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Jouanjan L, Stolz D, Frye BC. A pulmonary perspective on current challenges in connective tissue diseases. Eur J Intern Med 2024; 120:32-33. [PMID: 38103952 DOI: 10.1016/j.ejim.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Louis Jouanjan
- Department of Pneumology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany.
| | - Daiana Stolz
- Department of Pneumology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Björn C Frye
- Department of Pneumology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
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2
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Barasch JG, Tang W, Khalili L, Askanase A. The Evolving Role of Telemedicine in the Care of Patients With Connective Tissue Diseases. Arthritis Care Res (Hoboken) 2024; 76:19-21. [PMID: 37842736 DOI: 10.1002/acr.25259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Julia G Barasch
- Columbia University Vagelos College of Physicians and Surgeons, New York City
| | - Wei Tang
- Columbia University Irving Medical Center, New York City
| | - Leila Khalili
- Columbia University Irving Medical Center, New York City
| | - Anca Askanase
- Columbia University Irving Medical Center, New York City
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3
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Fu Y, Zhao L, Ye S. Intention to treat: The management of connective tissue disease-related immune thrombocytopenia. Int J Rheum Dis 2023; 26:1885-1888. [PMID: 37807615 DOI: 10.1111/1756-185x.14811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Yakai Fu
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Liling Zhao
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shuang Ye
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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4
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Fairley JL, Ross L, Burns A, Prior D, Conron M, Rouse H, McDonald J, MacIsaac A, La Gerche A, Morrisroe K, Ferdowsi N, Quinlivan A, Brown Z, Stevens W, Nikpour M. Multidisciplinary team discussion: the emerging gold standard for management of cardiopulmonary complications of connective tissue disease. Intern Med J 2023; 53:1919-1924. [PMID: 37772776 PMCID: PMC10947227 DOI: 10.1111/imj.16233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/28/2023] [Indexed: 09/30/2023]
Abstract
Cardiopulmonary complications of connective tissue diseases (CTDs), particularly pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD), are major determinants of morbidity and mortality. Multidisciplinary meetings may improve diagnostic accuracy and optimise treatment. We review the literature regarding multidisciplinary meetings in CTD-ILD and PAH and describe our tertiary centre experience of the role of the multidisciplinary meeting in managing CTD-PAH.
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Affiliation(s)
- Jessica L. Fairley
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Laura Ross
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Andrew Burns
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of CardiologySt Vincent's Hospital MelbourneMelbourneAustralia
| | - David Prior
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of CardiologySt Vincent's Hospital MelbourneMelbourneAustralia
| | - Matthew Conron
- Department of Respiratory MedicineSt Vincent's Hospital MelbourneMelbourneAustralia
| | - Hannah Rouse
- Department of RadiologySt Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Julie McDonald
- Department of Respiratory MedicineSt Vincent's Hospital MelbourneMelbourneAustralia
| | - Andrew MacIsaac
- Department of CardiologySt Vincent's Hospital MelbourneMelbourneAustralia
| | - André La Gerche
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Baker Heart and Diabetes InstituteVictoriaAustralia
| | - Kathleen Morrisroe
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Nava Ferdowsi
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Alannah Quinlivan
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Zoe Brown
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Wendy Stevens
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
| | - Mandana Nikpour
- Department of MedicineThe University of MelbourneMelbourneVictoriaAustralia
- Department of RheumatologySt. Vincent's Hospital MelbourneMelbourneVictoriaAustralia
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5
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Redhead C, Taye N, Hubmacher D. En route towards a personalized medicine approach: Innovative therapeutic modalities for connective tissue disorders. Matrix Biol 2023; 122:46-54. [PMID: 37657665 PMCID: PMC10529529 DOI: 10.1016/j.matbio.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 09/03/2023]
Abstract
Connective tissue disorders can be caused by pathogenic variants (mutations) in genes encoding extracellular matrix (ECM) proteins. Such disorders typically manifest during development or postnatal growth and result in significant morbidity and mortality. The development of curative treatments for connective tissue disorders is hampered in part by the inability of many mature connective tissues to efficiently regenerate. To be most effective, therapeutic strategies designed to preserve or restore tissue function will likely need to be initiated during phases of significant endogenous connective tissue remodeling and organ sculpting postnatally and directly target the underlying ECM protein mutations. With recent advances in whole exome sequencing, in-vitro and in-vivo disease modeling, and the development of mutation-specific molecular therapeutic modalities, it is now feasible to directly correct disease-causing mutations underlying connective tissue disorders and ameliorate their pathogenic consequences. These technological advances may lead to potentially curative personalized medicine approaches for connective tissue disorders that have previously been considered incurable. In this review, we highlight innovative therapeutic modalities including gene replacement, exon skipping, DNA/mRNA editing, and pharmacological approaches that were used to preserve or restore tissue function in the context of connective tissue disorders. Inherent to a successful application of these approaches is the need to deepen the understanding of mechanisms that regulate ECM formation and homeostasis, and to decipher how individual mutations in ECM proteins compromise ECM and connective tissue development and function.
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Affiliation(s)
- Charlene Redhead
- Orthopedic Research Laboratories, Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Nandaraj Taye
- Orthopedic Research Laboratories, Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Dirk Hubmacher
- Orthopedic Research Laboratories, Leni & Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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6
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Wesley A, Coussens M, Chan C, Pacey V, Bray P, Nicholson LL. Conservative management of hand impairment in children and adolescents with heritable disorders of connective tissue: A scoping review. Phys Occup Ther Pediatr 2023; 44:19-41. [PMID: 37125678 DOI: 10.1080/01942638.2023.2199846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 04/02/2023] [Indexed: 05/02/2023]
Abstract
AIMS To synthesize and critically appraise available interventions in the conservative management of hand impairment for children and adolescents with heritable disorders of connective tissue (HDCT). METHODS A search of peer-reviewed literature and online platforms were included with data regarding hand impairment and function, conservative management and outcome measures extracted and appraised. Levels of evidence were applied to published literature. RESULTS Ten peer-reviewed papers, eleven webpages and YouTube videos met the inclusion criteria. Reported interventions included: strengthening, orthoses, assistive equipment, education and pacing. Evidence of intervention effectiveness and evidence-based guidance on dosage were absent, with no consistency of outcome measures monitoring intervention effectiveness. Online platforms posted by health professionals predominantly provided advice for families without clinical detail of interventions. CONCLUSIONS There is a consistent suite of interventions identified in both peer-reviewed literature and online platforms used by clinicians and families to manage hand impairment for children and adolescents with HDCT. Clear dosage parameters and outcome measures are needed in future intervention studies to determine the effectiveness of interventions and guide clinicians in how best to treat hand impairment. Increasing accountability and quality of online resources posted by health professionals for families is warranted to ensure dosage details and precautions are provided.
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Affiliation(s)
- Alison Wesley
- Occupational Therapy Department, The Children's Hospital at Westmead, Sydney, Australia
- Department of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Marie Coussens
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Cliffton Chan
- Department of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Verity Pacey
- Department of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Paula Bray
- Department of Medicine and Health, The University of Sydney, Sydney, Australia
- The Sydney Children's Hospitals Network, Sydney, Australia
| | - Leslie L Nicholson
- Department of Medicine and Health, The University of Sydney, Sydney, Australia
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7
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Kuwana M, Bando M, Kawahito Y, Sato S, Suda T, Kondoh Y. Identification and management of connective tissue disease-associated interstitial lung disease: evidence-based Japanese consensus statements. Expert Rev Respir Med 2023; 17:71-80. [PMID: 36786105 DOI: 10.1080/17476348.2023.2176303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/31/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Interstitial lung disease (ILD) is a common complication of connective tissue diseases (CTD), but there are few clinical trials to guide disease management. We aimed to develop expert consensus statements and an algorithm for CTD-ILD management. RESEARCH DESIGN AND METHODS Based on a targeted literature review, we developed 109 statements on managing CTD-ILD across six domains. We used a modified Delphi process to survey 22 physicians in Japan involved in managing CTD-ILD (specialists in pulmonology, rheumatology, pathology, and radiology). These panelists participated in two rounds of web-based survey to establish consensus statements, which were used to define an algorithm. Consensus was defined as a mean value ≥70 on a scale of 0 (strong disagreement) to 100 (strong agreement). RESULTS Between May-August 2022, consensus was reached on 93 statements on CTD-ILD management. The most important consensus statements included screening CTD patients for ILD (typically with high-resolution computed tomography), using imaging, pulmonary function testing and serum biomarkers for diagnosis and severity assessment, regularly following up patients, and multidisciplinary management of CTD-ILD. Consensus statements were interpreted into an algorithm for clinical guidance. CONCLUSIONS Using the Delphi process, we have developed consensus statements and an algorithm to guide clinical decision-making for CTD-ILD.
