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Di Battista M, Vitali S, Barsotti S, Granieri G, Aringhieri G, Morganti R, Dini V, Della Rossa A, Romanelli M, Neri E, Mosca M. Ultra-high frequency ultrasound for digital arteries: improving the characterization of vasculopathy in systemic sclerosis. Semin Arthritis Rheum 2022; 57:152105. [DOI: 10.1016/j.semarthrit.2022.152105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/28/2022] [Accepted: 10/10/2022] [Indexed: 11/19/2022]
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2
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Wang Q, Zhang M, Zhai M, Li Z. Cerebral infarction caused by systemic sclerosis: a case report. J Int Med Res 2021; 49:3000605211044045. [PMID: 34510957 PMCID: PMC8442488 DOI: 10.1177/03000605211044045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Systemic sclerosis, also known as scleroderma, is a rare multisystem autoimmune disease characterized by vascular lesions caused by collagen deposition in the skin and viscera and damage to the endothelium. Endothelial injury and microvascular occlusion result in Raynaud's phenomenon, finger ischemia, pulmonary hypertension, and scleroderma renal crisis. Scleroderma itself is a rare disease with an incidence ranging from 0.1 to 14 per 100,000 people in the general population. Cerebral involvement is not considered a common manifestation of systemic sclerosis, although studies have shown that the brain can be involved. Therefore, to deepen the understanding of this disease, we herein report a case of cerebral infarction associated with systemic sclerosis.
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Affiliation(s)
- Qingqing Wang
- The Affiliated Fuyang Hospital of Bengbu Medical College, Fuyang City, Anhui Province, China.,Department of Neurology, Fuyang People's Hospital, Fuyang City, Anhui Province, China
| | - Mengen Zhang
- Department of Neurology, Fuyang People's Hospital, Fuyang City, Anhui Province, China
| | - Mingfeng Zhai
- Department of Neurology, Fuyang People's Hospital, Fuyang City, Anhui Province, China
| | - Zongyou Li
- The Affiliated Fuyang Hospital of Bengbu Medical College, Fuyang City, Anhui Province, China.,Department of Neurology, Fuyang People's Hospital, Fuyang City, Anhui Province, China
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Martínez-López-de-Castro N, Álvarez-Payero M, Samartín-Ucha M, Martín-Vila A, Piñeiro-Corrales G, Rodríguez-Rodríguez M, Maceiras-Pan FJ, Melero-González RB, Pego-Reigosa JM. Biological therapy safety in chronic inflammatory arthropathy patients. Eur J Rheumatol 2020:1-7. [PMID: 31922476 DOI: 10.5152/eurjrheum.2019.19074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/27/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The marketing of biological therapies transformed the treatment of rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. But there is still concern about patient safety and management in daily clinical practice. The aim of this study was to estimate risk factors of the adverse effects in a cohort of Spanish patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. METHODS A single institution, descriptive, retrospective, cohort study was developed from January 2009 to December 2016. Patients diagnosed with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis on biological therapies were included. Undesirable events affecting patients during biological therapy, their clinical implications and the use of health resources related to adverse effects were collected. RESULTS Three hundred and sixty-two patients corresponding to 478 biological therapy lines were analysed. It implied 1192 years of monitoring. There were 57 adverse effects per 100 biological patient- years and 4.8 serious adverse effects per 100 biological patient-years. The only significant factor for a likely serious adverse effect was having a Charlson Index ≥10, OR of 6.2 (CI 95%: 3.4-11.1, p<0.001). Around 15 % of patients with adverse effects were admitted to hospital and 25% received attention at the Emergency Department. CONCLUSION Over half of the patients with arthropathies on biological therapy can suffer adverse effect during treatment but only 8.5% of these effects are serious. Special vigilance must be paid to patients with a higher number of comorbidities because they are more likely to experience serious adverse effects.
