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Aron A, Zavaleta C. Current and Developing Lymphatic Imaging Approaches for Elucidation of Functional Mechanisms and Disease Progression. Mol Imaging Biol 2024; 26:1-16. [PMID: 37195396 PMCID: PMC10827820 DOI: 10.1007/s11307-023-01827-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/18/2023]
Abstract
Study of the lymphatic system, compared to that of the other body systems, has been historically neglected. While scientists and clinicians have, in recent decades, gained a better appreciation of the functionality of the lymphatics as well as their role in associated diseases (and consequently investigated these topics further in their experimental work), there is still much left to be understood of the lymphatic system. In this review article, we discuss the role lymphatic imaging techniques have played in this recent series of advancements and how new imaging techniques can help bolster this wave of discovery. We specifically highlight the use of lymphatic imaging techniques in understanding the fundamental anatomy and physiology of the lymphatic system; investigating the development of lymphatic vasculature (using techniques such as intravital microscopy); diagnosing, staging, and treating lymphedema and cancer; and its role in other disease states.
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Affiliation(s)
- Arjun Aron
- Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA, 90089, USA
- Michelson Center for Convergent Bioscience, University of Southern California, 1002 Childs Way, Los Angeles, CA, 90089, USA
| | - Cristina Zavaleta
- Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA, 90089, USA.
- Michelson Center for Convergent Bioscience, University of Southern California, 1002 Childs Way, Los Angeles, CA, 90089, USA.
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2
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Sevick-Muraca EM, Fife CE, Rasmussen JC. Imaging peripheral lymphatic dysfunction in chronic conditions. Front Physiol 2023; 14:1132097. [PMID: 37007996 PMCID: PMC10050385 DOI: 10.3389/fphys.2023.1132097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/17/2023] [Indexed: 03/17/2023] Open
Abstract
The lymphatics play important roles in chronic diseases/conditions that comprise the bulk of healthcare worldwide. Yet the ability to routinely image and diagnose lymphatic dysfunction, using commonly available clinical imaging modalities, has been lacking and as a result, the development of effective treatment strategies suffers. Nearly two decades ago, investigational near-infrared fluorescence lymphatic imaging and ICG lymphography were developed as routine diagnostic for clinically evaluating, quantifying, and treating lymphatic dysfunction in cancer-related and primary lymphedema, chronic venous disease, and more recently, autoimmune and neurodegenerative disorders. In this review, we provide an overview of what these non-invasive technologies have taught us about lymphatic (dys) function and anatomy in human studies and in corollary animal studies of human disease. We summarize by commenting on new impactful clinical frontiers in lymphatic science that remain to be facilitated by imaging.
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Affiliation(s)
- Eva M. Sevick-Muraca
- Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Caroline E. Fife
- Department of Geriatrics, Baylor College of Medicine, Houston, TX, United States
| | - John C. Rasmussen
- Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Maranini B, Ciancio G, Tessari M, Govoni M. Recurrent and refractory lower limbs lymphedema in psoriatic arthritis: a case description and literature review. VEINS AND LYMPHATICS 2021. [DOI: 10.4081/vl.2021.10079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Lymphedema is an uncommon extra-articular complication of rheumatoid arthritis (RA), but it can also be associated with psoriatic arthritis (PsA), although rarely. While lymphedema associated with RA is well characterized in literature, only few cases have been described among patients with PsA. Upper limbs are the most common sites involved, with asymmetric pattern, even if some patients may present lower limb oedema, or progressive bilateral oedema.
Chronic established lymphoedema deriving from lymphatic vessel dysfunction should be clearly distinct from inflammatory distal pitting edema (IDPE), resulting from tenosynovitis and frequently encountered in PsA. In contrast to lymphedema, the latter condition generally presents an excellent response to steroid therapy, therefore it is essential to recognize the exact etiology of lymphoedema to approach the correct treatment. Here we report a case of lower limbs lymphedema in PsA and review the available literature upon the topic.