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Affiliation(s)
- Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Masashi Bando
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Yutaka Kawahito
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinji Sato
- Division of Rheumatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
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Jia RF, Cao MC. [Interpretation of 2020 edition of Japanese "Guidelines for the management of connective tissue disease/vasculitis-associated skin ulcers"]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2022; 38:1196-1200. [PMID: 36594152 DOI: 10.3760/cma.j.cn501225-20220320-00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Patients with connective tissue diseases and vasculitis often develop refractory skin ulcers in various parts of the body due to abnormal autoimmune reactions, and the skin ulcers caused by different types of diseases have strong heterogeneity. In 2020, The Journal of Dermatology published the Japanese "Guidelines for the management of connective tissue disease/vasculitis-associated skin ulcers", which is an updated version of its 2016 edition, to guide clinical management of related diseases in a more scientific and standard way. By interpreting the guidelines, this paper aims to help domestic clinicians clarify the diagnosis and treatment objectives of connective tissue disease and vasculitis-associated skin ulcers, accelerate skin wound healing, and improve healing quality.
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Affiliation(s)
- R F Jia
- The Dean's Office of Brain Department District, Cangzhou Central Hospital, Cangzhou 061001, China
| | - M C Cao
- Blood Purification Room, Cangzhou Central Hospital, Cangzhou 061001, China
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Zou QH, Lu YW, Zhou JG, Liu XX, Li MT, Zhao Y. [Recommendations for the diagnosis and treatment of connective tissue disease-associated interstitial lung disease in China]. Zhonghua Nei Ke Za Zhi 2022; 61:1217-1223. [PMID: 36323562 DOI: 10.3760/cma.j.cn112138-20220525-00406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Interstitial lung disease (ILD) is a frequent complication of patients with connective tissue disease (CTD) and significantly affects morbidity and mortality. Disease course may vary from stable or mildly progressive to more severe, with rapid loss of lung function. At present, there are great challenges and poor prognosis in the diagnosis and treatment of CTD-ILD. Based on the evidence and guidelines from China and other countries, experts from the Chinese Rheumatology Association developed standardization of diagnosis and treatment of CTD-ILD. The aim is to strengthen the early identification of, standardize the diagnosis and treatment of CTD-ILD, and delay the progress of the disease.
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Affiliation(s)
- Q H Zou
- Department of Rheumatology and Immunology,the First Hospital Affiliated to Army Medical University,Chongqing 400038,China
| | - Y W Lu
- Department of Rheumatology and Immunology,Beijing Chao Yang Hospital, Capital Medical University,Beijing 100020,China
| | - J G Zhou
- Department of Rheumatology and Immunology,Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College,Chengdu 610500, China
| | - X X Liu
- Department of Rheumatology and Immunology,the Affiliated Hospital of Guizhou Medical University, Guiyang 550005, China
| | - M T Li
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, State Key Laboratory of Complex Sever and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education,Beijing 100730, China
| | - Yan Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, State Key Laboratory of Complex Sever and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education,Beijing 100730, China
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10
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Zhang X, Zhao JL, Ding F, Yang J, Wang J, Zeng XF, Zhao Y. [Recommendations for the diagnosis and treatment of connective tissue disease associated pulmonary arterial hypertension in China]. Zhonghua Nei Ke Za Zhi 2022; 61:1206-1216. [PMID: 36323561 DOI: 10.3760/cma.j.cn112138-20220309-00164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a clinicopathological syndrome caused by the increase of pulmonary artery, and it is the most serious complication of connective tissue disease (CTD). In recent years, a lot of progress has been made in the diagnosis, treatment and evaluation of PAH. Chinese Rheumatology Association formulated this recommendation on the basis of current experience and guidelines, in order to promote early screening, early diagnosis and early intervention of CTD-PAH, as well as patient follow-up and management, to improve the prognosis of CTD-PAH patients.
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Affiliation(s)
- X Zhang
- Department of Rheumatology, Guangdong Provincial Peolple's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510120, China
| | - J L Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, State Key Laboratory of Complex Sever and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - F Ding
- Department of Rheumatology, Shandong University Qilu Hospital, Jinan 250012, China
| | - J Yang
- Department of Rheumatology and Immunology, MianYang Central Hospital, Mianyang 621000, China
| | - J Wang
- Department of Rheumatology and Immunology, the First People's Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, China
| | - X F Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, State Key Laboratory of Complex Sever and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Yan Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, State Key Laboratory of Complex Sever and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
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11
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Mo YQ, Yan Q, Ye S, Dai L, Zhao Y. [Standardized diagnosis and treatment of undifferentiated connective tissue disease and mixed connective tissue disease]. Zhonghua Nei Ke Za Zhi 2022; 61:1119-1127. [PMID: 36207966 DOI: 10.3760/cma.j.cn112138-20220104-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Undifferentiated connective tissue disease (CTD) usually refers to patients who are presented with certain symptoms and signs related to CTD, and positive serological evidence of autoimmune diseases but don't fulfill any of the classification criteria for a certain CTD. Mixed CTD refers to patients who are presented with one or more clinical manifestations such as hand swelling, synovitis, myositis, Raynaud's phenomenon, and acrosclerosis. Patients with mixed CTD always have high-titer anti-nuclear antibodies (ANA) of speckled pattern and high-titer anti-U1 ribonuclear protein (RNP) antibody in serum, while with negative anti-Sm antibody. The update of diagnosis and treatment of undifferentiated CTD and mixed CTD lags behind other established CTD. There is a lack of evidence from randomized controlled trials or guidelines/recommendations on the treatment of undifferentiated CTD or mixed CTD. At present, the conventional therapy is mainly adopted according to the specific clinical manifestations of the disease. The standardized diagnosis and treatment of undifferentiated CTD and mixed CTD were drafted by the Chinese Rheumatology Association based on the previous guidelines and the progress of available evidence, so as to improve the management of these patients in China.
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Affiliation(s)
- Y Q Mo
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
| | - Q Yan
- Department of Rheumatology and Immunology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, China
| | - S Ye
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China
| | - L Dai
- Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
| | - Yan Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
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12
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Park JS, Kim HS, Choi CP. Utilizing Combined Pulsed Dye and Nd:YAG Lasers in the Treatment of Connective Tissue Disease Cutaneous Symptoms. J Clin Rheumatol 2021; 27:S451-S452. [PMID: 31868836 DOI: 10.1097/rhu.0000000000001245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Kondoh Y, Makino S, Ogura T, Suda T, Tomioka H, Amano H, Anraku M, Enomoto N, Fujii T, Fujisawa T, Gono T, Harigai M, Ichiyasu H, Inoue Y, Johkoh T, Kameda H, Kataoka K, Katsumata Y, Kawaguchi Y, Kawakami A, Kitamura H, Kitamura N, Koga T, Kurasawa K, Nakamura Y, Nakashima R, Nishioka Y, Nishiyama O, Okamoto M, Sakai F, Sakamoto S, Sato S, Shimizu T, Takayanagi N, Takei R, Takemura T, Takeuchi T, Toyoda Y, Yamada H, Yamakawa H, Yamano Y, Yamasaki Y, Kuwana M. 2020 guide for the diagnosis and treatment of interstitial lung disease associated with connective tissue disease. Respir Investig 2021; 59:709-740. [PMID: 34602377 DOI: 10.1016/j.resinv.2021.04.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 01/29/2023]
Abstract
The prognosis of patients with connective tissue disease (CTD) has improved significantly in recent years, but interstitial lung disease (ILD) associated with connective tissue disease (CTD-ILD) remains a refractory condition, which is a leading cause of mortality. Because it is an important prognostic factor, many observational and interventional studies have been conducted to date. However, CTD is a heterogeneous group of conditions, which makes the clinical course, treatment responses, and prognosis of CTD-ILD extremely diverse. To summarize the current understanding and unsolved questions, the Japanese Respiratory Society and the Japan College of Rheumatology collaborated to publish the world's first guide focusing on CTD-ILD, based on the evidence and expert consensus of pulmonologists and rheumatologists, along with radiologists, pathologists, and dermatologists. The task force members proposed a total of 27 items, including 7 for general topics, 9 for disease-specific topics, 3 for complications, 4 for pharmacologic treatments, and 4 for non-pharmacologic therapies, with teams of 2-4 authors and reviewers for each item to prepare a consensus statement based on a systematic literature review. Subsequently, public opinions were collected from members of both societies, and a critical review was conducted by external reviewers. Finally, the task force finalized the guide upon discussion and consensus generation. This guide is expected to contribute to the standardization of CTD-ILD medical care and is also useful as a tool for promoting future research by clarifying unresolved issues.