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Affiliation(s)
- Noemi Martínez-López-de-Castro
- Department of Pharmacy, University Hospital Complex of Vigo, Pontevedra, Spain
- Galicia Sur Biomedical Foundation, University Hospital Complex of Vigo Estrada Clara Campoamor, Pontevedra, Spain
| | - Miriam Álvarez-Payero
- Department of Pharmacy, University Hospital Complex of Vigo, Pontevedra, Spain
- Galicia Sur Biomedical Foundation, University Hospital Complex of Vigo Estrada Clara Campoamor, Pontevedra, Spain
| | - Marisol Samartín-Ucha
- Department of Pharmacy, University Hospital Complex of Vigo, Pontevedra, Spain
- Galicia Sur Biomedical Foundation, University Hospital Complex of Vigo Estrada Clara Campoamor, Pontevedra, Spain
| | | | | | - María Rodríguez-Rodríguez
- Galicia Sur Biomedical Foundation, University Hospital Complex of Vigo Estrada Clara Campoamor, Pontevedra, Spain
| | - Francisco José Maceiras-Pan
- Galicia Sur Biomedical Foundation, University Hospital Complex of Vigo Estrada Clara Campoamor, Pontevedra, Spain
- Department of Rheumatology, University Hospital Complex of Vigo, Pontevedra, Spain
| | - Rafael Benito Melero-González
- Galicia Sur Biomedical Foundation, University Hospital Complex of Vigo Estrada Clara Campoamor, Pontevedra, Spain
- Department of Rheumatology, University Hospital Complex of Vigo, Pontevedra, Spain
| | - Jose María Pego-Reigosa
- Galicia Sur Biomedical Foundation, University Hospital Complex of Vigo Estrada Clara Campoamor, Pontevedra, Spain
- Department of Rheumatology, University Hospital Complex of Vigo, Pontevedra, Spain
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Ying D, Gianfrancesco MA, Trupin L, Yazdany J, Greidinger EL, Schmajuk G. Increased Risk of Ischemic Stroke in Systemic Sclerosis: A National Cohort Study of US Veterans. J Rheumatol 2020; 47:82-88. [PMID: 30877213 PMCID: PMC7269199 DOI: 10.3899/jrheum.181311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Previously thought to involve primarily the microvasculature, systemic sclerosis (SSc) has been increasingly linked to macrovascular disease. Cardiovascular (CV) and cerebrovascular disease are responsible for 20-30% of mortality in SSc, but few studies have shown an independent association between SSc and stroke. We assessed whether SSc was an independent risk factor for ischemic stroke. METHODS We conducted a retrospective cohort study using the national Veterans Affairs (VA) administrative database containing records from 1999 to 2014. We obtained data for all patients with a diagnosis of SSc as well as 2 controls per SSc patient matched on sex, race, smoking status, and VA site. All patients were followed until development of ischemic stroke, death, or last encounter. We used a Cox proportional hazard regression model to estimate risk of ischemic stroke, with adjustments for CV comorbidities (hypertension, diabetes, atrial fibrillation, non-cerebrovascular atherosclerotic disease, hyperlipidemia), baseline medication use (aspirin, nonsteroidal antiinflammatory drugs), and Medicare enrollment. RESULTS Among 4545 individuals with SSc (83% male, mean age 60.9 yrs), the incidence rate of ischemic stroke was 15.3 per 1000 person-years (vs 12.2 in the control cohort), with an unadjusted HR 1.28 (95% CI 1.11-1.47). The adjusted HR was 1.21 (95% CI 1.05-1.40) after adjusting for baseline CV risk factors, medications, and Medicare enrollment. CONCLUSION SSc is independently associated with a higher risk of ischemic stroke among US veterans. Patients with SSc represent a population likely to benefit from targeted stroke screening or prevention therapies.
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Affiliation(s)
- David Ying
- From the San Francisco Veterans Affairs Medical Center, San Francisco; Division of Rheumatology, University of California, San Francisco, California; Miami Veterans Affairs Medical Center, Miami; Division of Rheumatology, University of Miami Miller School of Medicine, Miami, Florida, USA.
- D. Ying, MD, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco; M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, University of California, San Francisco; E.L. Greidinger, MD, Miami Veterans Affairs Medical Center, and Division of Rheumatology, University of Miami Miller School of Medicine; G. Schmajuk, MD, MS, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco. E.L. Greidinger and G. Schmajuk contributed equally to this work.
