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Bağlan E, Kızıldağ Z, Çağlayan Ş, Çakmak F, Yener GO, Özdel S, Öztürk K, Makay B, Çakan M, Ayaz NA, Sözeri B, Ünsal ŞE, Bülbül M. Remission rates and risk factors for relapse in pediatric morphea: a multicenter retrospective study of Pediatric Rheumatology Academy (PeRA)-Research Group (RG). Clin Rheumatol 2023; 42:2855-2860. [PMID: 37378874 DOI: 10.1007/s10067-023-06677-7] [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: 10/18/2022] [Revised: 05/27/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023]
Abstract
AIM Morphea, also known as localized scleroderma, is an immune-mediated disease and the most common form of scleroderma in children. It is a localized sclerosing disease of the skin, but can also involve such adjacent tissues as the fascia, muscle, bone, and underlying tissues. This multicenter study aimed to evaluate Turkish pediatric morphea patients, regarding demographics, treatments, and response to treatment. MATERIALS AND METHODS The study was performed by the Pediatric Rheumatology Academy and included pediatric morphea patients from 6 Turkish pediatric rheumatology centers who were followed up for ≥6 months. Demographic, clinical, and laboratory findings and treatment modalities were analyzed. The patients were divided into 3 groups according to treatment response, as follows: group 1: topical treatment response, group 2: methotrexate response, and group 3: methotrexate resistance. Clinical findings were compared between the 3 groups. RESULTS The study included 76 patients, of which 53 (69.7%) were female. Mean age at diagnosis of morphea was 9.7 ± 4.3 years and mean duration of follow-up was 3.2 ± 2.9 years. Linear morphea was the most common form, accounting for 43.4% (n = 33) of the patients. Extracutaneous features were noted in 17 patients (22.4%) and anti-nuclear antibody positivity was noted in 32 (42.1%). In all, 14.4% of the patients received topical treatment only, whereas 86.6% received both topical and systemic treatment. The methotrexate response rate was 76.9% in the patients that received systemic immunosuppressive therapy. The overall relapse rate while under treatment was 19.7%. CONCLUSION In this study, most of the pediatric morphea patients responded well to methotrexate. Bilateral lesions were more common in the methotrexate-resistant group. Multiple involvement, and bilateral lesions, were more common in relapsed patients than in non-relapsed patients. Key points • Most of the pediatric morphea patients respond well to MTX. • Multiple involvement, and bilateral involvement, were more common in relapsed patients than in non-relapsed patients. • Presence of extracutaneous findings in patients increased relapse rate 5.7 times.
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Affiliation(s)
- Esra Bağlan
- Department of Pediatric Rheumatology, Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, 06080, Ankara, Turkey.
| | - Zehra Kızıldağ
- Department of Pediatric Rheumatology, Dokuz Eylül University Medical School, Izmir, Turkey
| | - Şengül Çağlayan
- Department of Pediatric Rheumatology, Umraniye Research and Training Hospital, University of Health Science, Istanbul, Turkey
| | - Figen Çakmak
- Department of Pediatric Rheumatology, Istanbul University Medical School, Istanbul, Turkey
| | | | - Semanur Özdel
- Department of Pediatric Rheumatology, Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, 06080, Ankara, Turkey
| | - Kübra Öztürk
- Department of Pediatric Rheumatology, Göztepe Research and Training Hospital, Istanbul, Turkey
| | - Balahan Makay
- Department of Pediatric Rheumatology, Dokuz Eylül University Medical School, Izmir, Turkey
| | - Mustafa Çakan
- Department of Pediatric Rheumatology, Umraniye Research and Training Hospital, University of Health Science, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Istanbul University Medical School, Istanbul, Turkey
| | - Betül Sözeri
- Department of Pediatric Rheumatology, Umraniye Research and Training Hospital, University of Health Science, Istanbul, Turkey
| | - Şevket Erbil Ünsal
- Department of Pediatric Rheumatology, Dokuz Eylül University Medical School, Izmir, Turkey
| | - Mehmet Bülbül
- Department of Pediatric Rheumatology, Dr. Sami Ulus Gynecology Obstetrics and Child Health and Diseases Training and Research Hospital, 06080, Ankara, Turkey
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Luch S, Men P, Fischer G, Wu A. Diagnosing and Managing Linear Scleroderma in a Low-Resource Setting. Case Rep Pediatr 2023; 2023:3918638. [PMID: 37636244 PMCID: PMC10449588 DOI: 10.1155/2023/3918638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/29/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023] Open
Abstract
