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Driskill E, Zhang Z, Chi J, Cui Q. Increased rate of complications following total knee arthroplasty in patients with systemic sclerosis. INTERNATIONAL ORTHOPAEDICS 2023; 47:2563-2569. [PMID: 37354225 DOI: 10.1007/s00264-023-05873-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Outcomes after total knee arthroplasty (TKA) for patients with systemic sclerosis (SSc) are poorly documented in the literature. The purpose of this study was to evaluate SSc as a potential risk factor for increased rate of complications after TKA. METHODS Using the PearlDiver Mariner database, 2,002 patients with SSc undergoing primary TKA were identified and compared to matched controls of 19,892 patients without SSc. Multivariable logistic regression analyses were done for medical complications up to 90 days and surgical complications up to two years. 90-day ED-visit and inpatient readmission were also documented. RESULTS Compared to the matched controls, patients with SSc demonstrated higher rates of medical complications such as cerebrovascular accident (1.5% vs 0.6%, p < 0.001), myocardial infarction (1.3% vs 0.3%, p < 0.001), and sepsis (1.1% vs 0.4%, p < 0.001). Additionally, patients with SSc displayed elevated rates of surgical complications, including wound complications (3.9% vs 2.2%, p < 0.001) and aseptic loosening at 90 days (0.2% vs 0.1%; OR 3.53 [1.13-9.28]), one year (0.7% vs 0.4%; OR 1.78 [0.96-3.05]), and two years (1.4% vs 0.9%; OR 1.68 [1.10-2.45]). Patients with SSc also had higher rates of emergency department visits (21.2% vs 11.4%, p < 0.001). CONCLUSIONS Patients with SSc are at higher risks of postoperative complications, encompassing both medical and surgical complications. Specifically, patients with SSc have a significantly higher likelihood of experiencing wound complications, cerebrovascular accident, and myocardial infarction. It is crucial for orthopaedic surgeons and patients alike to consider the elevated risks when determining a course of TKA for patients with SSc.
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Affiliation(s)
- Elizabeth Driskill
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA
| | - Zhichang Zhang
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, Henan, China
| | - Jialun Chi
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA.
- , Charlottesville, USA.
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Esophageal dysmotility and lung disease in patients with systemic sclerosis: is there a possible association or correlation? A retrospective chart review. Rheumatol Int 2021; 41:1965-1970. [PMID: 34032895 DOI: 10.1007/s00296-021-04880-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Our aim was to evaluate the relationship between esophageal dysmotility and lung disease by correlating the results of Echocardiogram and Pulmonary Function Test (PFT) with Esophageal Transit Study (ETT). METHODS Charts of Systemic Sclerosis (SSc) patients fulfilling 2013 ACR/EULAR classification criteria seen in Rheumatology clinics were reviewed and their demographics, ETT result, PFT, and echocardiogram data were collected at baseline, years 1, 3, 5, and 10. Patients were divided based on their ETT status and were compared with respect to each variable using a two-sided two-sample t test for continuous variables and a Fisher's exact test for categorical variables. RESULTS 130 patients were identified with either limited cutaneous SSc (109) or diffuse cutaneous SSc (21) with a mean age of 52.65 years. The mean DLCO was statistically worse in abnormal ETT patients [p value = 0.0004] as were the progression rates per year for DLCO at - 2.25 (p value = 0.019). Progression rate of FVC per year was statistically significant in the abnormal ETT group, although the mean value was not. The number of patients with abnormal PASP was not statistically different between the two groups (p values 0.104, 0.178, 0.653 at baseline, years 3 and 5, respectively). CONCLUSION The presence of esophageal dysmotility was associated with increased pulmonary involvement in the form of abnormal DLCO with worsening progression rates per year. There was no statistically significant difference in PASP and FVC between the two groups; however, the progression rate for FVC was worse in adjusted models.
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Khan SI, Bachani P, Saleem A, Jameel A, Khawaja UA. Primary Biliary Cholangitis and CREST Syndrome: A Rare, Overlapping Presentation With a Review of the Literature. Cureus 2020; 12:e11986. [PMID: 33425554 PMCID: PMC7788041 DOI: 10.7759/cureus.11986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) syndrome, also known as the limited cutaneous form of systemic sclerosis (lcSSc), is a multisystem connective tissue disorder often manifesting as a consequence of superimposed autoimmune hepatitis. Herein, we present a case of a 40-year-old female with a past one-year history of hepatitis C presenting with the chief complaints of progressive thickness and tightness of the skin of hands and face and dysphagia for the past three months, along with arthralgia of the hands for the past two months, suggestive of CREST syndrome. Through this case, we intend to emphasize the association between extrahepatic manifestations and the emergence of autoantibodies in patients with hepatitis C virus (HCV) infection and discuss the clinical relevance of the autoantibodies in extrahepatic disorders, in our case, CREST syndrome. It is well-known that chronic HCV infection plays a significant part in the production of non-organ-specific autoantibodies, including antinuclear antibodies (ANA) and smooth muscle antibodies, and organ-specific autoantibodies. Clinicians must be aware of the possibility of such liver damage in patients with systemic sclerosis.
