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Stochmal A, Czuwara J, Zaremba M, Rudnicka L. Epoprostenol up-regulates serum adiponectin level in patients with systemic sclerosis: therapeutic implications. Arch Dermatol Res 2021; 313:783-791. [PMID: 33433715 DOI: 10.1007/s00403-020-02172-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 11/09/2020] [Accepted: 12/07/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Adiponectin, resistin and leptin belong to adipokines, a group of molecules secreted mainly by the adipose tissue, which impaired expression may be a missing link between various manifestations of systemic sclerosis. Adiponectin, which is also released in small amounts by the endothelium, possesses anti-inflammatory, anti-fibrotic and protective against endothelial injury properties. Both leptin and resistin exhibit features which are contradictory to adiponectin, as they trigger inflammation and the activation of skin fibroblasts. Epoprostenol is a prostaglandin analogue with powerful vasodilator activity and inhibitory effect on platelet aggregation. The aim of the study was to evaluate whether epoprostenol may have an effect on serum adipokine levels in patients with systemic sclerosis. METHODS A total of 27 patients were included in the study and received epoprostenol intravenously (25 µg of per day for 3 consecutive days). Serum concentrations of total adiponectin, resistin and leptin were assessed with enzyme-linked immunosorbent essay (R&D Systems, Minneapolis, MN, USA). RESULTS In all SSc patients, the basal level of adiponectin was significantly lower compared to healthy controls (mean 6.00 [Formula: see text] 2.81 μg/ml vs. 8.8 [Formula: see text] 4.3 μg/ml, p = 0.02) and basal level of resistin (mean 11.12 [Formula: see text] 3.36 ng/ml vs. 8.54 [Formula: see text] 3.07 ng/ml p = 0.02) was significantly higher than in the control group. The serum concentration of adiponectin increased significantly after treatment with epoprostenol (6.00 [Formula: see text] 2.81 μg/ml vs 9.29 [Formula: see text] 6.05 μg/ml; P = 0.002). The level of resistin and leptin remained unchanged. CONCLUSION Epoprostenol infusions up-regulate the serum concentration of adiponectin in patients with systemic sclerosis. In our opinion, future studies on treatments in systemic sclerosis should address the issue of their effect on adipokine metabolism.
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Affiliation(s)
- Anna Stochmal
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Czuwara
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Michał Zaremba
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland.
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Tapia-Haro RM, Guisado-Barrilao R, García-Ríos MDC, Raya-Álvarez E, Pérez-Mármol JM, Aguilar-Ferrándiz ME. Pain Intensity, Pressure Pain Hypersensitivity, Central Sensitization, and Pain Catastrophizing Related to Vascular Alterations in Raynaud's Phenomenon: A Preliminary Case-Control Study. PAIN MEDICINE 2020; 21:891-901. [PMID: 30986311 DOI: 10.1093/pm/pnz089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate pain intensity, widespread pressure pain, central sensitization (CS), and catastrophizing between subjects with primary and secondary Raynaud's phenomenon (RP) and healthy controls and to compare the relationships between vascular impairment and pain perception. METHODS A preliminary case-control study was performed with a total sample of 57 participants (37 with RP). Sociodemographic data, clinical/vascular data, and pain variables (pain intensity, pressure pain sensitivity, pain magnitude and threshold, CS, and catastrophizing) were registered. Results were analyzed by analysis of covariance and Pearson correlation. RESULTS Participants with RP had a lower basal temperature (more vasoconstriction) in their hands (P ≤ 0.012), higher pain intensity (P ≤ 0.001), higher electrical pain magnitude (P < 0.001), and lower pressure pain (P ≤ 0.05) and electrical pain (P < 0.001) thresholds in comparison with healthy controls. Secondary RP participants showed a significantly higher level of CS compared with controls and primary RP participants (P = 0.001). Catastrophizing was higher in the primary and secondary RP (P ≤ 0.001) groups than in controls. No correlations were observed between severity of vasoconstriction and pain variables. CONCLUSIONS RP participants showed bilateral hypersensitivity to pressure pain. However, the severity of vascular alterations seems not to be related to central pain experiences. Additional mechanisms such as catastrophizing may influence pain in RP; nevertheless, central sensitization only appears to be involved in the secondary form of RP.