Background Linear scleroderma is one of the five forms of scleroderma, but it is the most common form of localized scleroderma in childhood. If left untreated, it can lead to severe disfigurement and functional impairment. The typical appearance is a linear streak with cutaneous induration on the face or head in association with various ophthalmological and neurological signs and symptoms. Treatment typically includes corticosteroids and/or methotrexate with life-long monitoring for recurrence. Case Presentation. A 12-year-old girl presented to our clinic in northern rural Cambodia with a history of a linear streak on her forehead that was growing down her nasal bridge. She denied any tenderness or family history of rheumatic disease. Her history was significant for strabismus as a child. A visiting pediatric rheumatologist assisted us with the appropriate diagnosis and treatment plan. Conclusion In our case report, we present a child with linear scleroderma who fortunately came to medical attention early and received appropriate treatment before the onset of complications. She was treated with systemic immunosuppression as well as topical steroids. After treatment, she had no further progression on her face and continued to follow up with us to monitor for disease activity. To summarize, linear scleroderma is an uncommon diagnosis for general pediatricians and should be recognized early to provide appropriate treatment and follow-up.
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Affiliation(s)
- Sreyleak Luch
- Chenla Children's Healthcare, Sangkat Krachech, Krong Krachech, Kratie Province, Cambodia
| | - Pauravy Men
- Chenla Children's Healthcare, Sangkat Krachech, Krong Krachech, Kratie Province, Cambodia
| | - Gwenyth Fischer
- Department of Pediatrics, Pediatric Critical Care Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Andrew Wu
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
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Cetin S, Ayan A, Hekim H. Effects of fibromyalgia syndrome in patients with diffuse systemic sclerosis: Evaluation with 2010 American college of rheumatology criteria set. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_112_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Morphea, also known as localized scleroderma, is a chronic, autoimmune disease of connective tissue. It is characterized by a typical clinical feature. In morphea, there is no Raynaud’s phenomenon, no sclerodactyly or no ulcerations on the fingertips. Although morphea and systemic sclerosis have been perceived as separate disease entities for years, they are still confused both by patients (which is a source of unnecessary stress) and doctors. This may be due to, in part, misunderstood terminology. The controversy around morphea also concerns the division of this disease entity, including its less common subtypes, such as eosinophilic fasciitis. Discussions also revolve around the diagnostic aspects and possible treatment options. The paper attempts to present the debatable aspects regarding nomenclature, classification, diagnosis and treatment of morphea.
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Chen B, Xue M, Yang J, Li M. The efficacy of early immunosuppression in a morphea patient complicated with pulmonary interstitial fibrosis. Dermatol Ther 2019; 32:e13061. [PMID: 31412161 DOI: 10.1111/dth.13061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/08/2019] [Accepted: 08/10/2019] [Indexed: 01/15/2023]
Abstract
Currently seldom cases have been reported that generalized morphea could accompany with organ dysfunction. However, our study reveals not only morphea could complicate with intranet organ involvements but it may also be the early phase of systemic sclerosis. Furthermore, our therapy challenged the traditional morphea treatment to prove that cyclophosphamide and glucocorticoid are efficient to treat morphea with organ dysfunction.
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Affiliation(s)
- Binglin Chen
- Department of Dermatology, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Meijuan Xue
- Department of Dermatology, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Ji Yang
- Department of Dermatology, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Ming Li
- Department of Dermatology, Zhongshan Hospital of Fudan University, Shanghai, China
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Chatzinikolaou SL, Quirk B, Murray C, Planche K. Radiological findings in gastrointestinal scleroderma. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2019; 5:21-32. [DOI: 10.1177/2397198319848550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/09/2019] [Indexed: 11/17/2022]
Abstract
Gastrointestinal involvement is the most common visceral organ manifestation in systemic sclerosis. Symptoms from the gastrointestinal tract are very frequent among scleroderma patients and in many cases present a therapeutic challenge. However, gastrointestinal involvement may also be asymptomatic, presenting with complications later in the disease course. Early recognition of gastrointestinal scleroderma is therefore important both for symptomatic control and prevention of complications. Gastrointestinal imaging alongside clinical assessment forms the mainstay of diagnosis. Radiological investigations, traditionally plain radiographs and barium studies, with the more recent advances in computed tomography, magnetic resonance imaging and ultrasound, provide means for accurate evaluation of visceral organ involvement and more effective patient care. Awareness of the characteristic images is important not only for radiologists but also for the treating physicians and gastroenterologists.