| | - Milena A Gianfrancesco
- From the San Francisco Veterans Affairs Medical Center, San Francisco; Division of Rheumatology, University of California, San Francisco, California; Miami Veterans Affairs Medical Center, Miami; Division of Rheumatology, University of Miami Miller School of Medicine, Miami, Florida, USA
- D. Ying, MD, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco; M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, University of California, San Francisco; E.L. Greidinger, MD, Miami Veterans Affairs Medical Center, and Division of Rheumatology, University of Miami Miller School of Medicine; G. Schmajuk, MD, MS, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco. E.L. Greidinger and G. Schmajuk contributed equally to this work
| | - Laura Trupin
- From the San Francisco Veterans Affairs Medical Center, San Francisco; Division of Rheumatology, University of California, San Francisco, California; Miami Veterans Affairs Medical Center, Miami; Division of Rheumatology, University of Miami Miller School of Medicine, Miami, Florida, USA
- D. Ying, MD, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco; M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, University of California, San Francisco; E.L. Greidinger, MD, Miami Veterans Affairs Medical Center, and Division of Rheumatology, University of Miami Miller School of Medicine; G. Schmajuk, MD, MS, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco. E.L. Greidinger and G. Schmajuk contributed equally to this work
| | - Jinoos Yazdany
- From the San Francisco Veterans Affairs Medical Center, San Francisco; Division of Rheumatology, University of California, San Francisco, California; Miami Veterans Affairs Medical Center, Miami; Division of Rheumatology, University of Miami Miller School of Medicine, Miami, Florida, USA
- D. Ying, MD, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco; M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, University of California, San Francisco; E.L. Greidinger, MD, Miami Veterans Affairs Medical Center, and Division of Rheumatology, University of Miami Miller School of Medicine; G. Schmajuk, MD, MS, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco. E.L. Greidinger and G. Schmajuk contributed equally to this work
| | - Eric L Greidinger
- From the San Francisco Veterans Affairs Medical Center, San Francisco; Division of Rheumatology, University of California, San Francisco, California; Miami Veterans Affairs Medical Center, Miami; Division of Rheumatology, University of Miami Miller School of Medicine, Miami, Florida, USA
- D. Ying, MD, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco; M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, University of California, San Francisco; E.L. Greidinger, MD, Miami Veterans Affairs Medical Center, and Division of Rheumatology, University of Miami Miller School of Medicine; G. Schmajuk, MD, MS, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco. E.L. Greidinger and G. Schmajuk contributed equally to this work
| | - Gabriela Schmajuk
- From the San Francisco Veterans Affairs Medical Center, San Francisco; Division of Rheumatology, University of California, San Francisco, California; Miami Veterans Affairs Medical Center, Miami; Division of Rheumatology, University of Miami Miller School of Medicine, Miami, Florida, USA
- D. Ying, MD, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco; M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, University of California, San Francisco; E.L. Greidinger, MD, Miami Veterans Affairs Medical Center, and Division of Rheumatology, University of Miami Miller School of Medicine; G. Schmajuk, MD, MS, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco. E.L. Greidinger and G. Schmajuk contributed equally to this work
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Sanghera C, Wong LM, Panahi M, Sintou A, Hasham M, Sattler S. Cardiac phenotype in mouse models of systemic autoimmunity. Dis Model Mech 2019; 12:dmm036947. [PMID: 30858306 PMCID: PMC6451423 DOI: 10.1242/dmm.036947] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Patients suffering from systemic autoimmune diseases are at significant risk of cardiovascular complications. This can be due to systemically increased levels of inflammation leading to accelerated atherosclerosis, or due to direct damage to the tissues and cells of the heart. Cardiac complications include an increased risk of myocardial infarction, myocarditis and dilated cardiomyopathy, valve disease, endothelial dysfunction, excessive fibrosis, and bona fide autoimmune-mediated tissue damage by autoantibodies or auto-reactive cells. There is, however, still a considerable need to better understand how to diagnose and treat cardiac complications in autoimmune patients. A range of inducible and spontaneous mouse models of systemic autoimmune diseases is available for mechanistic and therapeutic studies. For this Review, we systematically collated information on the cardiac phenotype in the most common inducible, spontaneous and engineered mouse models of systemic lupus erythematosus, rheumatoid arthritis and systemic sclerosis. We also highlight selected lesser-known models of interest to provide researchers with a decision framework to choose the most suitable model for their study of heart involvement in systemic autoimmunity.