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Affiliation(s)
| | | | | | - Enrique Raya-Álvarez
- Department of Physical Therapy, Faculty of Health Science.,Rheumatology Division, University Hospital "San Cecilio," Granada, Spain
| | - José Manuel Pérez-Mármol
- Instituto de Investigación Biosanitaria Granada, Department of Physical Therapy, Faculty of Health Science, University of Granada, Granada, Spain
| | - María Encarnación Aguilar-Ferrándiz
- Instituto de Investigación Biosanitaria Granada, Department of Physical Therapy, Faculty of Health Science, University of Granada, Granada, Spain
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Tapia-Haro RM, García-Ríos MC, Toledano-Moreno S, Casas-Barragán A, Castro-Sánchez AM, Aguilar-Ferrándiz ME. The complementary effects of galvanic current electrical stimulation associated with conservative treatment to increase vasodilation in patients with Raynaud's phenomenon: a randomized trial. Clin Rehabil 2020; 34:595-606. [PMID: 32141306 DOI: 10.1177/0269215520907652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze the effectiveness of an electrotherapy intervention with galvanic current on symptoms associated with Raynaud's phenomenon. DESIGN Single-blind randomized controlled trial, parallel design (1:1 ratio) and intention-to-treat analysis. SETTING Virgen de las Nieves Hospital, Granada, Spain. SUBJECTS Thirty-four participants with Raynaud's phenomenon, with a mean (SD) age of 43.43 (17.62) years. INTERVENTIONS The patients were randomly assigned to a control group with conservative treatment (anti-inflammatory, vasodilatory and analgesic drugs) or an intervention group that received conservative treatment and vasodilatory electrical stimulation during seven weeks, three times/week for a total of 20 sessions. MAIN MEASURES The primary outcome was the number of attacks. Secondary outcomes were pain, peripheral blow flow, oxygen saturation, upper limb disability, central sensitization, pain catastrophizing and temperature recovery. All outcomes were assessed at baseline, posttreatment and at two months of follow-up. RESULTS The galvanic current electrotherapy group showed significantly greater improvements in the number of attacks (mean difference = 26.3, 95% confidence interval (CI) = 14.4 to 38.3), pre-cold stress pain (95% CI = 0.6 to 2.4), radial artery blood flow (95% CI = -7.8 ⩾ x ⩽ 1.3), ulnar artery blood flow (95% CI = -8.63 to 0.60), oxygen saturation (95% CI = -1.7 ⩾ x ⩽ -0.29), upper limb disability (95% CI = 1.1 to 22.3), central sensitization (95% CI = 6.7 to 18.2) and temperature recovery (95% CI = -5.7 ⩾ x ⩽ -0.32) than the conservative treatment group. CONCLUSION This study suggests that a complementary treatment with galvanic current in combination to conservative approach is superior to conservative applied as isolate, in reducing the clinical manifestations and disability in Raynaud's phenomenon.
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Affiliation(s)
- Rosa María Tapia-Haro
- Instituto de Investigación Biosanitaria ibs.GRANADA and Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), Granada, Spain
| | - Mª Carmen García-Ríos
- Instituto de Investigación Biosanitaria ibs.GRANADA and Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), Granada, Spain
| | - Sonia Toledano-Moreno
- Instituto de Investigación Biosanitaria ibs.GRANADA and Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), Granada, Spain
| | - Antonio Casas-Barragán
- Instituto de Investigación Biosanitaria ibs.GRANADA and Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), Granada, Spain
| | | | - María Encarnación Aguilar-Ferrándiz
- Instituto de Investigación Biosanitaria ibs.GRANADA and Department of Physical Therapy, Faculty of Health Sciences, University of Granada (UGR), Granada, Spain
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Herrick AL. Raynaud's phenomenon. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2019; 4:89-101. [PMID: 35382391 PMCID: PMC8922643 DOI: 10.1177/2397198319826467] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 11/27/2018] [Indexed: 09/05/2023]
Abstract
Raynaud's phenomenon can be either primary (idiopathic) or secondary to underlying disease including systemic sclerosis. Primary Raynaud's phenomenon is very common, affecting approximately 3%-5% of the general population. Although much rarer, systemic sclerosis-related Raynaud's phenomenon can be particularly severe, progressing to digital ulceration in approximately 50% of patients. Raynaud's phenomenon can have a major impact on quality of life. This review has a focus on the systemic sclerosis-related Raynaud's phenomenon (which is the most researched form of Raynaud's phenomenon and probably the most challenging to treat) and on recent advances. Epidemiology (including transition from 'isolated' to systemic sclerosis-related Raynaud's phenomenon), pathogenesis, diagnosis and assessment are discussed, followed by the treatment of both 'uncomplicated' and 'complicated' Raynaud's phenomena (i.e. Raynaud's phenomenon which has progressed to digital ulceration and/or critical ischaemia). Finally, some of the major challenges for the next 5-10 years are highlighted.