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Affiliation(s)
- Stamatia-Lydia Chatzinikolaou
- Department of Gastroenterology, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, Royal Free London NHS Foundation Trust, London, UK
| | - Bernadine Quirk
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Charles Murray
- Department of Gastroenterology, The Royal Free Hospital and University College London (UCL) Institute for Liver and Digestive Health, Royal Free London NHS Foundation Trust, London, UK
| | - Katie Planche
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
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Ha DH, Lee MJ, Kim SJ. Ultrasonographic Findings of Scleredema Adultorum of Buschke Involving the Posterior Neck. Korean J Radiol 2018; 19:425-430. [PMID: 29713220 PMCID: PMC5904469 DOI: 10.3348/kjr.2018.19.3.425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/18/2017] [Indexed: 11/23/2022] Open
Abstract
Objective To describe the clinical and ultrasonographic (US) findings in patients with scleredema adultorum of Buschke, who presented with sclerotic skin on their posterior neck. Materials and Methods After obtaining IRB approval, eight patients with scleredema adultorum of Buschke were enrolled. They underwent US examination of their posterior neck. The diagnoses were confirmed pathologically. The clinical history and US images were evaluated retrospectively. Dermal thickness was compared between the patient group and the age- and sex-matched control group. Results The patients included seven males and one female with a mean age of 51.5 years. All patients presented with thickening of the skin and/or a palpable mass on the posterior neck. Five (62.5%) of the eight patients showed erythematous discoloration. Six patients (75.0%) had a history of diabetes. The Hemoglobin A1c level was found to be increased in all patients. US images did not show any evidence of a soft tissue mass or infection. The mean dermal thickness in patients (7.01 ± 1.95 mm) was significantly greater than that in the control group (3.08 ± 0.87 mm) (p = 0.001). Multiple strong echogenic spots in the dermis were seen in all patients. Seven patients (87.5%) showed posterior shadowing in the lower dermis. Conclusion When a patient with a history of diabetes presents with a palpable mass or erythematous discoloration of the posterior neck and US shows the following imaging features: 1) no evidence of a soft tissue mass or infection, 2) thickening of the dermis, 3) multiple strong echogenic spots and/or posterior shadowing in the dermis, scleredema adultorum of Buschke should be considered in the differential diagnosis.
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Affiliation(s)
- Dong-Ho Ha
- Department of Radiology, Dong-A University College of Medicine, Busan 49201, Korea
| | - Myung Jin Lee
- Department of Orthopedics, Dong-A University College of Medicine, Busan 49201, Korea
| | - Su-Jin Kim
- Department of Pathology, Dong-A University College of Medicine, Busan 49201, Korea
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Brembilla NC, Dufour AM, Alvarez M, Hugues S, Montanari E, Truchetet ME, Lonati P, Fontao L, Gabrielli A, Vettori S, Valentini G, Boehncke WH, Meroni P, Chizzolini C. IL-22 capacitates dermal fibroblast responses to TNF in scleroderma. Ann Rheum Dis 2016; 75:1697-705. [PMID: 26452537 DOI: 10.1136/annrheumdis-2015-207477] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 09/20/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Interleukin (IL) 22 mRNA in systemic sclerosis (SSc) skin and Th22 cells in SSc peripheral blood are increased, but the role of IL-22 in fibrosis development remains poorly understood. METHODS Biopsies were obtained from the involved skin of 15 SSc, 4 morphea and 8 healthy donors (HD). The presence of IL-22+ cells in the skin was determined by immunostaining. The in vitro response of HD and SSc fibroblasts to IL-22, IL-22 in conjunction with tumour necrosis factor (TNF) or keratinocyte conditioned medium was assessed by ELISA, radioimmunoassay (RIA), real-time PCR and western blot. The in vivo response in mice was assessed by histomorphometry. RESULTS IL-22+ cells were over-represented in the dermis and epidermis of morphea and in the epidermis of SSc compared with HD. The majority of dermal IL-22+ cells were T cells. Dermal fibroblasts expressed both IL-22 receptor subunits IL-10RB and IL-22RA, expression of which was enhanced by TNF and reduced by transforming growth factor (TGF)-β. IL-22 induced rapid phosphorylation of p38 and ERK1/2 in fibroblasts, but failed to induce the synthesis of chemokines and extracellular matrix components. However, IL-22 enhanced the production of monocyte chemotactic protein 1, IL-8 and matrix metalloproteinase 1 induced by TNF. Fibroblast responses were maximal in the presence of conditioned medium from keratinocytes activated by IL-22 in conjunction with TNF. Dermal thickness was maximal in mice injected simultaneously with IL-22 and TNF. CONCLUSIONS IL-22 capacitates fibroblast responses to TNF and promotes a proinflammatory fibroblast phenotype by favouring TNF-induced keratinocyte activation. These results define a novel role for keratinocyte-fibroblast interactions in the context of skin fibrosis.