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Affiliation(s)
- Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan.
| | - Shigeki Makino
- Rheumatology Division, Osaka Medical College Mishima-Minami Hospital, Takatsuki, Osaka, Japan
| | - Takashi Ogura
- Division of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hiromi Tomioka
- Department of Respiratory Medicine, Kobe City Medical Center West Hospital, Kobe, Hyogo, Japan
| | - Hirofumi Amano
- Department of Internal Medicine and Rheumatology, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Masaki Anraku
- Department of Thoracic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Itabashi, Tokyo, Japan
| | - Noriyuki Enomoto
- Health Administration Center, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Takao Fujii
- Department of Rheumatology and Clinical Immunology, Wakayama Medical University, Wakayama, Wakayama, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Takahisa Gono
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Masayoshi Harigai
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Shinjuku, Tokyo, Japan
| | - Hidenori Ichiyasu
- Department of Respiratory Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Kumamoto, Japan
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan
| | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Hideto Kameda
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Toho University, Meguro, Tokyo, Japan
| | - Kensuke Kataoka
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Yasuhiro Katsumata
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Shinjuku, Tokyo, Japan
| | - Yasushi Kawaguchi
- Department of Rheumatology, Tokyo Women's Medical University School of Medicine, Shinjuku, Tokyo, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Hideya Kitamura
- Division of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Noboru Kitamura
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Kazuhiro Kurasawa
- Department of Rheumatology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Ran Nakashima
- Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Sakyo, Kyoto, Japan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Tokushima, Japan
| | - Osamu Nishiyama
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Masaki Okamoto
- Department of Respirology, National Hospital Organization Kyushu Medical Center, Fukuoka, Fukuoka, Japan
| | - Fumikazu Sakai
- Department of Diagnostic Radiology, Saitama International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Susumu Sakamoto
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - Shinji Sato
- Division of Rheumatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Toshimasa Shimizu
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Noboru Takayanagi
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya, Saitama, Japan
| | - Reoto Takei
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Tamiko Takemura
- Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan
| | - Tohru Takeuchi
- Department of Internal Medicine (IV), Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Yuko Toyoda
- Department of Respiratory Medicine, Japanese Red Cross Kochi Hospital, Kochi, Kochi, Japan
| | - Hidehiro Yamada
- Center for Rheumatic Diseases, Seirei Yokohama Hospital, Yokohama, Kanagawa, Japan
| | - Hideaki Yamakawa
- Department of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Saitama, Japan
| | - Yasuhiko Yamano
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan
| | - Yoshioki Yamasaki
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Bunkyo, Tokyo, Japan
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14
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Abstract
The presence of interstitial lung disease (ILD) negatively affects prognosis among patients with an underlying connective tissue disease (CTD). The initial approach to care should determine whether the CTD-ILD needs pharmacologic treatment or not. There is little direct evidence to guide who and how to treat. At present, any severe, active, and/or progressive ILD should be pharmacologically treated. Immunosuppressants and/or corticosteroids are the mainstay of pharmacologic therapy for all CTD-ILDs, whereas antifibrotics may be beneficial in some scenarios. A comprehensive and multidisciplinary approach to management is also an important aspect of patient care.
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Affiliation(s)
- Leticia Kawano-Dourado
- HCor Research Institute, Hospital do Coracao, Rua Abilio Soares, 250, 12º andar, Sao Paulo, Sao Paulo 04005-909, Brazil; Pulmonary Division, Heart Institute (InCor), Medical School, University of Sao Paulo, Sao Paulo, Brazil; INSERM UMR 1152, University of Paris, Paris, France.
| | - Joyce S Lee
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver - Anschutz Medical Campus, 12631 East 17th Avenue, C-323, Academic Office 1, Room 7223, Aurora, CO 80045, USA
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15
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Min MS, Kassamali B, Mazori DR, Vleugels RA, Merola JF, Cobos G, LaChance AH. The catch-22 of limited Food and Drug Administration approval for connective tissue disease therapies. J Am Acad Dermatol 2021; 85:517-519. [PMID: 33823201 DOI: 10.1016/j.jaad.2021.03.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Michelle S Min
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bina Kassamali
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel R Mazori
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joseph F Merola
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gabriela Cobos
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Avery H LaChance
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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16
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Vonk MC, Vandecasteele E, van Dijk AP. Pulmonary hypertension in connective tissue diseases, new evidence and challenges. Eur J Clin Invest 2021; 51:e13453. [PMID: 33216992 PMCID: PMC7988614 DOI: 10.1111/eci.13453] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/08/2020] [Accepted: 11/15/2020] [Indexed: 12/21/2022]
Abstract
Pulmonary arterial hypertension is a lethal complication of different connective tissue diseases such as systemic sclerosis, mixed connective tissue disease and systemic lupus erythematosus. Although the treatment possibilities for patients with pulmonary arterial hypertension have increased in the last two decades and survival of patients with idiopathic pulmonary arterial hypertension has improved, the latter is not the case for patients with pulmonary arterial hypertension associated with connective tissue disease. In this narrative review, we review recent literature and describe the improvement of early diagnostic possibilities, screening modalities and treatment options. We also point out the pitfalls in diagnosis in this patient category and describe the unmet needs and what the focus of future research should be.
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Affiliation(s)
- Madelon C. Vonk
- Department of the Rheumatic diseasesRadboud University Nijmegen Medical CentreNijmegenthe Netherlands
| | | | - Arie P. van Dijk
- Department of CardiologyRadboud University Nijmegen Medical CentreNijmegenthe Netherlands
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17
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Lefeuvre L, Dan D. [Connective tissue disease-related interstitial lung disease]. Rev Med Suisse 2021; 17:492-496. [PMID: 33689246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The connectivitides are autoimmune diseases that affect many organs. All of them can cause interstitial lung disease, the most frequent forms being the NSIP (nonspecific interstitial pneumonia) and the UIP (usual interstitial pneumonia). The best screening method is the high-resolution chest CT. The treatment of ILD includes glucocorticoids, immunosuppressive and antifibrotic agents, as well as non-pharmacological therapies. We present the screening and treatment algorithm for the ILD in systemic sclerosis, which is very well established. We also discuss the management of the ILD in rheumatoid arthritis, a very prevalent disease, and though of large public interest.
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Affiliation(s)
- Lucie Lefeuvre
- Service de rhumatologie, Département de l'appareil locomoteur, CHUV, 1011 Lausanne
| | - Diana Dan
- Service de rhumatologie, Département de l'appareil locomoteur, CHUV, 1011 Lausanne
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18
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Brulhart L. [Undifferentiated connective tissue disease : what is it ?]. Rev Med Suisse 2021; 17:498-500. [PMID: 33689247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The term undifferentiated connective tissue disease (UCTD) describe patients presenting with clinical and serological manifestations of systemic autoimmune diseases but not fulfilling the criteria for any defined connective tissue diseases. The challenge is to differentiate patient with a stable UCTD from patients that will evolve to a connective tissue disease with therapeutic and prognostic impact. This article describe UTCD concept, clinical presentation, evolution, and prognostic factors and patients management.