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Affiliation(s)
- Ariane L Herrick
- Centre for Musculoskeletal Research, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester, UK
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Ruaro B, Smith V, Sulli A, Pizzorni C, Tardito S, Patané M, Paolino S, Cutolo M. Innovations in the Assessment of Primary and Secondary Raynaud's Phenomenon. Front Pharmacol 2019; 10:360. [PMID: 31073287 PMCID: PMC6495407 DOI: 10.3389/fphar.2019.00360] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/22/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives: Raynaud's phenomenon (RP) is characterized by intense vasospasm of the digital arteries that causes characteristic color changes in fingers. There are two main types of RP: Primary RP (PRP) and Secondary RP (SRP). PRP is a benign condition. Whilst SRP is associated with several connective tissue diseases (CTD), in particular systemic sclerosis (SSc). The objectives of this report were: to present a short review on morphological (nailfold videocapillaroscopy, NVC) and functional techniques (laser tools and thermography) that allow for a correct diagnosis and treatment of RP and to investigate blood perfusion (BP) by laser speckle contrast analysis (LASCA) in different skin areas of hands and face in PRP, SRP to SSc, and healthy subjects (CNT). Methods: 31 PRP patients (LeRoy criteria), 70 SRP to SSc (ACR/EULAR criteria) and 68 CNT were enrolled. BP was assessed by LASCA at the level different areas of hands and face. NVC was performed to distinguish between PRP and SRP, and to detect the proper pattern of nailfold microangiopathy in SSc patients. Results: Both PRP and SRP showed a statistically significant lower BP than CNT at the level of fingertips (p < 0.0001), periungual (p < 0.0001), palmar aspect of 3rd finger (p < 0.0001), and palm areas (p < 0.0001). Moreover, BP was significantly lower in PRP than in SRP to SSc with the "Early" pattern of microangiopathy in the same areas as above (p < 0.04). Conclusion: By considering a small cohort of patients, BP of hands was found lower in PRP than in SSc patients with the "Early" NVC pattern of microangiopathy.
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Affiliation(s)
- Barbara Ruaro
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), San Martino Polyclinic Hospital, University of Genova, Genova, Italy
| | - Vanessa Smith
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine, Ghent University, Ghent, Belgium
- Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Alberto Sulli
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), San Martino Polyclinic Hospital, University of Genova, Genova, Italy
| | - Carmen Pizzorni
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), San Martino Polyclinic Hospital, University of Genova, Genova, Italy
| | - Samuele Tardito
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), San Martino Polyclinic Hospital, University of Genova, Genova, Italy
| | - Massimo Patané
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), San Martino Polyclinic Hospital, University of Genova, Genova, Italy
| | - Sabrina Paolino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), San Martino Polyclinic Hospital, University of Genova, Genova, Italy
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine (Di.M.I.), San Martino Polyclinic Hospital, University of Genova, Genova, Italy
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Abdulle AE, van Roon AM, Smit AJ, Pasch A, van Meurs M, Bootsma H, Bakker SJL, Said MY, Fernandez BO, Feelisch M, van Goor H, Mulder DJ. Rapid free thiol rebound is a physiological response following cold-induced vasoconstriction in healthy humans, primary Raynaud and systemic sclerosis. Physiol Rep 2019; 7:e14017. [PMID: 30916482 PMCID: PMC6436142 DOI: 10.14814/phy2.14017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 12/21/2022] Open
Abstract
Raynaud's phenomenon (RP) is often the first sign of systemic sclerosis (SSc). Molecular mechanisms involved are incompletely understood, but reactive oxygen, nitrogen, and sulfur species are thought to play an important role in the pathogenesis of SSc. Free thiol groups play a protective role against oxidative stress and may represent an attractive therapeutic target. We aimed to investigate the effects of hypothermia-induced vasoconstriction on the responsiveness of redox-related markers. Thirty participants (n = 10/group [SSc, primary Raynaud's phenomenon (PRP), healthy controls (HC)]) were included in this study. Fingertip photoelectric plethysmography was performed during a standardized cooling and recovery experiment. Venous blood was collected at four predetermined time points. Free thiols, NO-derived species (nitros(yl)ated species, nitrite, nitrate), sulfate and endothelin-1 were measured. Lower baseline concentrations of free thiols were observed in PRP and SSc patients (HC: 5.87 [5.41-5.99] μmol/g; PRP: 5.17 [4.74-5.61]; SSc 5.28 [4.75-5.80], P = 0.04). Redox-related markers remained unchanged during cooling. However, an unexpected increase in systemic free thiol concentrations was observed in all groups during the recovery phase. The response of this marker differed between groups, with a higher increase found in SSc patients (HC Δ = 1.30 [1.48-1.17]; PRP Δ = 1.04 [1.06-1.03]; SSc Δ = 1.72 [1.13-1.49], P = 0.04). NO-derived species, sulfate and endothelin-1 levels remained unchanged throughout the recovery phase. This exploratory study sheds light on the rapid responsiveness of systemic free thiol concentrations following reperfusion, which may reflect overall redox balance. The robust response to reperfusion in SSc patients suggests that reductive systems involved in this response are functionally intact in these patients.
