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Gauffenic A, Ratsimbazafy V, Ostertag A, Linglart A, Bourrat E, Leroy C, Lioté F, Latourte A, Richette P, Ea HK, Guigonis V. Effectiveness of topical sodium thiosulfate for ectopic calcifications and ossifications. Results of the CATSS-O study. Semin Arthritis Rheum 2023; 63:152306. [PMID: 37976811 DOI: 10.1016/j.semarthrit.2023.152306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/02/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Ectopic calcifications (ECs) and heterotopic ossifications (HOs) form in non-mineralized tissues, most often in subcutaneous and muscular areas. Local and systemic complications can cause severe disability. Systemic administration of sodium thiosulfate (STS) gives promising results but is difficult to use in clinical practice. OBJECTIVE Evaluation of the efficacy and safety of topical STS in ECs and HOs. METHODS Retrospective analysis of the CATSS-O registry that included patients receiving topical STS 25 % prepared by the pharmacy of Limoges hospital during 2014-2020. The efficacy of STS was assessed by imaging (radiography or CT) after at least 6 months' treatment. RESULTS Among 126 patients who received STS 25 %, 35 had complete clinical and radiographic data for analysis (28 with ECs and 7 with HOs; 18 children [mean age 8.9 years, range 1.5-16], 17 adults [mean age 52.4 years, range 24-90]). Calcifications or ossifications were due to dermatomyositis (8 children, 6 adults), systemic scleroderma (6 adults) or pseudo-hypoparathyroidism 1A (7 children). They were single (37.1 %) or multiple (62.9 %). Treated regions were in the lower limbs (31.4 %), upper limbs (37.1 %) or both (28.6 %) and the axial region (2.9 %). Topical STS was clinically effective in 9/28 (32.1 %) patients with ECs and 2/7 (28.6 %) children with HOs. Three patients experienced complete disappearance of their calcifications. Response for ECs was better in children than adults (54.5% vs 17.6 %, p = 0.035). Topical STS was well tolerated. CONCLUSION Local STS seems effective for ossifications, particularly pediatric calcifications or ossifications. Randomized and experimental studies are needed to confirm this observation and to identify the underlying mechanisms.
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Affiliation(s)
- Alan Gauffenic
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France; Service de Rhumatologie, Centre Viggo Petersen, Hôpital Lariboisière, APHP.Nord, F-75010 Paris, France
| | - Voa Ratsimbazafy
- University of Limoges, EpiMaCT Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France; Inserm, U1094, EpiMaCT-Epidemiology of chronic diseases in tropical zone, Limoges, France; IRD, U270, EpiMaCT-Epidemiology of chronic diseases in tropical zone, Limoges, France; CHU Limoges, Department of Pharmacy, Limoges, France
| | - Agnès Ostertag
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France
| | - Agnès Linglart
- INSERM-U1185, Paris Sud Paris-Saclay University, 75005 Paris, France; APHP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Network OSCAR and 'Platform of Expertise Paris Sud for Rare Diseases, 75005 Paris, France; APHP, Endocrinology and Diabetes for Children, 75005 Paris, France
| | - Emmanuelle Bourrat
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Paris, France
| | - Charles Leroy
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France
| | - Frédéric Lioté
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France; Service de Rhumatologie, Centre Viggo Petersen, Hôpital Lariboisière, APHP.Nord, F-75010 Paris, France
| | - Augustin Latourte
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France; Service de Rhumatologie, Centre Viggo Petersen, Hôpital Lariboisière, APHP.Nord, F-75010 Paris, France
| | - Pascal Richette
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France; Service de Rhumatologie, Centre Viggo Petersen, Hôpital Lariboisière, APHP.Nord, F-75010 Paris, France
| | - Hang Korng Ea
- Inserm UMR 1132 Bioscar, Université Paris Cité, F-75010 Paris, France; Service de Rhumatologie, Centre Viggo Petersen, Hôpital Lariboisière, APHP.Nord, F-75010 Paris, France.
| | - Vincent Guigonis
- Service de Pédiatrie, CHU de Limoges, Limoges, France; CIC 1435, CHU de Limoges, Limoges, France; UMR CNRS 7276, Limoges, France
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Pinotti CS, Cannon L, Dvergsten JA, Wu EY. Calcinosis in juvenile dermatomyositis: Updates on pathogenesis and treatment. Front Med (Lausanne) 2023; 10:1155839. [PMID: 36936211 PMCID: PMC10017873 DOI: 10.3389/fmed.2023.1155839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Calcinosis, or the deposition of insoluble calcium salts in the skin, subcutaneous tissue, fascia, tendons, and muscles, is a feared complication of juvenile dermatomyositis. Calcinosis is estimated to affect up to 40% of patients with juvenile dermatomyositis and contributes to significant disease morbidity. Calcinosis can be challenging to treat, and the most effective treatment remains unknown because of a lack of comparative studies. We aim to review the literature published in the last 5 years to summarize updates on the pathogenesis and treatment of calcinosis in juvenile dermatomyositis and describe future areas for research.