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Successful Treatment of Rheumatoid Lymphedema with Lymphatic Venous Anastomosis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3763. [PMID: 34414062 PMCID: PMC8367057 DOI: 10.1097/gox.0000000000003763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/25/2021] [Indexed: 12/03/2022]
Abstract
Rheumatoid lymphedema is a rare but severely disabling condition caused by reduced lymphatic drainage. Most treatment methods are conservative and may lead to the exacerbation of lymphedema. Lymphatic venous anastomosis (LVA) is an effective treatment for lymphedema after surgery involving the lymphatic system, such as lymph node dissection for cancer treatment. LVA has not been used to treat rheumatoid lymphedema. We present a case of rheumatoid lymphedema treated with surgical procedures, including LVA. Following LVA, objective and subjective symptom relief was noted, along with decreased swelling and pain in the affected area. The postoperative course was uneventful. LVA for the treatment of rheumatoid lymphedema may provide definitive clinical improvements.
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Aldrich MB, Rasmussen JC, Fife CE, Shaitelman SF, Sevick-Muraca EM. The Development and Treatment of Lymphatic Dysfunction in Cancer Patients and Survivors. Cancers (Basel) 2020; 12:E2280. [PMID: 32823928 PMCID: PMC7466081 DOI: 10.3390/cancers12082280] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/07/2020] [Accepted: 08/12/2020] [Indexed: 02/08/2023] Open
Abstract
Breast-cancer-acquired lymphedema is routinely diagnosed from the appearance of irreversible swelling that occurs as a result of lymphatic dysfunction. Yet in head and neck cancer survivors, lymphatic dysfunction may not always result in clinically overt swelling, but instead contribute to debilitating functional outcomes. In this review, we describe how cancer metastasis, lymph node dissection, and radiation therapy alter lymphatic function, as visualized by near-infrared fluorescence lymphatic imaging. Using custom gallium arsenide (GaAs)-intensified systems capable of detecting trace amounts of indocyanine green administered repeatedly as lymphatic contrast for longitudinal clinical imaging, we show that lymphatic dysfunction occurs with cancer progression and treatment and is an early, sub-clinical indicator of cancer-acquired lymphedema. We show that early treatment of lymphedema can restore lymphatic function in breast cancer and head and neck cancer patients and survivors. The compilation of these studies provides insights to the critical role that the lymphatics and the immune system play in the etiology of lymphedema and associated co-morbidities.
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Affiliation(s)
- Melissa B. Aldrich
- Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX 77030, USA; (M.B.A.); (J.C.R.)
| | - John C. Rasmussen
- Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX 77030, USA; (M.B.A.); (J.C.R.)
| | - Caroline E. Fife
- Department of Geriatrics, Baylor College of Medicine, Houston, TX 77030, USA;
- The Wound Care Clinic, CHI St. Luke’s Health, The Woodlands Hospital, The Woodlands, TX 77381, USA
| | - Simona F. Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Eva M. Sevick-Muraca
- Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX 77030, USA; (M.B.A.); (J.C.R.)
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6
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Aldrich MB, Velasquez FC, Kwon S, Azhdarinia A, Pinkston K, Harvey BR, Chan W, Rasmussen JC, Ross RF, Fife CE, Sevick-Muraca EM. Lymphatic delivery of etanercept via nanotopography improves response to collagen-induced arthritis. Arthritis Res Ther 2017; 19:116. [PMID: 28566090 PMCID: PMC5452411 DOI: 10.1186/s13075-017-1323-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/09/2017] [Indexed: 12/21/2022] Open
Abstract
Background Evidence suggests lymphatic function mediates local rheumatoid arthritis (RA) flares. Yet biologics that target the immune system are dosed systemically via the subcutaneous (SC) administration route, thereby inefficiently reaching local lymphatic compartments. Nanotopography has previously been shown to disrupt tight cellular junctions, potentially enhancing local lymphatic delivery and potentially improving overall therapeutic efficacy. Method We first characterized nanotopography (SOFUSA™) delivery of an anti-TNF drug, etanercept, by comparing pharmacokinetic profiles to those obtained by conventional SC, intravenous (IV), and intradermal (ID) routes of administration, and