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Affiliation(s)
- Amaal Eman Abdulle
- Department of Internal MedicineDivision Vascular MedicineUniversity of Groningen – University Medical Centre GroningenGroningenThe Netherlands
| | - Anniek M. van Roon
- Department of Internal MedicineDivision Vascular MedicineUniversity of Groningen – University Medical Centre GroningenGroningenThe Netherlands
| | - Andries J. Smit
- Department of Internal MedicineDivision Vascular MedicineUniversity of Groningen – University Medical Centre GroningenGroningenThe Netherlands
| | - Andreas Pasch
- Department of Biomedical ResearchUniversity of BernBernSwitzerland
| | - Matijs van Meurs
- Department of Critical CareUniversity of Groningen – University Medical Centre GroningenGroningenThe Netherlands
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical ImmunologyUniversity of Groningen – University Medical Centre GroningenGroningenThe Netherlands
| | - Stephan J. L. Bakker
- Department of Internal MedicineDivision of NephrologyUniversity of Groningen – University Medical Centre GroningenGroningenThe Netherlands
| | - Mohammad Y. Said
- Department of Internal MedicineDivision of NephrologyUniversity of Groningen – University Medical Centre GroningenGroningenThe Netherlands
| | - Bernadette O. Fernandez
- Clinical and Experimental SciencesFaculty of MedicineUniversity of SouthamptonSouthamptonUnited Kingdom
| | - Martin Feelisch
- Clinical and Experimental SciencesFaculty of MedicineUniversity of SouthamptonSouthamptonUnited Kingdom
| | - Harry van Goor
- Department of Pathology and Medical BiologySection PathologyUniversity of Groningen – University Medical Centre GroningenGroningenThe Netherlands
| | - Douwe J. Mulder
- Department of Internal MedicineDivision Vascular MedicineUniversity of Groningen – University Medical Centre GroningenGroningenThe Netherlands
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Abstract
Raynaud's phenomenon (RP) is a transient, acral, vasospastic phenomenon that manifests with characteristic color changes. This vasospasm, classically triggered by cold temperatures, may also be driven by shifts in temperature, climate, or emotional state. Primary RP (PRP) is a common condition without severe sequelae. Secondary RP (SRP), which may be driven by vascular, autoimmune, hematologic, or endocrine etiologies, can result in digital ulceration, irreversible ischemia and necrosis, and secondary infection. This review delineates the clinical manifestations of both primary and secondary RP, as well as the current understanding of RP epidemiology and pathogenesis. Proper examination, including nailfold capillary microscopy, and laboratory workup for secondary causes of RP are also discussed. The traditional armamentarium of therapies used for RP, as well as newer medical and surgical options, is also summarized with particular regard to the clinical evidence for their efficacy.
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Affiliation(s)
- Thomas Stringer
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Alisa N Femia
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA.
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Shen CY, Li KJ, Lai PH, Yu CL, Hsieh SC. Anti-CENP-B and anti-TOPO-1-containing sera from systemic sclerosis-related diseases with Raynaud’s phenomenon induce vascular endothelial cell senescence not via classical p53-p21 pathway. Clin Rheumatol 2017; 37:749-756. [DOI: 10.1007/s10067-017-3845-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 08/28/2017] [Accepted: 09/13/2017] [Indexed: 12/20/2022]
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