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Affiliation(s)
- Nicolò Costantino Brembilla
- Department of Immunology and Allergy, University Hospital and School of Medicine, Geneva, Switzerland Department of Dermatology, University Hospital and School of Medicine, Geneva, Switzerland Department of Pathology and Immunology, School of Medicine, Geneva, Switzerland
| | - Aleksandra Maria Dufour
- Department of Immunology and Allergy, University Hospital and School of Medicine, Geneva, Switzerland Department of Pathology and Immunology, School of Medicine, Geneva, Switzerland
| | - Montserrat Alvarez
- Department of Immunology and Allergy, University Hospital and School of Medicine, Geneva, Switzerland Department of Pathology and Immunology, School of Medicine, Geneva, Switzerland
| | - Stéphanie Hugues
- Department of Pathology and Immunology, School of Medicine, Geneva, Switzerland
| | - Elisa Montanari
- Department of Immunology and Allergy, University Hospital and School of Medicine, Geneva, Switzerland
| | - Marie-Elise Truchetet
- Department of Immunology and Allergy, University Hospital and School of Medicine, Geneva, Switzerland
| | - Paola Lonati
- Department of Immunology and Allergy, University Hospital and School of Medicine, Geneva, Switzerland Experimental Laboratory of Immunological and Rheumatologic Researches, IRCSS Istituto Auxologico Italiano, Milan, Italy
| | - Lionel Fontao
- Department of Dermatology, University Hospital and School of Medicine, Geneva, Switzerland
| | - Armando Gabrielli
- Department of Internal Medicine, Institute of Clinica Medica, Ancona, Italy
| | - Serena Vettori
- Department of Rheumatology, Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Gabriele Valentini
- Department of Rheumatology, Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Wolf-Henning Boehncke
- Department of Dermatology, University Hospital and School of Medicine, Geneva, Switzerland Department of Pathology and Immunology, School of Medicine, Geneva, Switzerland
| | - Pierluigi Meroni
- Experimental Laboratory of Immunological and Rheumatologic Researches, IRCSS Istituto Auxologico Italiano, Milan, Italy Division of Rheumatology, Istituto G Pini, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Carlo Chizzolini
- Department of Immunology and Allergy, University Hospital and School of Medicine, Geneva, Switzerland Department of Pathology and Immunology, School of Medicine, Geneva, Switzerland
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Orofacial Manifestations and Temporomandibular Disorders of Systemic Scleroderma: An Observational Study. Int J Mol Sci 2016; 17:ijms17071189. [PMID: 27455250 PMCID: PMC4964558 DOI: 10.3390/ijms17071189] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/08/2016] [Accepted: 07/19/2016] [Indexed: 12/22/2022] Open
Abstract
Scleroderma is a disorder involving oral and facial tissues, with skin hardening, thin lips, deep wrinkles, xerostomia, tongue rigidity, and microstomia. The aim of this study was to investigate the prevalence of oral manifestations and temporomandibular disorders (TMD) in Systemic Sclerosis (SSc) patients compared with healthy people. Eighty patients (6 men, 74 women) fulfilling ACR/EULAR SSc Criteria were enrolled. A randomly selected group of 80 patients, matched by sex and age served as control group. The examination for TMD signs and symptoms was based on the standardized Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) through a questionnaire and clinical examination. SSc patients complained more frequently (78.8%) of oral symptoms (Xerostomia, dysgeusia, dysphagia and stomatodynia) than controls (28.7%) (χ2 = 40.23 p = 0.001). TMD symptoms (muscle pain on chewing, difficulty in mouth opening, headaches) were complained by 92.5% of SSc patients and by 76.2% of controls (χ2 = 8.012 p = 0.005). At the clinical examination, 85% of SSc patients showed restricted opening versus 20.0% of controls (χ2 = 67.77 p = 0.001), 81.2% of SSc showed reduced right lateral excursion versus 50% of controls (χ2 = 17.316 p = 0.001); 73.8% of SSc showed limited left lateral excursion versus 53.8% of controls (χ2 = 6.924 p = 0.009); and 73.8% of SSc had narrow protrusion versus 56.2% of controls (χ2 = 5.385 p = 0.02).
