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Santiago T, Santiago M, Ruaro B, Salvador MJ, Cutolo M, Silva JAP. Ultrasonography for the Assessment of Skin in Systemic Sclerosis: A Systematic Review. Arthritis Care Res (Hoboken) 2019; 71:563-574. [DOI: 10.1002/acr.23597] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/15/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Tânia Santiago
- Centro Hospitalar e Universitário de Coimbra and University of Coimbra Coimbra Portugal
| | - Mariana Santiago
- Centro Hospitalar e Universitário de Coimbra and University of Coimbra Coimbra Portugal
| | - Barbara Ruaro
- University of GenoaIRCCS San Martino Polyclinic Hospital Genoa Italy
| | - Maria João Salvador
- Centro Hospitalar e Universitário de Coimbra and University of Coimbra Coimbra Portugal
| | - Maurizio Cutolo
- University of GenoaIRCCS San Martino Polyclinic Hospital Genoa Italy
| | - J. A. P. Silva
- Centro Hospitalar e Universitário de Coimbra and University of Coimbra Coimbra Portugal
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Galluccio F, Allanore Y, Czirjak L, Furst DE, Khanna D, Matucci-Cerinic M. Points to consider for skin ulcers in systemic sclerosis. Rheumatology (Oxford) 2017; 56:v67-v71. [PMID: 28992171 DOI: 10.1093/rheumatology/kex200] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Indexed: 12/22/2022] Open
Abstract
This article discusses points to consider when undertaking a clinical trial to test therapy for skin ulcers in SSc. A validated definition of skin ulcers should be used if available. Defining a uniform SSc patient population, including consideration of disease duration, history of digital ulcers and capillaroscopic patterns, is important. Excluding confounding factors such as infection, calcinosis and trauma should be strongly considered, or at least accounted for, in defining patients. Outcome measures such as time to healing, prevention of new ulcers, function, pain and objective measures such as US, laser Doppler and thermography can be considered as outcome measures, although their validation has not yet been achieved and efforts may be needed to validate them before use. Likewise, biomarkers should be considered or consideration should be given to storing serum, plasma or cells for possible future analysis. A pre-planned analysis is important and should include consideration of missing data.
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Affiliation(s)
- Felice Galluccio
- Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence, AOU Careggi, Florence, Italy
| | - Yannick Allanore
- Department of Rheumatology A, Cochin Hospital and Cochin Institute, Assistance Publique-Hôpitaux de Paris, Paris-Descartes University, Paris, France
| | - Lázló Czirjak
- Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary
| | - Daniel E Furst
- Department of Rheumatology, David Geffen School of Medicine, University of California. Los Angeles, Los Angeles, CA
| | - Dinesh Khanna
- Department of Medicine, University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
| | - Marco Matucci-Cerinic
- Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence, AOU Careggi, Florence, Italy
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Ch'ng SS, Roddy J, Keen HI. A systematic review of ultrasonography as an outcome measure of skin involvement in systemic sclerosis. Int J Rheum Dis 2013; 16:264-72. [DOI: 10.1111/1756-185x.12106] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Shereen S. Ch'ng
- Rheumatology Unit; Department of Medicine; Selayang Hospital; Selangor Malaysia
| | - Janet Roddy
- Department of Rheumatology; Royal Perth Hospital; University of Western Australia; Perth Australia
| | - Helen I. Keen
- School of Medicine and Pharmacology; University of Western Australia; Perth Australia
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Hart DA. Treatments for fibrosis development and progression: Lessons learned from preclinical models and potential impact on human conditions such as scleroderma, pulmonary fibrosis, hypertrophic scarring and tendinopathies. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/jbise.2013.68a2001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Koehler MJ, Lange-Asschenfeldt S, Kaatz M. Non-invasive imaging techniques in the diagnosis of skin diseases. ACTA ACUST UNITED AC 2011; 5:425-40. [DOI: 10.1517/17530059.2011.599064] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Postiglione L, Montuori N, Riccio A, Di Spigna G, Salzano S, Rossi G, Ragno P. The Plasminogen Activator System in Fibroblasts from Systemic Sclerosis. Int J Immunopathol Pharmacol 2010; 23:891-900. [DOI: 10.1177/039463201002300325] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Systemic sclerosis (SSc) is characterized by excessive fibrosis throughout the body. There are two major subsets of SSc, diffuse cutaneous Systemic sclerosis (dSSc) and limited cutaneous Systemic sclerosis (ISSc). Fibroblasts play a key role in SSc. The expression and function of the urokinase (uPA)-mediated plasminogen activation (PA) system, a well-characterized system of serine-proteases involved in several pathological processes, has been investigated in SSc fibroblasts. The expression of the components of the PA system, including uPA, its type-1 and type-2 inhibitors (PAI-1 and PAI-2) and its receptor (uPAR), was examined by Western blot in fibroblasts from patients affected by limited and diffuse forms of SSc. uPA and PAI-1 secretion increased only in fibroblasts from ISSc lesions compared to normal fibroblasts. PAI-2 levels were decreased in fibroblasts from both SSc forms. Interestingly, fibroblasts from areas not adjacent to the lesions (not-affected) of the diffuse form showed reduced levels of PAI-1 and increased uPAR expression. Adhesion experiments showed reduced adherence to VN of fibroblasts from ISSc lesions and from non-affected areas of the diffuse form, as compared to normal controls. These results suggest a role for uPA and PAI-1 in the ISSc form, likely related to the activation of latent forms of cytokines and to the accumulation of ECM components, whereas a role for uPAR can be hypothesized in the evolvement of the diffuse form, based on its up-regulation in the non-affected areas.