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Affiliation(s)
- Laure Brulhart
- Service de rhumatologie, Département de médecine, Réseau hospitalier neuchâtelois, 2300 La Chaux-de-Fonds
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19
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Cannizzo S, Palla I, Pirri S, Triulzi I, Carta C, Taruscio D, Turchetti G. One year in review 2020: economic and organisational aspects in rare and complex connective tissue diseases. Clin Exp Rheumatol 2020; 38:1037-1045. [PMID: 33242303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/27/2020] [Indexed: 06/11/2023]
Abstract
Rare and complex connective tissue diseases (rCTDs) encompass a considerable number of diseases and syndromes and their variability highly impacts on the clinical management, resulting in variable economic and organisational burden that might represent a challenge for healthcare systems. This paper is aimed at providing an overview of the most recent evidence regarding the economic and organisational impact of rCTDs. In particular, this work discusses the most relevant data on specific aspects related to health economics in rCTDs published in 2019.
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Affiliation(s)
- Sara Cannizzo
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Ilaria Palla
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Salvatore Pirri
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Isotta Triulzi
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Claudio Carta
- National Centre for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Domenica Taruscio
- National Centre for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
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20
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Giollo A, Cioffi G, Rossini M, Viapiana O, De Simone G. Very low reporting rate of connective tissue diseases among coronavirus disease 2019 (Covid-19) patients and the renin-angiotensin system - An overlooked association? Eur J Intern Med 2020; 80:106-107. [PMID: 32553588 PMCID: PMC7290229 DOI: 10.1016/j.ejim.2020.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/12/2020] [Accepted: 06/10/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Alessandro Giollo
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy.
| | - Giovanni Cioffi
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | - Maurizio Rossini
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | - Ombretta Viapiana
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni De Simone
- Centro Interdipartimentale di Ricerca sull'Ipertensione Arteriosa e le Patologie Associate (CIRIAPA), Dipartimento di Scienze Biomediche Avanzate, Università Federico II, Napoli, Italy
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21
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Padoan R, Felicetti M, Gatto M, Polito P, Doria A, Schiavon F. Rituximab-associated hypogammaglobulinaemia in ANCA-associated vasculitis and connective tissue diseases: a longitudinal observational study. Clin Exp Rheumatol 2020; 38 Suppl 124:188-194. [PMID: 32441645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The burden of hypogammaglobulinaemia following rituximab (RTX) treatment in rheumatic diseases has not been fully elucidated yet. Our aim was to evaluate the frequency and predictors of hypogammaglobulinaemia in patients affected by ANCA-associated vasculitis (AAV) and connective tissue diseases (CTD). METHODS We retrospectively reviewed prospectively collected data of patients receiving RTX. Immunoglobulins (Ig) levels and lymphocyte subsets were recorded at RTX administration and 3-6 months later. We assessed frequency of hypogammaglobulinaemia (serum IgG<6 g/L) and its related events. Univariate and multivariable analysis were performed using SPSS 20.0 package. RESULTS Sixty-eight patients (30 AAV, 25 systemic lupus erythematosus, 9 systemic sclerosis and 4 idiopathic inflammatory myopathies) were treated with RTX (95 infusions, median 2 [2-6]). Following RTX, IgG<6 g/L were observed in 15/68 patients (15.8%), IgM<0.4 g/L in 28/68 (41%) and IgA<0.7 g/L in 7/68 (10.2%). Hypogammaglobulinaemia was more common in patients with AAV (p=0.008), short disease duration (p=0.001), low IgG levels at baseline (p=0.008), high cyclophosphamide exposure (p=0.018), high daily and cumulative prednisone dosage (p=0.001 and p=0.006). At multivariate analysis, cumulative cyclophosphamide dosage (OR 1.1 [1.0-1.3] p=0.045), daily prednisone intake >15mg (OR 9.5 [2.2-41.7] p=0.03) and IgG levels before RTX (OR 0.74 [0.59-0.93] p=0.009) were independent predictors of hypogammaglobulinaemia. Five patients experienced severe infections within 12 months, more frequently in those with IgG<6 g/L (26.7% vs 1.9%, p=0.007). CONCLUSIONS Hypogammaglobulinaemia following RTX is uncommon in AAV and CTD and is more likely in patients with high glucocorticoids and cyclophosphamide exposure and low IgG levels at baseline.
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Affiliation(s)
- Roberto Padoan
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Mara Felicetti
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Mariele Gatto
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Pamela Polito
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy.
| | - Franco Schiavon
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Italy
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22
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Gao Y, Moua T. Treatment of the Connective Tissue Disease-Related Interstitial Lung Diseases: A Narrative Review. Mayo Clin Proc 2020; 95:554-573. [PMID: 32138882 DOI: 10.1016/j.mayocp.2019.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/27/2019] [Accepted: 07/16/2019] [Indexed: 11/20/2022]
Abstract
Interstitial lung disease (ILD) is a frequent complication of patients with connective tissue disease (CTD) and significantly affects morbidity and mortality. Disease course may vary from stable or mildly progressive to more severe, with rapid loss of lung function. We conducted a search of PubMed (National Library of Medicine) and the Web of Science Core Collection using the key words lung, pulmonary, pneumonia, pneumonitis, and alveolar and subtypes of CTD. All clinical studies from January 1, 1980, through September 1, 2018, were reviewed for descriptions of specific therapies and their efficacy or safety and were categorized as controlled interventional trials, observational prospective or retrospective cohort studies, case series (>5 patients), and case reports (<5 patients). Low-quality reports (<5 patients) before 2000, reviews, editorials, popular science papers, and letters to the editor without complete descriptions of the therapies used or their outcomes were excluded. Directed therapy for CTD-ILD is dominated by empirical use of immunosuppressive agents, with the decision to treat, treatment choice, and treatment duration limited to cases and cohort observations. Only a few higher-level controlled studies were available specifically in scleroderma-related ILD. We summarize herein for the clinician the published treatment scope and experience, highlighted clinical response, and common adverse reactions for the management of CTD-ILD.
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Affiliation(s)
- Yang Gao
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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23
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Abstract
Raynaud's phenomenon (RP) is common, affecting approximately 5% of the population, and is important to the rheumatologist because it is often the presenting symptom of connective tissue disease, especially of systemic sclerosis (SSc)-spectrum disorders. RP therefore provides a window of opportunity for early diagnosis. When RP is associated with SSc it is particularly challenging to treat. This review begins with a discussion of some of the recent advances in our understanding of the pathogenesis of RP: it is through increased understanding of the complex pathophysiology of RP that we are most likely to develop new therapies. The following questions are then addressed (with three clinical scenarios demonstrating key principles of assessment and management): 1. How can we predict underlying connective tissue disease in the patient presenting with Raynaud's? 2. How can we measure severity of Raynaud's? 3. What are the latest advances in treatment of connective tissue disease-related digital vasculopathy?
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Affiliation(s)
- Ariane L Herrick
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
| | - Fredrick M Wigley
- Department of Medicine, Division of Rheumatology, Johns Hopkins School of Medicine, Baltimore, USA.
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24
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Fidut-Wrońska J, Chołuj K, Chmiel J, Pikto-Pitkiewicz K, Majcher P. Observation using thermography of post-operative reaction after fascial manipulation®. Ann Agric Environ Med 2019; 26:468-471. [PMID: 31559805 DOI: 10.26444/aaem/103456] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION AND OBJECTIVE Fascia Manipulation® is one of the methods focusing on the deep fascia. The assumption is that fascial manipulation is carried out on precisely determined points - coordination centres (cc), and on a limited area so as the friction occurring during manipulation would cause a local rise in temperature due to the inflammatory reaction. Rise in temperature influences modification in consistency of elementary matter in the manipulated area, and by the same token causing a decrease in the negative effects of fascia densification which stems from accumulation of hyaluronic acid. The purpose of the research is to prove the thesis that fascial manipulation causes local rise in temperature due to inflammatory reaction. MATERIAL AND METHODS For the research, 25 individuals with densification in lower limb area were qualified. They were exposed to a single, 3-minute facial manipulation®. By means of a thermal-imaging camera, changes in the temperature of the body in the examined area were evaluated. The body's temperature evaluation was carried out 8 times: before the treatment, 5 minutes after the treatment, and, next, 6, 12, 18, 24, 36, 48 hours after the treatment. RESULTS The average surface temperature of the treated area before mobilization was 33.4°C. A statistically relevant increase in temperature was already observed 5 minutes after the treatment (increase of 0.5°C; p<0.001). However, the highest temperature was observed 24 hours after mobilization (increase of 2.4°C). The difference between the first and 7 other measurements was statistically relevant (p<0.001). CONCLUSIONS The statistically relevant increase in temperature under the influence of fascial manipulation® in the treatment area can confirm the occurrence of inflammatory reaction.