assessed uptake of radiolabeled etanercept in draining lymph nodes (LNs) in single dosing studies. We then compared etanercept efficacy in a progressive rat model of collagen-induced arthritis (CIA), administered systemically via SC route of administration; via the regional lymphatics through ID delivery; or through a nanotopography (SOFUSA™) device at 10, 12, and 14 days post CIA induction. Measurements of hind limb swelling and near-infrared fluorescence (NIRF) imaging of afferent lymph pumping function and reflux were conducted on days 11, 13, and 18 post CIA induction and compared to untreated CIA animals. Univariate and multivariate analysis of variance were used to compare the group differences for percentage swelling and lymphatic contractile activity. Results Even though all three modes of administration delivered an equal amount of etanercept, SOFUSA™ delivery resulted in increased lymphatic pumping and significantly reduced swelling as compared to untreated, ID, and SC groups. Pharmacokinetic profiles in serum and LN uptake studies showed that using the nanotopography device resulted in the greatest uptake and retention in draining LNs. Conclusions Locoregional lymphatic delivery of biologics that target the immune system may have more favorable pharmacodynamics than SC or IV administration. Nanotopography may provide a more efficient method for delivery of anti-TNF drugs to reverse impairment of lymphatic function and reduce swelling associated with RA flares. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1323-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Melissa B Aldrich
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX, 77030, USA
| | - Fred C Velasquez
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX, 77030, USA
| | - Sunkuk Kwon
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX, 77030, USA
| | - Ali Azhdarinia
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX, 77030, USA
| | - Kenneth Pinkston
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX, 77030, USA
| | - Barrett R Harvey
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX, 77030, USA
| | - Wenyaw Chan
- Department of Biostatistics, The School of Public Health, The University of Texas Health Science Center, Houston, TX, 77030, USA
| | - John C Rasmussen
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX, 77030, USA
| | | | - Caroline E Fife
- The Wound Care Clinic, CHI St. Luke's Health, The Woodlands Hospital, The Woodlands, TX, 77382, USA
| | - E M Sevick-Muraca
- The Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX, 77030, USA.
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Bouomrani S, Nouma H, Slama A, Chebbi S, Neffoussi M, Fara A, Beji M. [Unilateral lymphedema of the upper limb in a rheumatoid arthritis]. Pan Afr Med J 2015; 21:214. [PMID: 26448809 PMCID: PMC4587082 DOI: 10.11604/pamj.2015.21.214.2708] [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] [Received: 04/09/2013] [Accepted: 04/28/2014] [Indexed: 11/18/2022] Open
Abstract
Les lymphœdèmes chroniques et localisés des membres ne sont qu'exceptionnellement signalés au cours de la polyarthrite rhumatoïde (PR). Nous rapportons l'observation d'une patiente âgée de 63 ans ayant une PR diagnostiquée depuis dix ans et traitée par hydroxychloroquine, prednisone et méthotrexate avec une bonne évolution fût explorée pour une tuméfaction du membre supérieur gauche évoluant depuis deux ans. À l'examen clinique on notait un membre infiltré en totalité, indolore, élastique et recouvert d'une peau tendue, luisante mais d'aspect normal. Le reste de l'examen somatique était sans particularités. La biologie ne montrait pas d'anomalies. L'imagerie médicale (radiographies-X standards des os de l'avant bras et du thorax, scanner-X thoracique, échographie des parties molles et du creux axillaire, doppler artériel et veineux du membre atteint et écho-mammographie) se révélait normale. La lympho-scintigraphie concluait à l'absence de visualisation du réseau lymphatique superficiel gauche. Le diagnostic de lymphœdème secondaire associé à la PR était retenu devant la négativité du bilan étiologique. Une kinésithérapie de drainage lymphatique fût prescrite en association à des assauts cortisoniques mais l'amélioration n’était que partielle. Parmi les manifestations extra articulaires de la PR, les lymphœdèmes chroniques localisés des membres restent inhabituels et souvent méconnus. Leurs mécanismes physiopathologiques sont mal élucidés et leur traitement ne fait pas encore l'unanimité. Ils gardent en revanche une implication pronostique fonctionnelle majeure.