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Affiliation(s)
- Chandan Sanghera
- National Heart and Lung Institute, Imperial College London, London, W12 0NN, UK
| | - Lok Man Wong
- National Heart and Lung Institute, Imperial College London, London, W12 0NN, UK
| | - Mona Panahi
- National Heart and Lung Institute, Imperial College London, London, W12 0NN, UK
| | - Amalia Sintou
- National Heart and Lung Institute, Imperial College London, London, W12 0NN, UK
| | - Muneer Hasham
- The Jackson Laboratory, 600 Main Street, Bar Harbor, ME 04609, USA
| | - Susanne Sattler
- National Heart and Lung Institute, Imperial College London, London, W12 0NN, UK
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Colaci M, Giuggioli D, Spinella A, Vacchi C, Lumetti F, Mattioli AV, Coppi F, Aiello V, Perticone M, Malatino L, Ferri C. Established coronary artery disease in systemic sclerosis compared to type 2 diabetic female patients: a cross-sectional study. Clin Rheumatol 2019; 38:1637-1642. [DOI: 10.1007/s10067-019-04427-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/24/2018] [Accepted: 01/01/2019] [Indexed: 12/13/2022]
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Survival and causes of death in systemic sclerosis patients: a single center registry report from Iran. Rheumatol Int 2016; 36:925-34. [PMID: 27061806 DOI: 10.1007/s00296-016-3475-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 03/29/2016] [Indexed: 10/22/2022]
Abstract
The aims of the study were to determine prognostic factors for survival and causes of death in a cohort of patients with systemic sclerosis (SSc). This was a cohort study of SSc patients in single rheumatologic center from January 1998 to August 2012. They fulfilled the American College of Rheumatology classification criteria for SSc or had calcinosis Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia or sine sclerosis. Causes of death were classified as SSc related and non-SSc related. Kaplan-Meier and Cox proportional hazard regression models were used in univariate and multivariate analysis to analyse survival in subgroups and determine prognostic factors of survival. The study includes 220 patients (192 female, 28 male). Out of thirty-two (14.5 %) who died, seventeen (53.1 %) deaths were SSc related and in nine (28.1 %) non-SSc-related causes, and in six (18.8 %) of patients causes of death were not defined. Overall survival rate was 92.6 % (95 % CI 87.5-95.7 %) after 5 years and 82.3 % (95 % CI 73.4-88.4 %) after 10 years. Pulmonary involvement was a major SSc-related cause of death, occurred in seven (41.1 %) patients. Cardiovascular events were leading cause of in overall death (11) 34.3 % and 6 in non-SSc-related death. Independent risk factors for mortality were age >50 at diagnosis (HR 5.10) advance pulmonary fibrosis (HR 11.5), tendon friction rub at entry (HR 6.39), arthritis (HR 3.56). In this first Middle Eastern series of SSc registry, pulmonary and cardiac involvements were the leading cause of SSc-related death.
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Lambova S. Cardiac manifestations in systemic sclerosis. World J Cardiol 2014; 6:993-1005. [PMID: 25276300 PMCID: PMC4176808 DOI: 10.4330/wjc.v6.i9.993] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 05/11/2014] [Accepted: 07/15/2014] [Indexed: 02/06/2023] Open
Abstract
Primary cardiac involvement, which develops as a direct consequence of systemic sclerosis (SSc), may manifest as myocardial damage, fibrosis of the conduction system, pericardial and, less frequently, as valvular disease. In addition, cardiac complications in SSc may develop as a secondary phenomenon due to pulmonary arterial hypertension and kidney pathology. The prevalence of primary cardiac involvement in SSc is variable and difficult to determine because of the diversity of cardiac manifestations, the presence of subclinical periods, the type of diagnostic tools applied, and the diversity of patient populations. When clinically manifested, cardiac involvement is thought to be an important prognostic factor. Profound microvascular disease is a pathognomonic feature of SSc, as both vasospasm and structural alterations are present. Such alterations are thought to predict macrovascular atherosclerosis over time. There are contradictory reports regarding the prevalence of atherosclerosis in SSc. According to some authors, the prevalence of atherosclerosis of the large epicardial coronary arteries is similar to that of the general population, in contrast with other rheumatic diseases such as rheumatoid arthritis and systemic lupus erythematosus. However, the level of inflammation in SSc is inferior. Thus, the atherosclerotic process may not be as aggressive and not easily detectable in smaller studies. Echocardiography (especially tissue Doppler imaging), single-photon emission computed tomography, magnetic resonance imaging and cardiac computed tomography are sensitive techniques for earlier detection of both structural and functional scleroderma-related cardiac pathologies. Screening for subclinical cardiac involvement via modern, sensitive tools provides an opportunity for early diagnosis and treatment, which is of crucial importance for a positive outcome.