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Affiliation(s)
- Joanna Fidut-Wrońska
- Department of Rehabilitation, Physiotherapy and Balneotherapy, Rehabilitation and Physiotherapy Institute, Medical University, Lublin, Poland
| | - Kamil Chołuj
- Department of Rehabilitation, Physiotherapy and Balneotherapy, Rehabilitation and Physiotherapy Institute, Medical University, Lublin, Poland
| | - Justyna Chmiel
- Department of Rehabilitation, Physiotherapy and Balneotherapy, Balneotherapy Institute, Medical University, Lublin, Poland
| | - Katarzyna Pikto-Pitkiewicz
- Department of Rehabilitation, Physiotherapy and Balneotherapy, Balneotherapy Institute, Medical University, Lublin, Poland
| | - Piotr Majcher
- Department of Rehabilitation, Physiotherapy and Balneotherapy, Rehabilitation and Physiotherapy Institute, Medical University, Lublin, Poland
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25
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Van Zuylen C, Thimmesch M, Lewin M, Dome F, Piérart F. [Non-specific interstitial pneumonia : a rare clinical entity in adolescents]. Rev Med Liege 2019; 74:197-203. [PMID: 30997969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Non-specific Interstitial Pneumonia (NSIP) is an anatomo-clinical entity within the group of Diffuse Infiltrative Pulmonary Diseases (DPID). It is very rarely found in pediatrics. Main symptoms are dry cough and dyspnea. Bronchoalveolar lavage and biology are non specific. The thoracic CT scan suspects the diagnosis, but histological examination of a lung biopsy remains the reference examination and makes the diagnosis highly probable according to the ATS / ERS criteria. An autoimmune assessment should be performed because NSIPs are often associated with connective tissue disease or may even be the first sign of connectivitive tissues diseases. The treatment of the acute phase is mainly based on the administration of corticosteroids and the prognosis is generally good. In this article, we describe the management of NSIP, based on a pediatric clinical case.
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Affiliation(s)
| | - M Thimmesch
- CHC Liège, Clinique de l'Espérance, Liège, Belgique
| | - M Lewin
- CHC Liège, Clinique de l'Espérance, Liège, Belgique
| | - F Dome
- CHC Liège, Clinique Saint-Joseph, Liège, Belgique
| | - F Piérart
- CHC Liège, Clinique de l'Espérance, Liège, Belgique
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26
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Abstract
Connective tissue diseases (CTDs), also known as systemic autoimmune diseases, involve a variety of autoantibodies against cellular components. An important factor regarding these autoantibodies is that each antibody is exclusively related to a certain clinical feature of the disease type, which may prove useful in clinical practice. Thus far, more than 100 types of autoantibodies have been found in CTDs, and most of their target antigens have been identified. Many of these autoantigens are enzymes or regulators involved in important cellular functions, such as gene replication, transcription, repair/recombination, RNA processing, and protein synthesis, as well as proteins that form complexes with RNA and DNA. This article reviews the autoantibodies for each CTD, along with an assessment of their clinical significance, and provides suggestions regarding their utilization for clinical practice.
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Affiliation(s)
- Kosaku Murakami
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Japan
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27
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Ferro F, Delle Sedie A. The use of ultrasound for assessing interstitial lung involvement in connective tissue diseases. Clin Exp Rheumatol 2018; 36 Suppl 114:165-170. [PMID: 30296990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 06/08/2023]
Abstract
Interstitial lung disease (ILD) is one of the most serious pulmonary complications associated with connective tissue diseases (CTDs), resulting in significant morbidity and mortality. Recently, lung ultrasound examination has appeared as a useful, feasible, non-invasive, radiation-free imaging technique with high sensitivity and specificity for the diagnosis of CTD-associated ILD. In this review, we discuss the literature concerning lung ultrasound findings (B-lines and pleural irregularities) in systemic sclerosis. We also examine the possible utility and potential limitations of lung ultrasound in other CTDs including: inflammatory myopathies, mixed connective tissue disease, and Sjögren's syndrome. Specifically, we compare the diagnostic accuracy of lung ultrasound with traditional imaging techniques and pulmonary functional tests.
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Affiliation(s)
- Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Andrea Delle Sedie
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Italy
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28
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Teclessou JN, Saka B, Akakpo SA, Matakloe H, Mouhari-Toure A, Kombate K, Oniankitan I, Pitche P. Les connectivites en milieu hospitalier à Lomé: étude rétrospective de 231 cas. Pan Afr Med J 2018; 30:176. [PMID: 30455805 PMCID: PMC6235477 DOI: 10.11604/pamj.2018.30.176.14565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/19/2018] [Indexed: 11/11/2022] Open
Abstract
Le but de cette étude était de documenter le profil épidémiologique, clinique, thérapeutique et évolutif des connectivites en milieu hospitalier à Lomé. Il s'agissait d'une étude rétrospective descriptive menée du 1er Janvier 1993 au 31 Décembre 2012. Elle a porté sur les dossiers des malades ayant souffert d'une connectivite dans cinq services de dermatologie et de rhumatologie des centres hospitaliers de Lomé. Au cours de la période d'étude, nous avons recensé 231 cas de connectivites dans les cinq centres d'étude, ce qui correspondait à une fréquence de 0,19% des consultations. L'âge moyen des patients était de 36,96±15 ans et la sex-ratio de 0,2. Les principales connectivites étaient la maladie lupique (50,22%); les sclérodermies (21,64%) et la polyarthrite rhumatoïde (20,35%). Sur le plan clinique, les principales manifestations cliniques des connectivites étaient les lésions de lupus discoïde (87,50%) et la photosensibilité (82,50%) chez les patients ayant un lupus érythémateux systémique; la sclérose cutanée (90,48%) chez les patients ayant une sclérodermie systémique; et une atteinte articulaire distale (100%) chez les patients ayant une polyarthrite rhumatoïde. La corticothérapie générale était le traitement de base des patients ayant un lupus érythémateux systémique (92,5%) et une polyarthrite rhumatoïde (73,47%). Les connectivites sont des affections rares à Lomé, avec une prédominance de la maladie lupique. Elles sont plus fréquentes chez la femme jeune. La corticothérapie générale reste leur traitement de base.
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Affiliation(s)
| | - Bayaki Saka
- Service de Dermatologie-Vénérologie, Faculté des Sciences de Santé Lomé, Lomé, Togo
| | - Séfako Abla Akakpo
- Service de Dermatologie-Vénérologie, Faculté des Sciences de Santé Lomé, Lomé, Togo
| | | | - Abas Mouhari-Toure
- Service de Dermatologie-Vénérologie, Faculté des Sciences de Santé Kara, Kara,Togo
| | - Kousaké Kombate
- Service de Dermatologie-Vénérologie, Faculté des Sciences de Santé Lomé, Lomé, Togo
| | - Inoussa Oniankitan
- Service de Rhumatologie, CHU Faculté de Sciences de Santé Lomé, Lomé, Togo
| | - Palokinam Pitche
- Service de Dermatologie-Vénérologie, Faculté des Sciences de Santé Lomé, Lomé, Togo
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Zrubka Z, Rencz F, Závada J, Golicki D, Rupel VP, Simon J, Brodszky V, Baji P, Petrova G, Rotar A, Gulácsi L, Péntek M. EQ-5D studies in musculoskeletal and connective tissue diseases in eight Central and Eastern European countries: a systematic literature review and meta-analysis. Rheumatol Int 2017; 37:1957-1977. [PMID: 28849432 DOI: 10.1007/s00296-017-3800-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/17/2017] [Indexed: 02/05/2023]
Abstract
EQ-5D is becoming the preferred instrument to measure health-state utilities involved in health technology assessment. The objective of this study is to assess the state of EQ-5D research in musculoskeletal disorders in 8 Central and Eastern European countries and to provide a meta-analysis of EQ-5D index scores. Original research articles published in any language between Jan 2000 and Sept 2016 were included, if they reported any EQ-5D outcome from at least two musculoskeletal patients from Austria, Bulgaria, the Czech Republic, Hungary, Poland, Romania, Slovakia, or Slovenia. Risk of bias was assessed with the Cochrane Collaboration's tool. Twenty-nine articles (5992 patients) were included on rheumatoid arthritis (n = 7), osteoporosis (n = 5), chronic pain (n = 5), osteoarthritis (n = 4), ankylosing spondylitis (n = 2), psoriatic arthritis (n = 2), total hip replacement (n = 2), and scleroderma (n = 2). Low back pain was under-represented, while studies in neck pain, systemic lupus erythematosus, gout, and childhood disorders were lacking. EQ-5D index scores were reported in 24 studies, while the version of the instrument and the value-set was not specified in 41% and 46% of the articles, respectively. Meta-analysis was performed on 24 disease states involving 6876 observation points. Intervention effect was reported in 22 subgroups, out of which risk of bias was low in 41%. This review provides recommendations to improve reporting standards of EQ-5D results and highlights potential areas for future research. Coordinated research in conditions with greatest public health impact as well as a development of a regional value-set could provide locally relevant health-state utilities that are transferable among countries within the region.