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Affiliation(s)
- Salem Bouomrani
- Service de Médecine Interne, Hôpital Militaire de Gabès, 6000 Gabès, Tunisie
| | - Hanène Nouma
- Service de Médecine Interne, Hôpital Militaire de Gabès, 6000 Gabès, Tunisie
| | - Alaeddine Slama
- Service de Médecine Interne, Hôpital Militaire de Gabès, 6000 Gabès, Tunisie
| | - Safouane Chebbi
- Service de Médecine Interne, Hôpital Militaire de Gabès, 6000 Gabès, Tunisie
| | - Marwa Neffoussi
- Service de Médecine Interne, Hôpital Militaire de Gabès, 6000 Gabès, Tunisie
| | - Afef Fara
- Service de Médecine Interne, Hôpital Militaire de Gabès, 6000 Gabès, Tunisie
| | - Maher Beji
- Service de Médecine Interne, Hôpital Militaire de Gabès, 6000 Gabès, Tunisie
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8
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Shi J, Liang Q, Zuscik M, Shen J, Chen D, Xu H, Wang YJ, Chen Y, Wood RW, Li J, Boyce BF, Xing L. Distribution and alteration of lymphatic vessels in knee joints of normal and osteoarthritic mice. Arthritis Rheumatol 2014; 66:657-66. [PMID: 24574226 DOI: 10.1002/art.38278] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 11/07/2013] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the distribution and alteration of lymphatic vessels and draining function in knee joints of normal and osteoarthritic mice. METHODS For the mouse models of osteoarthritis (OA), we used mice with meniscal-ligamentous injury or mice with conditional knockout of the gene for cartilage transforming growth factor β (TGFβ) type II receptor. The severity of cartilage loss and joint destruction was assessed histologically. Capillary and mature lymphatic vessels were identified and analyzed using double immunofluorescence staining and a whole-slide digital imaging system. Lymphatic drainage of knee joints was examined using near-infrared lymphatic imaging. Patient joint specimens obtained during total knee or hip arthroplasty were evaluated to verify the content validity of the mouse findings. RESULTS Lymphatic vessels were distributed in soft tissues (mainly around the joint capsule, ligaments, fat pads, and muscles of normal knees). The number of lymphatic vessels, particularly the number of capillaries, was significantly increased in joints of mice with mild OA, while the number of mature lymphatic vessels was markedly decreased in joints of mice with severe OA. OA knees exhibited significantly decreased lymph clearance. The number of both capillary and mature lymphatic vessels was significantly decreased in the joints of patients with OA. CONCLUSION The whole-slide digital imaging system is a powerful tool, enabling the identification and assessment of lymphatic microvasculature in the entire mouse knee. Lymphatic capillaries and mature vessels are present in various soft tissues around articular spaces. Abnormalities of lymphatic vessels and draining function, including significantly reduced numbers of mature vessels and impaired clearance, are present in OA joints.
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Affiliation(s)
- Jixiang Shi
- Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; University of Rochester Medical Center, Rochester, New York
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9
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Barone F, Nayar S, Buckley CD. The role of non-hematopoietic stromal cells in the persistence of inflammation. Front Immunol 2013; 3:416. [PMID: 23335923 PMCID: PMC3543945 DOI: 10.3389/fimmu.2012.00416] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 12/20/2012] [Indexed: 11/13/2022] Open
Abstract
Inflammation results from the complex interaction between hematopoietic and stromal cells and growing evidence supports a key role for the stroma in driving the switch from acute resolving to persistence in chronic inflammatory diseases. Stromal cells have also been shown to play a critical role in cancer biology, being involved in cancer growth, dissemination, and inhibition of the autologous immune response, ultimately favoring persistence and metastatic spread. Similarly, blood and lymphatic endothelial cells contribute to tissue homeostasis during physiological inflammation but also lead to discorded leukocyte and tumor cell accumulation in pathological inflammation and cancer. This review aims to summarize the role that pathogenic stroma plays in the pathogenesis of diseases such as cancer and chronic inflammation.
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Affiliation(s)
- Francesca Barone
- Centre for Translational Inflammation Research, Arthritis Research UK, Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham Research Laboratories, Queen Elizabeth Hospital Birmingham, UK
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Arrault M, Blanchard M, Vignes S. Maladie inflammatoire chronique de l’intestin et lymphœdème primaire des membres inférieurs : une association fortuite ? Rev Med Interne 2011; 32:43-5. [DOI: 10.1016/j.revmed.2010.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 09/16/2010] [Accepted: 10/03/2010] [Indexed: 01/06/2023]
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Rozin AP, Toledano K, Markovits D, Balbir-Gurman A. Imaging mystery. Rheumatol Int 2009; 30:1409-10. [PMID: 19826818 DOI: 10.1007/s00296-009-1180-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 09/20/2009] [Indexed: 10/20/2022]
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Eyigor S, Karapolat H, Kirazli Y. Efficacy of etanercept and complete decongestive physical therapy in bilateral lower-limb lymphoedema associated with rheumatoid arthritis: a case report. Adv Ther 2008; 25:23-8. [PMID: 18227980 DOI: 10.1007/s12325-008-0006-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A 54-y-old patient with rheumatoid arthritis (RA) and bilateral lower-limb lymphoedema is presented. Complete decongestive physical therapy (CDP) is the cornerstone of the management programme in all patients suffering from lymphoedema associated with RA, but it is not clear which therapy is the most effective in decreasing the oedema. We report on a patient with bilateral lower-limb lymphoedema associated with RA who, after receiving etanercept and CDP, showed moderate improvement. There is little information on the benefit of etanercept therapy for the extra-articular manifestations of RA. Further research is necessary to confirm the beneficial effect of etanercept and CDP.