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Affiliation(s)
- Shayan Iqbal Khan
- Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Parkash Bachani
- Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Amna Saleem
- Medicine, Jinnah Medical and Dental College, Karachi, PAK
| | - Arifa Jameel
- Internal Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Uzzam Ahmed Khawaja
- Internal Medicine, Jinnah Medical and Dental College, Karachi, PAK.,Clinical and Translational Research, Larkin Community Hospital, South Miami, USA
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Seyam O, Smith NL, Reid I, Gandhi J, Jiang W, Khan SA. Clinical utility of ozone therapy for musculoskeletal disorders. Med Gas Res 2018; 8:103-110. [PMID: 30319765 PMCID: PMC6178642 DOI: 10.4103/2045-9912.241075] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/09/2018] [Indexed: 01/03/2023] Open
Abstract
Oxygen-ozone (O3) therapy serves as an alternative medical technique that increases the oxygen in the body along with the introduction of O3. O3 therapy has finally reached a level where the biological mechanisms of action have been understood, showing that they are in the domain of physiology, biochemistry, and pharmacology. Few clinical applications have been reviewed here as well as exemplifying that O3 therapy is particularly useful in musculoskeletal disorders. In the therapeutic range, O3 can be used as a more effective and safe substitute of standard medications. O3 therapy has been used for many years for its ability to inactivate various viruses, cancer, and acquired immune deficiency syndrome but is now making strides in the treatment of musculoskeletal disorders such as rheumatoid arthritis, lumbar facet joint syndrome, subacromial bursitis, carpal tunnel syndrome, osteoarthritis, hip bursitis, shoulder adhesive capsulitis, herniated disc, and temporomandibular joint disorder.
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Affiliation(s)
- Omar Seyam
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | | | - Inefta Reid
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Jason Gandhi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA.,Medical Student Research Institute, St. George's University School of Medicine, Grenada, West Indies
| | - Wendy Jiang
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA.,Department of Urology, Stony Brook University School of Medicine, Stony Brook, NY, USA
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Silva BRA, Rodrigues RS, Rufino R, Costa CH, Vilela VS, Levy RA, Guimarães ARM, Carvalho ARS, Lopes AJ. Computed tomography trachea volumetry in patients with scleroderma: Association with clinical and functional findings. PLoS One 2018; 13:e0200754. [PMID: 30067820 PMCID: PMC6070209 DOI: 10.1371/journal.pone.0200754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 07/01/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In scleroderma, excessive collagen production can alter tracheal geometry, and computed tomography (CT) volumetry of this structure may aid in detecting possible abnormalities. The objectives of this study were to quantify the morphological abnormalities in the tracheas of patients with scleroderma and to correlate these findings with data on clinical and pulmonary function. METHODS This was a cross-sectional study in which 28 adults with scleroderma and 27 controls matched by age, gender and body mass index underwent chest CT with posterior segmentation and skeletonization of the images. In addition, all participants underwent pulmonary function tests and clinical evaluation, including the modified Rodnan skin score (mRSS). RESULTS Most patients (71.4%) had interstitial lung disease on CT. Compared to controls, patients with scleroderma showed higher values in the parameters measured by CT trachea volumetry, including area, eccentricity, major diameter, minor diameter, and tortuosity. The tracheal area and equivalent diameter were negatively correlated with the ratio between forced expiratory flow and forced inspiratory flow at 50% of forced vital capacity (FEF50%/FIF50%) (r = -0.44, p = 0.03 and r = -0.46, p = 0.02, respectively). The tracheal tortuosity was negatively correlated with peak expiratory flow (r = -0.51, p = 0.008). The mRSS showed a positive correlation with eccentricity (r = 0.62, p < 0.001) and tracheal tortuosity (r = 0.51, p = 0.007), while the presence of anti-topoisomerase I antibody (ATA) showed a positive correlation with tracheal tortuosity (r = 0.45, p = 0.03). CONCLUSIONS In a sample composed predominantly of scleroderma patients with associated interstitial lung disease, there were abnormalities in tracheal geometry, including greater eccentricity, diameter and tortuosity. In these patients, abnormalities in the geometry of the trachea were associated with functional markers of obstruction. In addition, tracheal tortuosity was correlated with cutaneous involvement and the presence of ATA.
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Affiliation(s)
- Bruno Rangel Antunes Silva
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rogério Rufino
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cláudia Henrique Costa
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Veronica Silva Vilela
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roger Abramino Levy
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alan Ranieri Medeiros Guimarães
- Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alysson Roncally Silva Carvalho
- Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratory of Pulmonary Engineering, Biomedical Engineering Programme, Alberto Luiz Coimbra Institute of Post-Graduation and Research in Engineering, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Agnaldo José Lopes
- Postgraduate Programme in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Shah J, Shahidullah A. Chronic Intestinal Pseudo-Obstruction in Systemic Sclerosis: An Uncommon Presentation. Case Rep Gastroenterol 2018; 12:373-378. [PMID: 30057521 PMCID: PMC6062715 DOI: 10.1159/000490526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/29/2018] [Indexed: 01/10/2023] Open
Abstract
Chronic intestinal pseudo-obstruction (CIPO) is an uncommon disorder characterized by the presence of bowel dilatation and abnormal motility. It is an important cause of chronic intestinal failure in patients with systemic sclerosis (SSc). Although intestinal pseudo-obstruction is an infrequent reason for hospitalization in these patients, it has been correlated with high in-hospital mortality compared to SSc patients hospitalized for other reasons as well as patients with intestinal pseudo-obstruction arising from other causes. Patients present with signs and symptoms of mechanical bowel obstruction, such as nausea, vomiting, constipation, abdominal pain, and abdominal distension, in the absence of an anatomic lesion blocking the movement of intestinal contents. Despite breakthroughs in our understanding of this disorder, these patients continue to be treated largely with organ-based symptomatic therapy. Unfortunately, despite treatment, they often experience decreased quality of life and impairment in their everyday lives. Here, we present an interesting case of an individual with SSc for many years who presented with signs and symptoms of CIPO.
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Affiliation(s)
- Jamil Shah
- Department of Internal Medicine, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, New York, USA
| | - Abul Shahidullah
- Department of Medicine, Henry J. Carter Specialty Hospital and Nursing Facility, New York, New York, USA
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