,Department of Internal Medicine, Division of Geriatrics, University of Utah, Salt Lake City, UT, USA.,Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA.,Center on Aging, University of Utah, Salt Lake City, UT, USA
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Cao Z, Mathai SC, Hummers LK, Shah AA, Wigley FM, Lechtzin N, Hassoun PM, Girgis RE. Exhaled nitric oxide in pulmonary arterial hypertension associated with systemic sclerosis. Pulm Circ 2017; 6:545-550. [PMID: 28090297 DOI: 10.1086/688768] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The fractional exhaled concentration of nitric oxide (FENO) has been shown to be reduced in idiopathic pulmonary arterial hypertension (PAH) but has not been adequately studied in PAH associated with systemic sclerosis (SSc). We measured FENO at an expiratory flow rate of 50 mL/s in 21 treatment-naive patients with SSc-associated PAH (SSc-PAH), 94 subjects with SSc without pulmonary involvement, and 84 healthy volunteers. Measurements of FENO at additional flow rates of 100, 150, and 250 mL/s were obtained to derive the flow-independent nitric oxide exchange parameters of maximal airway flux (J'awNO) and steady-state alveolar concentration (CANO). FENO at 50 mL/s was similar (P = 0.22) in the SSc-PAH group (19 ± 12 parts per billion [ppb]) compared with the SSc group (17 ± 12 ppb) and healthy control group (21 ± 11 ppb). No change was observed after 4 months of targeted PAH therapy in 14 SSc-PAH group patients (P = 0.9). J'awNO was modestly reduced in SSc group subjects without lung disease (1.2 ± 0.5 nl/s) compared with healthy controls (1.64 ± 0.9; P < 0.05) but was similar to that in the SSc-PAH group. CANO was elevated in individuals with SSc-PAH (4.8 ± 2.6 ppb) compared with controls with SSc (3.3 ± 1.4 ppb) and healthy subjects (2.6 ± 1.5 ppb; P < 0.001 for both). However, after adjustment for the diffusing capacity of CO, there was no significant difference in CANO between individuals with SSc-PAH and controls with SSc. We conclude that FENO is not useful for the diagnosis of PAH in SSc. Increased alveolar nitric oxide in SSc-PAH likely represents impaired diffusion into pulmonary capillary blood.
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Affiliation(s)
- Zeling Cao
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laura K Hummers
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ami A Shah
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Fredrick M Wigley
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Noah Lechtzin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Reda E Girgis
- Division of Pulmonary and Critical Care Medicine, Spectrum Health and Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
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Luo JY, Liu X, Jiang M, Zhao HP, Zhao JJ. Oxidative stress markers in blood in systemic sclerosis: A meta-analysis. Mod Rheumatol 2016; 27:306-314. [PMID: 27425641 DOI: 10.1080/14397595.2016.1206510] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jing-Ying Luo
- Department of Dermatology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China,
- Department of Dermatology, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China,
| | - Xin Liu
- Tumor Research Institute of Yunnan Province, the Third Affiliated Hospital of Kunming Medical College, Kunming, Yunnan, China, and
| | - Miao Jiang
- Department of Dermatology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China,
| | - Hui-Ping Zhao
- Department of Dermatology, The Hospital of Shanxi University of TCM, Taiyuan, Shanxi, China
| | - Jing-Jun Zhao
- Department of Dermatology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China,
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Iudici M, Fasano S, Iacono D, Russo B, Cuomo G, Valentini G. Prevalence and factors associated with glucocorticoids (GC) use in systemic sclerosis (SSc): a systematic review and meta-analysis of cohort studies and registries. Clin Rheumatol 2013; 33:153-64. [DOI: 10.1007/s10067-013-2422-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 10/18/2013] [Indexed: 11/30/2022]
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Tiev KP, Le-Dong NN, Duong-Quy S, Hua-Huy T, Cabane J, Dinh-Xuan AT. Exhaled nitric oxide, but not serum nitrite and nitrate, is a marker of interstitial lung disease in systemic sclerosis. Nitric Oxide 2009; 20:200-6. [DOI: 10.1016/j.niox.2008.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 11/12/2008] [Accepted: 11/26/2008] [Indexed: 01/03/2023]
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10
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Current world literature. Curr Opin Rheumatol 2008; 20:729-35. [PMID: 18946335 DOI: 10.1097/bor.0b013e328317a234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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