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Affiliation(s)
- Sibel Eyigor
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Ege, 35100, Bornova, Izmir, Turkey.
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13
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Vignes S, Arrault M, Bonhomme S, Spielmann M. [Upper limb lymphedema revealing breast cancer]. Rev Med Interne 2007; 28:631-4. [PMID: 17521779 DOI: 10.1016/j.revmed.2007.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 02/13/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Upper limb lymphedema occurs in 15 to 20% of patients after breast cancer treatment. Upper limb lymphedema without any history of neoplasia is an unusual situation. In this situation, breast cancer should be suspected. EXEGESIS We reported two women, 53 and 67 years old, who developed upper limb lymphedema, 18 and 8 months before the diagnosis of breast cancer. In the two cases, clinical examination (breast and axillary palpation) was normal. In one case, mammography led to the diagnosis and in the other breast MRI was required to confirm the cancer. DISCUSSION Upper limb lymphedema may be the presenting clinical feature of breast cancer. Breast cancer should be actively sought despite normal clinical and radiological findings. Breast MRI is required in this situation.
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Affiliation(s)
- S Vignes
- Unité de lymphologie, hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
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14
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Buckland GT, Carlson JA, Meyer DR. Persistent periorbital and facial lymphedema associated with Group A beta-hemolytic streptococcal infection (erysipelas). Ophthalmic Plast Reconstr Surg 2007; 23:161-3. [PMID: 17413641 DOI: 10.1097/01.iop.0000256161.79015.38] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chronic lymphedema is both a risk factor for and consequence of erysipelas (cellulitis). We report a case of a 62-year-old woman with rheumatoid arthritis treated with etanercept and prednisone, who developed chronic periorbital lymphedema 2 months after Group A beta-hemolytic streptococcus infection of the face. She had significant ptosis OS and thickened, hyperpigmented periorbital skin. Biopsies were consistent with chronic lymphedema. Of note, on 6 months follow-up, the patient's appearance was improved though she still had residual ptosis. A period of extended observation may be warranted in these cases.
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Affiliation(s)
- Golden T Buckland
- Department of Ophthalmology, Division of Dermatology and Dermatopathology, Albany Medical College, Albany, New York, USA.
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15
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Vignes S, Stoyanova M, Vasseur E, Haicault de la Regontais G, Hanslik T. Lymphœdème réversible des membres inférieurs précédant le diagnostic de périartérite noueuse cutanée pure. Rev Med Interne 2005; 26:58-60. [DOI: 10.1016/j.revmed.2004.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2004] [Accepted: 09/01/2004] [Indexed: 11/29/2022]
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16
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Kugathasan S, Miranda A, Nocton J, Drolet BA, Raasch C, Binion DG. Dermatologic manifestations of Crohn disease in children: response to infliximab. J Pediatr Gastroenterol Nutr 2003; 37:150-4. [PMID: 12883301 DOI: 10.1097/00005176-200308000-00013] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Dermatologic extraintestinal manifestations of Crohn disease may be refractory to treatment with corticosteroids and immunomodulators. The authors describe four children with Crohn disease with dermatologic manifestations: pyoderma gangrenosum, orofacial involvement, erythema nodosum, and idiopathic lymphedema. These dermatologic conditions were unresponsive to conventional therapy but had rapid and sustained response to the anti-TNF-alpha antibody infliximab. No adverse reactions occurred. Infliximab should be considered for treating the extraintestinal dermatologic manifestations of Crohn disease in children.
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Affiliation(s)
- Subra Kugathasan
- Division of Pediatric Gastroenterology and Nutrition, Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53226, USA.
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17
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Abstract
We describe four patients with rheumatoid arthritis and unilateral upper limb oedema. In all cases, qualitative lymphoscintigraphy showed lymphatic obstruction in the affected limb.
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Affiliation(s)
- S M Sant
- Department of Rheumatology, St. James's Hospital, Dublin, Ireland
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