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Affiliation(s)
| | | | - A. Riccio
- Department of Clinical and Experimental Medicine, Federico II University Medical School of Naples
| | | | - S. Salzano
- IEOS Institute of Experimental Endocrinology and Oncology (CNR), Federico II University Medical School of Naples
| | | | - P. Ragno
- Department of Chemistry, University of Salerno, Italy
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Affiliation(s)
- Michele Ramien
- From the Division of Dermatology, University of Toronto, Toronto, ON, and the Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta, Edmonton, AB
| | - Alain Brassard
- From the Division of Dermatology, University of Toronto, Toronto, ON, and the Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta, Edmonton, AB
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Villela R, Yuen SY, Pope JE, Baron M. Assessment of unmet needs and the lack of generalizability in the design of randomized controlled trials for scleroderma treatment. ACTA ACUST UNITED AC 2008; 59:706-13. [PMID: 18438906 DOI: 10.1002/art.23567] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine the generalizability of randomized controlled trials (RCTs) in the treatment of systemic sclerosis (SSc) using the Canadian Scleroderma Research Group (CSRG) database. METHODS We identified articles related to SSc published from 1958 to 2006. Key points on trial design were recorded. The inclusion/exclusion criteria were used in conjunction with the CSRG database to determine the proportion of patients with SSc who would theoretically be eligible for these trials. Articles were classified into subcategories according to the target system. The CSRG database contains 438 patients with SSc from 14 Canadian centers. Results were in median (%) and mean (%) with 95% confidence intervals (95% CIs). RESULTS In total, 210 articles were evaluated and 73 were selected for inclusion in this study. The mean percentage of eligible patients with SSc associated with other conditions was 35% (95% CI 17-53) for Raynaud's phenomenon, 24% (95% CI 1-47) for digital ulcers, 48% (95% CI 27-68) for gastrointestinal (GI) involvement, 32% (95% CI 20-43) for overall disease modification, 6% (95% CI 4-8) for pulmonary arterial hypertension, 2% (95% CI 0-4) for interstitial lung disease, and 38% (95% CI 12-64) for other categories. CONCLUSION Except for GI trials, <38% of the identified patients with SSc would have been suitable to enter the RCTs. Although some patients would be ineligible because they lack certain organ involvement, RCTs designed to include appropriate patients with SSc are needed; there are few proven treatments and trials typically do not include the majority of those who could potentially benefit from the intervention.
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Francès C, Allanore Y, Cabane J, Carpentier P, Dumontier C, Hachulla É, Hatron PY, Lipsker D, Meaume S, Mouthon L, Senet P, Sibilia J. Prise en charge des ulcères digitaux de la sclérodermie systémique. Presse Med 2008; 37:271-85. [DOI: 10.1016/j.lpm.2007.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2007] [Revised: 07/02/2007] [Accepted: 07/07/2007] [Indexed: 10/22/2022] Open
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Abstract
Digital ulcers (DU) affect up to half of all patients with systemic sclerosis at some point during their disease. These lesions are extremely painful, heal slowly, and lead to substantial disability. DU arise from recurrent ischemic injury and microtrauma. Treatments for DU include non-pharmacologic modalities such as avoiding cold,stress,and trauma,as well as smoking cessation. Possible pharmacologic therapies for the prevention of DU include vasodilating agents to treat Raynaud phenomenon, statins, and oral agents used in the treatment of pulmonary hypertension (endothelin receptor antagonists, phosphodiesterase-5 inhibitors). The treatment of existing DU includes hydrocolloid occlusion, wound care, pain control, antibiotics, and the use of vasodilating medications. Intravenous or subcutaneous prostacyclins and digital or cervical sympathectomy should be considered for severe cases.