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Affiliation(s)
- Zsombor Zrubka
- Doctoral School of Business and Management, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary
- Sandoz Hungária Kft, Bartók Béla u. 43-47, 1134, Budapest, Hungary
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary
| | - Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary
| | - Jakub Závada
- Institute of Rheumatology, Na Slupi 4, Prague, 128 00, Czech Republic
| | - Dominik Golicki
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, ul. Banacha 1b, 02-097, Warsaw, Poland
| | | | - Judit Simon
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1 1090, Vienna, Austria
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary
| | - Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary
| | - Guenka Petrova
- Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University, Sofia, Bulgaria
| | - Alexandru Rotar
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Meibergdreef 9, 22660, 1100 DD, Amsterdam, The Netherlands
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8., 1093, Budapest, Hungary.
- Department of Rheumatology, Flór Ferenc County Hospital, Semmelweis tér 1, 2143, Kistarcsa, Hungary.
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30
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Kishi J. [MANAGEMENT OF CONNECTIVE TISSUE DISEASE-ASSOCIATED INTERSTITIAL LUNG DISEASE]. Arerugi 2017; 66:1161-1164. [PMID: 29129886 DOI: 10.15036/arerugi.66.1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Jun Kishi
- Department of Respiratory Medicine and Rheumatology Institute of Biomedical Sciences, Tokushima University Graduate School
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Abstract
Chronic itch is a common skin manifestation in many connective tissue diseases. However, the cause of chronic itch in these diseases is still not fully understood. The complex, and in some cases incomplete understanding of, pathogenesis in each condition makes it difficult to target specific mediators of chronic itch. It is important to better understand the pathophysiology of chronic itch in these conditions, as this information might provide a fuller understanding of the pathogenesis of the diseases in general and lead to the development of more specific treatments for connective tissue diseases in patients with chronic itch. We present a review of the literature on what is known about the prevalence, possible pathophysiology, and effect on quality of life of chronic itch in patients with scleroderma, Sjögren's syndrome, dermatomyositis, systemic lupus erythematosus, cutaneous lupus erythematosus, and mixed connective tissue disease.
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Affiliation(s)
- Jessica Sue Haber
- Department of Dermatology and Itch Center, Lewis Katz Medical School Temple University, 3322 North Broad Street, Medical Office Building, Suite 212, Philadelphia, PA, 19140, USA
| | - Rodrigo Valdes-Rodriguez
- Department of Dermatology and Itch Center, Lewis Katz Medical School Temple University, 3322 North Broad Street, Medical Office Building, Suite 212, Philadelphia, PA, 19140, USA
| | - Gil Yosipovitch
- Department of Dermatology and Itch Center, Lewis Katz Medical School Temple University, 3322 North Broad Street, Medical Office Building, Suite 212, Philadelphia, PA, 19140, USA.
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32
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Erickson BJ, Campbell K, Cvetanovich GL, Harris JD, Bach BR, Sherman SL. Nonligamentous Soft Tissue Pathology About the Knee: A Review. Orthopedics 2016; 39:32-42. [PMID: 26709560 DOI: 10.3928/01477447-20151218-06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/20/2015] [Indexed: 02/03/2023]
Abstract
Knee pain is one of the most frequent complaints evaluated by orthopedic surgeons. It encompasses a broad range of pathology and can present in a variety of ways. Most of this pain can be attributed to essential structures of the knee, including the menisci, cruciate or collateral ligaments, and articular cartilage. However, there are underrecognized structures in and around the knee that can frequently be a cause of knee pathology and pain. Knee pain stemming from these structures may be missed or incorrectly diagnosed, and these patients often present for second and third opinions because of failure to diagnose and treat the underlying pathology. The synovial plica, suprapatellar pouch, lateral retinaculum, infrapatellar fat pad, and infrapatellar branch of the saphenous nerve are less common but still significant causes of knee pain. Although initial treatment involves various nonoperative modalities, operative treatment is often warranted. Operative and nonoperative management of these soft tissue structures may occur in isolation or with concomitant procedures, including knee ligament reconstruction, total knee arthroplasty, tibial tuberosity osteotomy, or lysis of adhesions. With proper recognition of the role of these structures in knee pain, the orthopedic surgeon can offer a valuable primary or adjunctive treatment option for patients with knee pain, especially those without localizing signs of meniscal, ligamentous, or cartilage damage.
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Galiè N, Manes A, Farahani KV, Pelino F, Palazzini M, Negro L, Romanazzi S, Branzi A. Pulmonary arterial hypertension associated to connective tissue diseases. Lupus 2016; 14:713-7. [PMID: 16218473 DOI: 10.1191/0961203305lu2206oa] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pulmonary arterial hypertension is a well-known complication of connective tissue diseases such as systemic sclerosis, systemic lupus erythematosus, mixed connective tissue diseases, and to a lesser extent, rheumatoid arthritis, dermatopolymyositis and primary Sjögren’s syndrome. In these patients, pulmonary hypertension may occur in association with left heart disease, interstitial fibrosis or as a result of a isolated pulmonary arteriopathy. The incidence of pulmonary arterial hypertension in the limited form of systemic sclerosis is about 10%. The pathophysiologic mechanisms leading to pulmonary arterial hypertension remain unknown. Symptoms and clinical presentation are very similar to idiopathic pulmonary arterial hypertension but mortality was confirmed to be higher. Echocardiography is the reference investigation for the detection of pulmonary arterial hypertension but the results should be confirmed by right heart catheterization. Treatment appears more complex as compared to idiopathic pulmonary arterial hypertension. Intravenous epoprostenol therapy has been shown to be effective in a special trail. Also, the endothelin receptor antagonists bosentan and sitaxentan, the phosphodyesterase-type-5 sildenafil and subcutaneous treprostinil have shown favourable results.
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Affiliation(s)
- N Galiè
- Institute of Cardiology, University of Bologna, Bologna, Italy.
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34
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Motta M, Tincani A, Lojacono A, Faden D, Gorla R, Airò P, Neri F, Gasparoni A, Ciardelli L, de Silvestri A, Marconi M, Chirico G. Neonatal outcome in patients with rheumatic disease. Lupus 2016; 13:718-23. [PMID: 15485111 DOI: 10.1191/0961203403lu2002oa] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Rheumatic autoimmune diseases have a higher prevalence in women, particularly during their childbearing age. Due to improved management, an increasing number of patients plan and carry out one or more pregnancies. Therefore, a growing interest is being paid to the possible consequences of maternal disease and associated treatment on the fetus and newborn infant. If maternal disease is characterized by the presence of IgG isotype autoantibodies, these can cross the placenta with possible antibody-mediated damage to the fetus. This is typically the case of the so called neonatal lupus erythematosus (NLE); a similar mechanism has been shown in infants of patients with immune thrombocytopenic purpura (ITP) and, less frequently, in those from mothers with antiphospholipid syndrome (APS). Indeed, this last condition is often responsible for placental, rather than neonatal, pathology. In addition, immunosuppressive and other drugs administered to the mothers during pregnancy and lactation might affect the fetal and neonatal immune system development. Finally, mothers disease and/or treatment could be related to neuropsychological alteration reported in some of their children.