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Amaya-Amaya J, Montoya-Sánchez L, Rojas-Villarraga A. Cardiovascular involvement in autoimmune diseases. BIOMED RESEARCH INTERNATIONAL 2014; 2014:367359. [PMID: 25177690 PMCID: PMC4142566 DOI: 10.1155/2014/367359] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/01/2014] [Indexed: 12/15/2022]
Abstract
Autoimmune diseases (AD) represent a broad spectrum of chronic conditions that may afflict specific target organs or multiple systems with a significant burden on quality of life. These conditions have common mechanisms including genetic and epigenetics factors, gender disparity, environmental triggers, pathophysiological abnormalities, and certain subphenotypes. Atherosclerosis (AT) was once considered to be a degenerative disease that was an inevitable consequence of aging. However, research in the last three decades has shown that AT is not degenerative or inevitable. It is an autoimmune-inflammatory disease associated with infectious and inflammatory factors characterized by lipoprotein metabolism alteration that leads to immune system activation with the consequent proliferation of smooth muscle cells, narrowing arteries, and atheroma formation. Both humoral and cellular immune mechanisms have been proposed to participate in the onset and progression of AT. Several risk factors, known as classic risk factors, have been described. Interestingly, the excessive cardiovascular events observed in patients with ADs are not fully explained by these factors. Several novel risk factors contribute to the development of premature vascular damage. In this review, we discuss our current understanding of how traditional and nontraditional risk factors contribute to pathogenesis of CVD in AD.
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Affiliation(s)
- Jenny Amaya-Amaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia
- Mederi, Hospital Universitario Mayor, Calle 24 No. 29-45, 11001000 Bogotá, Colombia
| | - Laura Montoya-Sánchez
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia
- Mederi, Hospital Universitario Mayor, Calle 24 No. 29-45, 11001000 Bogotá, Colombia
| | - Adriana Rojas-Villarraga
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, 11001000 Bogotá, Colombia
- Mederi, Hospital Universitario Mayor, Calle 24 No. 29-45, 11001000 Bogotá, Colombia
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McKay ND, Griffiths B, Di Maria C, Hedley S, Murray A, Allen J. Novel photoplethysmography cardiovascular assessments in patients with Raynaud's phenomenon and systemic sclerosis: a pilot study. Rheumatology (Oxford) 2014; 53:1855-63. [PMID: 24850874 DOI: 10.1093/rheumatology/keu196] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Multisite photoplethysmography (PPG) cardiovascular assessments can evaluate endothelial, peripheral autonomic and arterial dysfunction. The aim of this pilot study was to investigate the potential clinical utility of the technology in assessing patients with SSc and primary RP (PRP). METHODS Multisite PPG pulse measurements, a reference ankle brachial pressure index (ABPI) and a full clinical assessment were undertaken for three subject groups: SSc, PRP and controls. Endothelial and autonomic function and arterial disease measures were obtained using pulse wave analysis. RESULTS Nineteen SSc, 19 PRP and 23 control subjects were assessed and compared. Endothelial function was significantly impaired in SSc (P < 0.02), but with no difference between controls and PRP. Receiver operating characteristic-based classification accuracy was 81% (sensitivity 90%, specificity 74%) for separating SSc from controls and 82% (sensitivity 84%, specificity 79%) for separating SSc from PRP. SSc patients with digital ulcers had significantly lower endothelial function compared with those without ulcers (P < 0.05). Autonomic dysfunction was suggested in both SSc and PRP and was most exaggerated in patients with diffuse SSc. All groups had overall normal ABPI and arterial stiffness timing measures. Bilateral timing differences at the toes, which represents peripheral occlusive arterial disease, did show increased asymmetry in SSc (P < 0.02). CONCLUSION Multisite PPG pulse technology showed potential diagnostic ability. By using measures of endothelial function, it differentiated SSc from control and PRP subjects with an accuracy of at least 81%. Objective pulse-derived measures of autonomic function and arterial disease in SSc have also been reported in this pilot study.