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Affiliation(s)
- Lorinda Chung
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
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Generini S, Del Rosso A, Pignone A, Matucci Cerinic M. Current Treatment Options in Raynaud's Phenomenon. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2003; 5:147-161. [PMID: 12686012 DOI: 10.1007/s11936-003-0023-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The treatment of Raynaud's phenomenon (RP) strictly depends on the severity of symptoms and on the presence of an underlying systemic disease. For this reason, any patient with RP should be carefully assessed for signs and symptoms that may herald an underlying disease. Primary RP can usually be managed with conservative nonpharmacologic lifestyle modifications (eg, avoidance of cold temperatures, tobacco, caffeine, and any drug interfering with vascular tone) and pharmacologic treatment added only if attacks are poorly controlled. Vasodilating drugs (eg, calcium channel blockers, angiotensin II receptor antagonists, topical nitrates, and prostanoids) are still the mainstay of medical therapy for RP. Anecdotal reports with different kinds of therapies appear regularly but always need evidence-based confirmation. In particular, antioxidant agents may be useful in limiting the progressive endothelial damage. Novel therapeutic tools interfering either with primary or secondary pathogenetic processes (ie, endothelial and peripheral nervous system dysfunction and smooth muscle cell hypertrophy) are awaited.
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Affiliation(s)
- Sergio Generini
- Section of Rheumatology, Department of Internal Medicine, University of Florence, Viale Pieraccini, 18-50139 Florence, Italy.
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Kyriakidi M, Ioannidis JPA. Design and quality considerations for randomized controlled trials in systemic sclerosis. ARTHRITIS AND RHEUMATISM 2002; 47:73-81. [PMID: 11932881 DOI: 10.1002/art1.10218] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To appraise systematically randomized controlled trials (RCTs) on systemic sclerosis (SSc) in order to determine whether the parameter of study design and its quality may influence the reporting of efficacy for tested interventions. METHODS Seventy RCTs were analyzed (1965-2000) in terms of design, patient characteristics, outcomes, and reported results. RESULTS Median sample size was 28 patients. Fifty-nine trials were double blind, but only 16 mentioned the randomization mode and only 7 described allocation concealment. There was sufficient information on withdrawals in 37 trials. Larger trials with longer followup scored higher on quality characteristics, but had higher withdrawal rates. Only 8 trials had a followup of more than 1 year. Significant efficacy was less likely to be reported in double-blind studies (P = 0.029) and in studies with larger rates of withdrawal (P = 0.032). Specification of the following parameters improved over time: power calculations (P = 0.0003), outcomes (P = 0.001), and sample size per arm (P = 0.011). CONCLUSIONS Several aspects of the quality of design and conduct of SSc RCTs can be improved. Adequately powered trials with longer followup and clear outcomes are needed.
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Naschitz JE, Misselevich I, Rosner I, Yeshurun D, Weiner P, Amar M, Amato L, Ciompi ML, Boss JH. Lymph-node-based malignant lymphoma and reactive lymphadenopathy in eosinophilic fasciitis. Am J Med Sci 1999; 318:343-9. [PMID: 10555099 DOI: 10.1097/00000441-199911000-00011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lymph node enlargement in patients with eosinophilic fasciitis is a rare occurrence and its clinical significance is unknown. METHODS The literature and authors' registries were searched for eosinophilic fasciitis associated with lymphadenopathy. Clinical data, time sequence of appearance of either disorder, and pathological diagnoses were analyzed. RESULTS Six patients presenting with eosinophilic fasciitis had a lymph-node-based lymphoma and 4 patients had a reactive lymphadenopathy. The patients with lymphoma were elderly and the subcutaneous induration preceded the lymphadenopathy by 2 to 36 months. The patients with eosinophilic fasciitis and reactive lymphadenopathy were young and the onset of subcutaneous induration and lymph node enlargement coincided with one another. Favorable response of the eosinophilic fasciitis to prednisone therapy was attained in 3 of 3 patients with reactive lymphadenopathy and in 4 of the 6 cases with lymphoma. CONCLUSIONS Eosinophilic fasciitis is rarely associated with clinically significant lymph node enlargement. Subcutaneous induration preceding the lymphadenopathy by 6 months or more, especially in elderly patients, suggests an underlying lymphoma. A favorable response of the subcutaneous induration to prednisone treatment does not exclude the diagnosis of lymphoma; therefore, it does not supersede the need of a pathological evaluation. A lymph node biopsy is mandatory in all cases.
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Affiliation(s)
- J E Naschitz
- Department of Internal Medicine, Bnai-Zion Medical Center, Haifa, Israel
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Naschitz JE, Misselevich I, Rosner I, Yeshurun D, Weiner P, Amar M, Amato L, Ciompi ML, Boss JH. Lymph-Node—Based Malignant Lymphoma and Reactive Lymphadenopathy in Eosinophilic Fasciitis. Am J Med Sci 1999. [DOI: 10.1016/s0002-9629(15)40650-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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