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Gorkiewicz-Petkow A, Kalinska-Bienias A. Systemic involvement in localized scleroderma/morphea. Clin Dermatol 2015; 33:556-62. [DOI: 10.1016/j.clindermatol.2015.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Toki S, Motegi SI, Yamada K, Uchiyama A, Kanai S, Yamanaka M, Ishikawa O. Clinical and laboratory features of systemic sclerosis complicated with localized scleroderma. J Dermatol 2015; 42:283-7. [PMID: 25582037 DOI: 10.1111/1346-8138.12775] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 12/09/2014] [Indexed: 02/04/2023]
Abstract
Localized scleroderma (LSc) primarily affects skin, whereas systemic sclerosis (SSc) affects skin and various internal organs. LSc and SSc are considered to be basically different diseases, and there is no transition between them. However, LSc and SSc have several common characteristics, including endothelial cell dysfunction, immune activation, and excess fibrosis of the skin, and there exist several SSc cases complicated with LSc during the course of SSc. Clinical and laboratory characteristics of SSc patients with LSc remain unclear. We investigated the clinical and laboratory features of 8 SSc patients with LSc among 220 SSc patients (3.6%). The types of LSc included plaque (5/8), guttate (2/8), and linear type (1/8). All cases were diagnosed as having SSc within 5 years before or after the appearance of LSc. In three cases of SSc with LSc (37.5%), LSc skin lesions preceded clinical symptoms of SSc. Young age, negative antinuclear antibody, and positive anti-RNA polymerase III antibody were significantly prevalent in SSc patients with LSc. The positivity of anticentromere antibody tended to be prevalent in SSc patients without LSc. No significant difference in the frequency of complications, such as interstitial lung disease, reflux esophagitis, and pulmonary artery hypertension, was observed. The awareness of these characteristic of SSc with LSc are essential to establish an early diagnosis and treatment.
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Affiliation(s)
- Sayaka Toki
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Arslan Tas D, Yıldız F, Sakallı H, Kelle B, Ballı T, Erken E. Sacroiliac joint involvement in systemic sclerosis. Int J Rheum Dis 2014; 18:84-90. [PMID: 24807846 DOI: 10.1111/1756-185x.12379] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM One of the major problems for systemic sclerosis (SSc) patients is suggested to be articular involvement. Mostly involved joints in SSc were reported as wrist, carpometacarpal-interphalangeal, foot, knee, hip and shoulder; however, there has been little knowledge on the sacroiliac joint. Our aim was to evaluate sacroiliac joint involvement in SSc. METHODS Fifty-seven SSc patients, 54 rheumatoid arthritis patients and 64 healthy subjects were included. Anteroposterior pelvic radiographs were obtained and graded twice by three blinded rheumatologists. One competent radiologist has re-evaluated the X-ray results. The ASAS (Assessment of Spondylo Arthritis International Society) scoring method was applied for grading sacroiliac involvement. Inflammatory back pain was also evaluated. Other clinical and laboratory data were collected as proposed by the European Study Group. RESULTS In the SSc group sacroiliitis was found in 13 patients (23%) and was significantly different from RA patients (two patients, 4%), P = 0.003; and the healthy control group (one participant, 2%), P < 0.001. The frequency of inflammatory back pain in SSc patients with sacroiliitis (8/13 patients, 62%) was significantly higher in SSc patients without sacroiliitis (4/44 patients, 9%), P < 0.001. The SSc patients with sacroiliitis and with inflammatory back pain (8/57 patients, 14%) were regarded as axial spondyloarthritis overlap. Male gender, diffuse subtype, inflammatory back pain and high C-reactive protein levels (odds ratio: 1.069, 1.059, 1.059 and 3.698, respectively) were found to be the significant risk factors for sacroiliitis. CONCLUSION We suggest that, sacroiliitis may be a concern to be considered in SSc practice.