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Affiliation(s)
- Neil D McKay
- Department of Rheumatology, Freeman Hospital, Newcastle upon Tyne, Lothian Rheumatic Diseases Unit, Western General Hospital, Edinburgh, Department of Microvascular Diagnostics, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. Department of Rheumatology, Freeman Hospital, Newcastle upon Tyne, Lothian Rheumatic Diseases Unit, Western General Hospital, Edinburgh, Department of Microvascular Diagnostics, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Bridget Griffiths
- Department of Rheumatology, Freeman Hospital, Newcastle upon Tyne, Lothian Rheumatic Diseases Unit, Western General Hospital, Edinburgh, Department of Microvascular Diagnostics, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Costanzo Di Maria
- Department of Rheumatology, Freeman Hospital, Newcastle upon Tyne, Lothian Rheumatic Diseases Unit, Western General Hospital, Edinburgh, Department of Microvascular Diagnostics, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. Department of Rheumatology, Freeman Hospital, Newcastle upon Tyne, Lothian Rheumatic Diseases Unit, Western General Hospital, Edinburgh, Department of Microvascular Diagnostics, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Hedley
- Department of Rheumatology, Freeman Hospital, Newcastle upon Tyne, Lothian Rheumatic Diseases Unit, Western General Hospital, Edinburgh, Department of Microvascular Diagnostics, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Alan Murray
- Department of Rheumatology, Freeman Hospital, Newcastle upon Tyne, Lothian Rheumatic Diseases Unit, Western General Hospital, Edinburgh, Department of Microvascular Diagnostics, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. Department of Rheumatology, Freeman Hospital, Newcastle upon Tyne, Lothian Rheumatic Diseases Unit, Western General Hospital, Edinburgh, Department of Microvascular Diagnostics, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - John Allen
- Department of Rheumatology, Freeman Hospital, Newcastle upon Tyne, Lothian Rheumatic Diseases Unit, Western General Hospital, Edinburgh, Department of Microvascular Diagnostics, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. Department of Rheumatology, Freeman Hospital, Newcastle upon Tyne, Lothian Rheumatic Diseases Unit, Western General Hospital, Edinburgh, Department of Microvascular Diagnostics, Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
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11
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Ischemic heart disease in systemic inflammatory diseases. An appraisal. Int J Cardiol 2013; 170:286-90. [PMID: 24331863 DOI: 10.1016/j.ijcard.2013.11.048] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 11/17/2013] [Indexed: 02/07/2023]
Abstract
Systemic inflammatory diseases are inflammatory syndromes that are associated with increased cardiovascular morbidity and mortality. The link between inflammatory and cardiovascular diseases can be attributed to coexistence of classical risk factors and of inflammatory mechanisms activated in systemic inflammatory diseases and involving the immune system. Yet, clinical implications of these findings are not entirely clear and deeper knowledge and awareness of cardiac involvement in inflammatory diseases are necessary. The aims of this review are to summarize cardiac involvement in systemic inflammatory diseases and to identify areas where evidence is currently lacking that deserve further investigation in the future.
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12
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Tissue Doppler assessment of right ventricular function in female patients with limited form of systemic sclerosis. Egypt Heart J 2013. [DOI: 10.1016/j.ehj.2013.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Dimitroulas T, Sandoo A, Kitas GD. Asymmetric dimethylarginine as a surrogate marker of endothelial dysfunction and cardiovascular risk in patients with systemic rheumatic diseases. Int J Mol Sci 2012. [PMID: 23202900 PMCID: PMC3497274 DOI: 10.3390/ijms131012315] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The last few decades have witnessed an increased life expectancy of patients suffering with systemic rheumatic diseases, mainly due to improved management, advanced therapies and preventative measures. However, autoimmune disorders are associated with significantly enhanced cardiovascular morbidity and mortality not fully explained by traditional cardiovascular disease (CVD) risk factors. It has been suggested that interactions between high-grade systemic inflammation and the vasculature lead to endothelial dysfunction and atherosclerosis, which may account for the excess risk for CVD events in this population. Diminished nitric oxide synthesis—due to down regulation of endothelial nitric oxide synthase—appears to play a prominent role in the imbalance between vasoactive factors, the consequent impairment of the endothelial hemostasis and the early development of atherosclerosis. Asymmetric dimethylarginine (ADMA) is one of the most potent endogenous inhibitors of the three isoforms of nitric oxide synthase and it is a newly discovered risk factor in the setting of diseases associated with endothelial dysfunction and adverse cardiovascular events. In the context of systemic inflammatory disorders there is increasing evidence that ADMA contributes to the vascular changes and to endothelial cell abnormalities, as several studies have revealed derangement of nitric oxide/ADMA pathway in different disease subsets. In this article we discuss the role of endothelial dysfunction in patients with rheumatic diseases, with a specific focus on the nitric oxide/ADMA system and we provide an overview on the literature pertaining to ADMA as a surrogate marker of subclinical vascular disease.