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Affiliation(s)
- M Motta
- Neonatology and Neonatal Intensive Care, Spedali Civili, Brescia, Italy.
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35
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Kuza C, Matheos T, Kathman D, Heard SO. Life after acute fibrinous and organizing pneumonia: a case report of a patient 30 months after diagnosis and review of the literature. J Crit Care 2016; 31:255-61. [PMID: 26578116 PMCID: PMC7126573 DOI: 10.1016/j.jcrc.2015.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/17/2015] [Accepted: 10/01/2015] [Indexed: 01/03/2023]
Abstract
Acute fibrinous and organizing pneumonia (AFOP) is a rare histologic interstitial pneumonia pattern recently described in the literature with fewer than 120 cases published. AFOP is often difficult to diagnose and may be mistaken for other pulmonary disorders such as interstitial pneumonias or pneumonitides. Patients often present with vague symptoms of cough, dyspnea, hemoptysis, fatigue, and occasionally respiratory failure. Radiological findings show diffuse patchy opacities and ground glass appearance of the lungs. On histologic examination, intra-alveolar fibrin balls are observed. We discuss a case of a man who presented with hemoptysis and dyspnea and whose open lung biopsy revealed AFOP. We will describe the presentation, diagnosis, and post-discharge course, and review the current literature. There are only 4 cases which have reported the patients' course of disease after 1 year, the longest being 2 years. To our knowledge, this is the only case of AFOP in the literature that describes the course of a patient more than 2 years after the diagnosis of AFOP, and is the most comprehensive review of the current literature.
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Affiliation(s)
- Catherine Kuza
- Department of Anesthesiology and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA; Department of Anesthesiology, University of Massachusetts Medical School, 55 North Lake Avenue, Worcester, MA, 01655, USA.
| | - Theofilos Matheos
- Department of Anesthesiology, University of Massachusetts Medical School, 55 North Lake Avenue, Worcester, MA, 01655, USA
| | - Deirdre Kathman
- Department of Medicine (Pulmonary/Critical Care Medicine), University of Massachusetts Medical School, 55 North Lake Avenue, Worcester, MA, 01655, USA
| | - Stephen O Heard
- Department of Anesthesiology, University of Massachusetts Medical School, 55 North Lake Avenue, Worcester, MA, 01655, USA
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36
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Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 2016. [PMID: 26320113 DOI: 10.1093/eurheartj/ehv317)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
MESH Headings
- Adult
- Algorithms
- Antihypertensive Agents/therapeutic use
- Arrhythmias, Cardiac/etiology
- Balloon Embolectomy/methods
- Biomarkers/metabolism
- Cardiac Catheterization/methods
- Child
- Combined Modality Therapy/methods
- Connective Tissue Diseases/complications
- Connective Tissue Diseases/diagnosis
- Connective Tissue Diseases/therapy
- Cross Infection/prevention & control
- Drug Interactions
- Echocardiography/methods
- Elective Surgical Procedures/methods
- Electrocardiography
- Exercise Test/methods
- Exercise Therapy/methods
- Female
- Genetic Counseling
- Genetic Testing/methods
- HIV Infections/complications
- HIV Infections/diagnosis
- HIV Infections/therapy
- Health Status
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/therapy
- Hemangioma/complications
- Hemangioma/diagnosis
- Hemangioma/therapy
- Hemoptysis/etiology
- Humans
- Hypertension, Portal/complications
- Hypertension, Portal/diagnosis
- Hypertension, Portal/therapy
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/therapy
- Lung Transplantation/methods
- Magnetic Resonance Angiography/methods
- Multimodal Imaging/methods
- Patient Compliance
- Pregnancy
- Pregnancy Complications, Cardiovascular/therapy
- Referral and Consultation
- Respiratory Function Tests/methods
- Risk Assessment/methods
- Risk Factors
- Social Support
- Terminal Care/methods
- Therapies, Investigational/methods
- Thromboembolism/complications
- Thromboembolism/diagnosis
- Thromboembolism/therapy
- Tomography, X-Ray Computed/methods
- Travel Medicine/methods
- Treatment Outcome
- Ventricular Dysfunction, Right/complications
- Ventricular Dysfunction, Right/therapy
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37
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Bartosiewicz M. [Pulmonary involvement in connective tissue disease]. Wiad Lek 2016; 69:130-138. [PMID: 27421127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The connective tissue diseases are a variable group of autoimmune mediated disorders characterized by multiorgan damage. Pulmonary complications are common, usually occur after the onset of joint symptoms, but can also be initially presenting complaint. The respiratory system may be involved in all its component: airways, vessels, parenchyma, pleura and respiratory muscles. Lung involvement is an increasing cause of morbidity and mortality in the connective tissue diseases. Clinical course is highly variable - can range from mild to rapidly progressive, some processes are reversible, while others are irreversible. Thus, the identification of reversible disease , and separately progressive disease, are important clinical issues. The frequency, clinical presentation, prognosis and responce to therapy are different, depending on the pattern of involvement as well as on specyfic diagnostic method used to identify it. High- resolution computed tompography plays an important role in identifying patients with respiratory involvement. Pulmonary function tests are a sensitive tool detecting interstitial lung disease. In this article, pulmonary lung involvement accompanying most frequently apperaing connective tissue diseases - rheumatoid arthritis, systemic sclerosis, lupus erythematosus, polymyositis/dermatomyositis, Sjögrens syndrome and mixed connective tissue disaese are reviewed.
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Affiliation(s)
- Małgorzata Bartosiewicz
- I Klinika Chorób Płuc Instytutu Gruźlicy i Chorób Płuc ul. Płocka 26, 01-138 Warszawa tel.: 22 4312143 fax: 22 4312443 e-mail:
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38
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Abstract
In common rheumatologic diseases skin findings are an important diagnostic clue for astute clinicians. Skin manifestations can help identify systemic disease or may require therapy uniquely targeted at the cutaneous problem. This article discusses 3 common rheumatologic conditions seen in adults by dermatologists: cutaneous lupus, dermatomyositis, and morphea. The focus is on the cutaneous findings and clinical presentation. Some approaches to treatment are explored. Clues to help identify systemic disease are also highlighted.
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Affiliation(s)
- Andrea Kalus
- Dermatology Division, Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA 98115, USA.
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39
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Heath KR, Rogers RS, Fazel N. Oral manifestations of connective tissue disease and novel therapeutic approaches. Dermatol Online J 2015; 21:13030/qt7030d6gd. [PMID: 26632801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 10/15/2015] [Indexed: 06/05/2023] Open
Abstract
Connective tissue diseases such as systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and Sjögren syndrome (SS) have presented many difficulties both in their diagnosis and treatment. Known causes for this difficulty include uncertainty of disease etiology, the multitude of clinical presentations, the unpredictable disease course, and the variable cell types, soluble mediators, and tissue factors that are believed to play a role in the pathogenesis of connective tissue diseases. The characteristic oral findings seen with these specific connective tissue diseases may assist with more swift diagnostic capability. Additionally, the recent use of biologics may redefine the success rate in the treatment and management of the disease. In this review we describe the oral manifestations associated with SLE, SSc, and SS and review the novel biologic drugs used to treat these conditions.
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40
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Fischer A, Chartrand S. Assessment and management of connective tissue disease-associated interstitial lung disease. Sarcoidosis Vasc Diffuse Lung Dis 2015; 32:2-21. [PMID: 26237351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 08/11/2014] [Indexed: 06/04/2023]
Abstract
The intersection of the connective tissue diseases (CTD) and the interstitial lung diseases (ILD) is complex. Although often considered as a single entity, "CTD-ILD" actually reflects a heterogeneous spectrum of diverse CTDs and a variety of patterns of interstitial pneumonia. The evaluation of patients with CTD that develop ILD, or the assessment for underlying CTD in those presenting with presumed "idiopathic" ILD can be challenging and these evaluations can be optimized by effective multidisciplinary collaboration. When a diagnosis of CTD-ILD is confirmed, careful and thorough assessments to determine extra- versus intra-thoracic disease activity, and degrees of impairment are needed. Pharmacologic intervention with immunosuppression is the mainstay of therapy for all forms of CTD-ILD, but should be reserved only for those that demonstrate clinically significant and/or progressive disease. The management of CTD-ILD is not yet evidence based and there is a desperate need for controlled trials across the spectrum of CTD-ILD. Non-pharmacologic management strategies and addressing comorbidities or aggravating factors should be part of a comprehensive treatment plan for individuals with CTD-ILD.