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Affiliation(s)
- Caitlan S. Pinotti
- Division of Pediatric Rheumatology, Department of Pediatrics, Duke University, Durham, NC, United States
- *Correspondence: Caitlan S. Pinotti,
| | - Laura Cannon
- Division of Pediatric Rheumatology, Department of Pediatrics, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States
| | - Jeffrey A. Dvergsten
- Division of Pediatric Rheumatology, Department of Pediatrics, Duke University, Durham, NC, United States
| | - Eveline Y. Wu
- Division of Pediatric Rheumatology, Department of Pediatrics, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
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Valenzuela A, Chung L. Subcutaneous calcinosis: Is it different between systemic sclerosis and dermatomyositis? JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2022; 7:7-23. [PMID: 35386947 PMCID: PMC8922676 DOI: 10.1177/23971983211053245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/27/2021] [Indexed: 02/03/2023]
Abstract
Calcinosis cutis is the deposition of insoluble calcium in the skin and subcutaneous tissues. It is a manifestation of several autoimmune connective tissue diseases, most frequently with systemic sclerosis and juvenile dermatomyositis, followed by adult dermatomyositis. Autoimmune connective tissue disease-associated calcinosis is of the dystrophic subtype, which occurs at sites of damaged tissue in the setting of normal serum calcium and phosphate levels. In juvenile dermatomyositis, calcinosis is considered a marker of ongoing disease activity and possibly inadequate treatment, while in adult dermatomyositis, it is a hallmark of skin damage due to chronic rather than active disease. Calcinosis is associated with long disease duration in systemic sclerosis and dermatomyositis, anti-polymyositis/sclerosis autoantibodies in systemic sclerosis and NXP-2 and melanoma differentiation-associated gene 5 in dermatomyositis. Calcinosis in systemic sclerosis occurs most frequently in the hands, particularly the fingers, whereas in dermatomyositis, it affects mainly the trunk and extremities. The primary mineral component of calcinosis is hydroxyapatite in systemic sclerosis and carbonate apatite in dermatomyositis. Calcinosis in dermatomyositis and systemic sclerosis share some pathogenic mechanisms, but vascular hypoxia seems to play a more important role in systemic sclerosis, whereas the release of calcium from mitochondria in muscle cells damaged by myopathy may be a primary mechanism contributing to dermatomyositis-related calcinosis. Multiple treatment strategies for dermatomyositis and systemic sclerosis-related calcinosis have been used with variable results. Early aggressive treatment of underlying myositis in patients with dermatomyositis may improve long-term outcomes of calcinosis. A better understanding of the pathogenesis of calcinosis is needed to improve treatment options.
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Affiliation(s)
- Antonia Valenzuela
- Division of Clinical Immunology and Rheumatology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA,Division of Immunology and Rheumatology, VA Palo Alto Health Care System, Palo Alto, CA, USA,Lorinda Chung, Division of Immunology and Rheumatology, Stanford University School of Medicine, 1000 Welch Rd Ste 203, MC 5755, Palo Alto, CA 94304, USA.
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Nowaczyk J, Zawistowski M, Fiedor P. Local, non-systemic, and minimally invasive therapies for calcinosis cutis: a systematic review. Arch Dermatol Res 2021; 314:515-525. [PMID: 34165603 PMCID: PMC9232439 DOI: 10.1007/s00403-021-02264-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/11/2021] [Indexed: 11/24/2022]
Abstract
Calcinosis cutis is a deposition of calcium in the skin and subcutaneous tissue, often accompanied by pain, reduced mobility, and chronic infections. Limited evidence is available about the feasibility and efficacy of therapies alternative to systemic treatment and surgical excision, both of which often lead to unsatisfactory results or complications. We conducted a systematic review to evaluate the efficacy and safety of topical and intralesional sodium thiosulfate, extracorporeal shock-wave lithotripsy (ESWL), and laser for calcinosis cutis. PubMed, Embase, and Web of Science were searched. Reports of calciphylaxis and treatment combined with systemic medications were excluded. A total of 40 studies including 136 patients were analysed. Partial or complete remission after monotherapy was observed in 64% to 81% of cases. Self-applied topical sodium thiosulfate required patient’s adherence (mean treatment duration, 4.9 months; range 2–24). Laser therapy enabled complete remission of microcalcifications after a single procedure (57%; 12/21). ESWL and intralesional sodium thiosulfate injections decreased calcinosis-associated pain (median reduction in VAS score, 3; range 0–9 and 1; range 0–5, respectively). The most common adverse event was scarring and hyperkeratosis, observed after CO2 laser (56%; 10/18). Intralesional sodium thiosulfate injections caused transient pain in over 11% of patients. Recurrences within the follow-up were rare (2%; 3/136). This study provides an overview of minimally invasive and local therapies that in selected cases might transcend conventional treatment. The limitation of this study is the poor level of evidence, which emerges mainly from non-randomized studies at high risk of bias.
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Affiliation(s)
- Joanna Nowaczyk
- Department of General and Transplantation Surgery, Medical University of Warsaw, Nowogrodzka 59, 02-006, Warsaw, Poland
| | - Michał Zawistowski
- Department of General and Transplantation Surgery, Medical University of Warsaw, Nowogrodzka 59, 02-006, Warsaw, Poland
| | - Piotr Fiedor
- Department of General and Transplantation Surgery, Medical University of Warsaw, Nowogrodzka 59, 02-006, Warsaw, Poland.
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