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Affiliation(s)
- Theodoros Dimitroulas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands DY1 2HQ, UK; E-Mails: (A.S.); (G.D.K.)
- Author to whom correspondence should be addressed; E-Mail: or ; Tel.: +44-1384-244842; Fax: +44-1283-244272
| | - Aamer Sandoo
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands DY1 2HQ, UK; E-Mails: (A.S.); (G.D.K.)
| | - George D. Kitas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands DY1 2HQ, UK; E-Mails: (A.S.); (G.D.K.)
- Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester M15 6SZ, UK
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[Critical limb ischemia in systemic sclerosis]. Z Rheumatol 2012; 71:261-9. [PMID: 22538844 DOI: 10.1007/s00393-011-0914-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Vascular complications are common in systemic sclerosis (SSc). Critical limb ischemia leading to gangrene or amputation occurs in more than 10% of these patients and hence is a common emergency. This report highlights the different pathogenetic mechanisms leading to critical ischemic events and provides guidance for the diagnosis and therapy. Apart from SSc-associated vasculopathy and peripheral arterial disease, thromboembolic events and rarely also vasculitis may cause critical limb ischemia. An interdisciplinary approach to the diagnosis and therapy of these lesions is mandatory. Therapy goals are the prevention of further ischemia and, if possible, revascularization as well as optimal pain management.
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Galarraga B, McSwiggan S, Caswell FR, Brodie RC, Sharma P, Abel EW, Newton DJ, Belch JJF. A novel approach to measuring skin elasticity in systemic sclerosis: results from a pilot study. Scand J Rheumatol 2011; 40:211-6. [PMID: 21231806 DOI: 10.3109/03009742.2010.530610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Systemic sclerosis (SSc) is characterized by progressive fibrosis of various organs, and causes hard, tethered, and inelastic skin. The modified Rodnan score is used to quantify skin involvement, but this method is subjective and user dependent. The aim of this study was to test the ability of a new skin torsion device to measure skin elasticity in patients with SSc. METHODS The study included 16 female SSc patients and 58 healthy controls. Skin elasticity was assessed on the forearms and backs of the hands using a new hand-held device that gently rotates the skin for 15 s to a maximum of 40 deg, and measures the speed of rotation and the angle of rotation at 15 s. Total and localized modified Rodnan scores were also documented. RESULTS Measurements produced by the skin torsion device had good intra-subject reproducibility, particularly in the control group. The SSc patients had significantly lower skin elasticity than an age-matched subgroup of control subjects, as determined by the median speed of rotation of the device in the hands (1.91 vs. 2.60 deg/s, p < 0.0001) and forearms (1.84 vs. 2.46 deg/s, p < 0.0001), and the rotation at 15 s in the hands (28.6 vs. 39.0 deg, p < 0.0001) and forearms (27.6 vs. 36.9 deg, p < 0.0001). The presence of SSc disease was the only independent predictor of skin elasticity. CONCLUSIONS This pilot study has shown the potential value of a new skin torsion device to assess skin involvement in patients with SSc.