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Affiliation(s)
- Didem Arslan Tas
- Rheumatology-Immunology Department, Faculty of Medicine, Cukurova University, Adana, Turkey
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Szramka-Pawlak B, Dańczak-Pazdrowska A, Rzepa T, Szewczyk A, Sadowska-Przytocka A, Żaba R. Quality of Life and Optimism in Patients with Morphea. APPLIED RESEARCH IN QUALITY OF LIFE 2013; 9:863-870. [PMID: 25400708 PMCID: PMC4224736 DOI: 10.1007/s11482-013-9273-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 10/23/2013] [Indexed: 06/04/2023]
Abstract
Despite extensive knowledge about quality of life of people suffering from dermatological diseases, data on patients with morphea are scarce. The aim of our study was to compare the quality of life of healthy controls and morphea patients, as well as to determine the correlation of this variable with the level of dispositional optimism. The study included 47 patients with morphea and 47 healthy controls, matched for gender and age. Cantril's Ladder and Life Orientation Test-Revised were used to assess the levels of life satisfaction and dispositional optimism, respectively. LoSSI was used for the objective assessment. The anticipated level of life quality and the level of dispositional optimism were statistically significantly lower in morphea patients (p = 0.032 and p = 0.014, respectively) when compared to controls. There were no differences in the assessment of current (p = 0.168) and past (p = 0.318) levels of life quality. Also, we proved that type of morphea did not differentiate the current (p = 0.175), past (p = 0.620) and future (p = 0.356) assessment of the quality of life. In the group of morphea patients there was a statistically significant correlation between the level of dispositional optimism and current (p = 0.002, r = 0.43), as well as anticipated (p < 0.001, r = 0.57) levels of life quality. Current level of life quality of healthy controls and morphea patients is comparable, whereas the latter anticipate their future life situation to be significantly worse than the former. Higher level of life satisfaction correlates with higher level of optimism.
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Affiliation(s)
- Beata Szramka-Pawlak
- Department of Dermatology and Venereology, Poznan University of Medical Sciences, ul. Przybyszewskiego 49, Poznan, 60-355 Poland
| | | | - Teresa Rzepa
- Faculty in Poznan, University of Social Sciences and Humanities, Poznan, Poland
| | - Aleksandra Szewczyk
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Ryszard Żaba
- Department of Dermatology and Venereology, Poznan University of Medical Sciences, ul. Przybyszewskiego 49, Poznan, 60-355 Poland
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Dvornikov AS. Treatment of localized scleroderma with hyaluronidase. VESTNIK DERMATOLOGII I VENEROLOGII 2013. [DOI: 10.25208/vdv627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Goal. To evaluate the efficacy of treatment of patients suffering from localized scleroderma with Longidaza. Materials and methods. The study sample included 300 patients with localized scleroderma (158 with the plaque form and 142 with white spot disease) treated with Longidaza in 2002—2010. Results. Complex therapy of patients suffering from localized scleroderma with Longidaza proved to be efficient in 71.3% of the patients. Conclusion. These results confirm that inclusion of the Russian enzymatic drug Longidaza into the complex treatment of patients suffering from the aforesaid pathology seems to be expedient.