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Affiliation(s)
- B Galarraga
- Vascular and Inflammatory Diseases Research Unit, The Institute of Cardiovascular Research, Dundee, UK
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Pinter T, Faludi R, Magyari B, Vorobcsuk A, Kumanovics G, Minier T, Czirjak L, Komocsi A. Mechanism of coronary flow reserve reduction in systemic sclerosis: insight from intracoronary pressure wire studies. Rheumatology (Oxford) 2010; 50:781-8. [DOI: 10.1093/rheumatology/keq402] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Abstract
Systemic sclerosis (SSc) is a chronic disease of unknown etiology, characterized by enhanced fibrosis, and microvascular abnormalities. During the past several decades, the death rates due to cardiovascular disease or cerebrovascular disease in SSc patients substantially increased and are currently responsible for 20-30% of mortality. Various autoimmune rheumatic diseases such as rheumatoid arthritis and systemic lupus erythematosus accelerate atherosclerosis. Although microvascular disease is a hallmark of SSc, an ongoing debate exists regarding the presence and extent of macrovascular diseases and the presence of accelerated atherosclerosis in SSc patients. Despite conflicting results as to intima-media thickness (IMT) in SSc patients, the most recent and largest study has found no difference in either plaque occurrence or IMT. Additionally, abnormal coronary flow reserve in SSc patients appears to be due to microvascular involvement rather than atherosclerosis of the epicardial coronary arteries. Angiographic findings as well as computed tomography studies have generated conflicting reports as to coronary atherosclerosis in SSc. Herein, we review the current knowledge of macrovascular involvement and atherosclerosis in SSc. The differences between SSc and other autoimmune rheumatic diseases in the presence and extent of atherosclerosis need to be further investigated.
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Vascular Complications of Systemic Sclerosis during Pregnancy. Int J Rheumatol 2010; 2010. [PMID: 20814538 PMCID: PMC2931377 DOI: 10.1155/2010/287248] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 07/02/2010] [Indexed: 11/24/2022] Open
Abstract
Systemic sclerosis (SSc) is a chronic autoimmune disorder characterized by progressive fibrosis of the skin and visceral tissues as well as a noninflammatory vasculopathy. Vascular disease in systemic sclerosis is a major cause of morbidity and mortality among nonpregnant patients with SSc and is even a bigger concern in the pregnant SSc patient, as the underlying vasculopathy may prevent the required hemodynamic changes necessary to support a growing pregnancy. Vascular manifestations including scleroderma renal crisis and pulmonary arterial hypertension should be considered relative contraindications against pregnancy due to the high associations of both maternal and fetal morbidity and mortality. In contrast, Raynaud's phenomenon may actually improve somewhat during pregnancy. Women with SSc who are considering a pregnancy or discover they are pregnant require evaluation for the presence and extent of underlying vasculopathy. In the absence of significant visceral vasculopathy, most women with SSc can expect to have reasonable pregnancy outcomes.
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Abstract
Patients with rheumatoid arthritis (RA) have a reduced life expectancy when compared with the general population, largely attributable to cardiovascular disease. Factors that contribute to this increased cardiovascular risk include traditional risk factors, which account for only part of the excess, along with manifestations of the disease itself. RA is characterized by inflammation, which also is a key component in the development of atherosclerosis. Inflammation leads to the activation of endothelial cells, which, through an increase in the expression of leukocyte adhesion molecules, promotes a pro-atherosclerotic environment. Endothelial dysfunction is an early preclinical marker of atherosclerosis, and is commonly found in patients with RA. Several methods are available for the assessment of endothelial function, such as flow-mediated dilatation and laser Doppler flowmetry combined with iontophoresis, each with its own advantages and limitations. Studies have shown that endothelial dysfunction in RA is closely associated with inflammation, and therapeutic reduction of inflammation leads to improvements in endothelial function. As such, assessments of endothelial function could prove to be useful tools in the identification and monitoring of cardiovascular risk in patients with RA. Given the increase in cardiovascular mortality associated with RA, effective management must involve prevention of cardiovascular risk, in addition to control of disease activity and inflammation.
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Abstract
Rheumatic disease is characterized by inflammation and endothelial dysfunction, which contribute to accelerated atherosclerosis. Circulating endothelial progenitor cells (EPCs) can restore dysfunctional endothelium and thereby protect against atherosclerotic vascular disease. The number and function of EPCs are, however, affected in rheumatic diseases such as psoriatic arthritis, rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and antineutrophil cytoplasmic autoantibody-associated vasculitis. rheumatic disease is often characterized by decreased numbers, and impaired function, of EPCs, although numbers of these cells might increase during the initial years of systemic sclerosis. Pioneering studies show that EPC dysfunction might be improved with pharmacological treatment. How best to restore EPC function, and whether achieving this aim can prevent long-term cardiovascular complications in rheumatic disease, remain to be established.
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