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Fuschiotti P, Larregina AT, Ho J, Feghali-Bostwick C, Medsger TA. Interleukin-13-producing CD8+ T cells mediate dermal fibrosis in patients with systemic sclerosis. ACTA ACUST UNITED AC 2013; 65:236-46. [PMID: 23001877 DOI: 10.1002/art.37706] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Accepted: 09/11/2012] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Fibrosis is a major contributor to morbidity and mortality in systemic sclerosis (SSc). T cells are the predominant inflammatory infiltrate in affected tissue and are thought to produce cytokines that drive the synthesis of extracellular matrix (ECM) proteins by fibroblasts, resulting in excessive fibrosis. We have previously shown that aberrant interleukin-13 (IL-13) production by peripheral blood effector CD8+ T cells from SSc patients correlates with the extent of skin fibrosis. The present study was undertaken to investigate the role of IL-13 production by CD8+ T cells in dermal fibrosis, an early and specific manifestation of SSc. METHODS ECM protein production by normal dermal fibroblasts cocultured with SSc CD8+ T cell supernatants was determined by quantitative polymerase chain reaction and Western blotting. Skin-homing receptor expression and IL-13 production by CD8+ T cells in the peripheral blood of SSc patients were measured by flow cytometry. IL-13+ and CD8+ cells in sclerotic skin were identified by immunohistochemistry. RESULTS IL-13-producing circulating CD8+ T cells from patients with SSc expressed skin-homing receptors and induced a profibrotic phenotype in normal dermal fibroblasts, which was inhibited by an anti-IL-13 antibody. High numbers of CD8+ T cells and IL-13+ cells were found in the skin lesions of SSc patients, particularly during the early inflammatory phase of the disease. CONCLUSION These findings show that IL-13-producing CD8+ T cells are directly involved in modulating dermal fibrosis in SSc. The demonstration that CD8+ T cells homing to the skin early in the course of SSc are associated with accumulation of IL-13 is an important mechanistic contribution to the understanding of the pathogenesis of dermal fibrosis in SSc and may represent a potential target for therapeutic intervention.
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Affiliation(s)
- Patrizia Fuschiotti
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA.
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Abstract
This article outlines the epidemiology, pathogenesis, clinical presentation, diagnosis, and treatment of childhood morphea. Also known as localized scleroderma, morphea is a fibrosing disorder of the skin and subcutaneous tissues. Morphea is differentiated from systemic sclerosis (scleroderma) based on the absence of sclerodactyly, Raynaud phenomenon, and nail-fold capillary changes. Confusion may occur because patients with morphea often have systemic symptoms such as malaise, fatigue, arthralgias, myalgias, and positive autoantibodies. Unlike morphea, systemic sclerosis has organ involvement, particularly gastrointestinal, pulmonary, and renal.
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Affiliation(s)
- John C Browning
- Division of Dermatology and Cutaneous Surgery, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
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Moulin C, Cavailhes A, Balme B, Skowron F. Morphoea-like plaques revealing an eosinophilic (Shulman) fasciitis. Clin Exp Dermatol 2009; 34:e851-3. [DOI: 10.1111/j.1365-2230.2009.03602.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Reddy BY, Hantash BM. Cutaneous Connective Tissue Diseases: Epidemiology, Diagnosis, and Treatment. ACTA ACUST UNITED AC 2009; 3:22-31. [PMID: 21218179 DOI: 10.2174/1874372200903010022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Connective tissue diseases (CTDs) are a group of clinical disorders that have an underlying autoimmune pathogenesis. These include a diverse set of diseases such as relapsing polychondritis, rheumatoid arthritis, and eosinophilic fasciitis, along with more common entities like Sjogren's syndrome, dermatomyositis, scleroderma, and lupus erythematosus. The latter three will be the focus of this review, as they constitute the most significant and common CTD with cutaneous manifestations. The cutaneous signs often represent the preliminary stages of disease and the presenting clinical symptoms. Therefore, comprehensive knowledge of CTD manifestations is essential for accurate diagnosis, better assessment of prognosis, and effective management. Although the precise etiologies of CTDs remain obscure, recent advances have allowed for further understanding of their pathogenesis and improved disease classifications. In addition, there have been developments in therapeutic options for CTDs. This review provides an overview of the epidemiology, clinical presentations, and current treatment options of cutaneous lupus erythematous, dermatomyositis and scleroderma.
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