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41
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Li M, Zeng X. [The more particular clinical classification of connective tissue diseases with pulmonary arterial hypertension, the more precise choice of therapy]. Zhonghua Nei Ke Za Zhi 2015; 54:6-8. [PMID: 25877137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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42
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Saketkoo LA, Mittoo S, Frankel S, LeSage D, Sarver C, Phillips K, Strand V, Matteson EL. Reconciling healthcare professional and patient perspectives in the development of disease activity and response criteria in connective tissue disease-related interstitial lung diseases. J Rheumatol 2014; 41:792-8. [PMID: 24488412 PMCID: PMC4369780 DOI: 10.3899/jrheum.131251] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Interstitial lung diseases (ILD), including those related to connective tissue disease (CTD), and idiopathic pulmonary fibrosis (IPF) carry high morbidity and mortality. Great efforts are under way to develop and investigate meaningful treatments in the context of clinical trials. However, efforts have been challenged by a lack of validated outcome measures and by inconsistent use of measures in clinical trials. Lack of consensus has fragmented effective use of strategies in CTD-ILD and IPF, with a history of resultant difficulties in obtaining agency approval of treatment interventions. Until recently, the patient perspective to determine domains and outcome measures in CTD-ILD and IPF had never been applied. Efforts described here demonstrate unequivocally the value and influence of patient involvement on core set development. Regarding CTD-ILD, this is the first OMERACT working group to directly address a manifestation/comorbidity of a rheumatic disease (ILD) as well as a disease not considered rheumatic (IPF). The OMERACT 11 proceedings of the CTD-ILD Working Group describe the forward and lateral process to include both the medical and patient perspectives in the urgently needed identification of a core set of preliminary domains and outcome measures in CTD-ILD and IPF.
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Affiliation(s)
- Lesley Ann Saketkoo
- From the Louisiana State University (LSU) Scleroderma and Sarcoidosis Patient Care and Research Center, LSU Interstitial Lung Disease Program, LSU Health Sciences Center, New Orleans, Louisiana, USA; University of Toronto, Interstitial Lung Disease Program, University Health Network/Mount Sinai Hospital, Toronto, Ontario; Faculty of Social Work, University of Manitoba, Winnipeg, Manitoba, Canada; Louisiana Office of Public Health, Department of Health and Human Services, New Orleans, Louisiana; Division of Rheumatology/Internal Medicine, University of Michigan, Ann Arbor, Michigan; Division of Immunology, Stanford University, Palo Alto, California; and Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
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43
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Tingey P, Khanafer M, Singh K, Thompson A, Le Riche N, Barra L, Haig S, Rohekar G, Rohekar S, Nielson W, Pope JE. Social persuasion in rheumatology: a randomized trial of testimonials on television in the rheumatology clinic waiting room to increase attendance for multidisciplinary education. Rheumatol Int 2014; 34:903-7. [PMID: 24509936 DOI: 10.1007/s00296-014-2961-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 01/31/2014] [Indexed: 11/26/2022]
Abstract
Multidisciplinary self-management programs are important in inflammatory arthritis as adjunctive treatment. Patients often have excuses as to why they do not attend these programs. The purpose of this study was to determine whether an intervention of televised testimonials from rheumatologists and allied health professionals increases attendance at a multidisciplinary education day for rheumatology patients seen in a large university hospital clinic. This was an RCT of intervention: playing televised interviews in the waiting room where rheumatology patients were seen versus no TV. There was a total of 6 months (3 months with and 3 without the televised interview playing). All eligible patients who attended the rheumatology outpatient clinic were then tracked to determine whether they attended a subsequent education day over the next 10 months. The sample size was calculated to have a 15% increase in attendance at the education days. There was a 20% increase in attendees at the multidisciplinary education days for patients who saw the televised testimonials. Sixty-three patients who viewed the testimonials (2.17% of 2,908) attended the education day compared to 39 who did not receive the intervention (1.80% of 2,168); however, the increase was not statistically significant (p = 0.36). Attendance of eligible patients increased using televised testimonials; however, the increase was not significant as the rates of attendance were still very low in both groups. Many eligible patients did not attend the program. Other interventions are necessary to encourage attendance in a multidisciplinary program.
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Affiliation(s)
- Paul Tingey
- St. Joseph's Health Care, 268 Grosvenor St., London, ON, N6A 4V2, Canada
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Abstract
Raynaud's phenomenon (RP) is a well defined clinical syndrome characterized by recurrent episodes of digital vasospasm triggered by exposure to physical/chemical or emotional stress. RP has been classified as primary or secondary, depending on whether it occurs as an isolated condition (pRP) or is associated to an underlying disease, mainly a connective tissue disease (CTD-RP). In both cases, it manifests with unique "triple" (pallor, cyanosis and erythema), or "double" color changes. pRP is usually a benign condition, while sRP can evolve and be complicated by acral digital ulcers and gangrene, which may require surgical treatment. The pathogenesis of RP has not yet been entirely clarified, nor is it known whether autoantibodies have a role in RP. Even so, recent advances in our understanding of the pathophysiology have highlighted novel potential therapeutic targets. The aim of this review is to discuss the etiology, epidemiology, risk factors, clinical manifestations, recently disclosed pathogenic mechanisms underlying RP and their correlation with the available therapeutic options, focusing primarily on pRP and CTD-RP.
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Affiliation(s)
- Marcella Prete
- Internal Medicine, University of Bari Medical School, I-70124 Bari, Italy
| | | | - Elvira Favoino
- Rheumatological and Autoimmune Systemic Diseases Units, University of Bari Medical School, I-70124 Bari, Italy
| | - Federico Perosa
- Rheumatological and Autoimmune Systemic Diseases Units, University of Bari Medical School, I-70124 Bari, Italy.
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45
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Baresić M, Anić B. [Capillaroscopy in rheumatological practice--one center experience]. Lijec Vjesn 2014; 136:28-32. [PMID: 24720153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Capillaroscopy is a method for evaluating morphological characteristics of nailfold capillaries. The simplicity, noninvasiveness and easiness-to-perform make the method accessible in everyday rheumatological practice. Raynaud's phenomenon is the main indication for performing capillaroscopy (differentiating between primary and secondary Raynaud's phenomenon) and diagnosing early stages of systemic sclerosis. According to some authors capillaroscopy should be included in the work-up algorithm for patients with puffy fingers and Raynaud's phenomenon. Other autoimmune conditions (systemic lupus erythematosus, polymyositis/dermatomyositis, mixed connective tissue disease, antiphospholipid syndrome and other diseases which affect microvasculature - diabetes mellitus, thromboangiitis obliterans) can have some abnormalities of the capillaroscopic pattern. We present the results of the capillaroscopies performed in our center during the period of one year.
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Abstract
Connective tissue diseases (CTD) include a variety of chronic multisystem disorders with a high percentage of autoimmune conditions. Many of these conditions affect women of childbearing age and, therefore, pregnancy poses an important challenge for doctors looking after such women. Knowledge of medication safety, the effect of pregnancy on such diseases and vice versa, together with preconception counselling and multidisciplinary team care, are the basic pillars needed to provide the best obstetric and medical care to these women. In this review, we discuss the management of the most common autoimmune CTD before, during and after pregnancy, along with the most relevant issues regarding appropriate medication.
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Ozaki S. [Serious organ damage and intractable clinical conditions in rheumatic and connective tissue disease--progress in pathophysiology and treatment. Editorial: Autoimmunity, inflammation, and organ damage]. ACTA ACUST UNITED AC 2013; 102:2529-31. [PMID: 24400531 DOI: 10.2169/naika.102.2529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Marigliano B, Soriano A, Margiotta D, Vadacca M, Afeltra A. Lung involvement in connective tissue diseases: a comprehensive review and a focus on rheumatoid arthritis. Autoimmun Rev 2013; 12:1076-84. [PMID: 23684699 DOI: 10.1016/j.autrev.2013.05.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 05/03/2013] [Indexed: 12/20/2022]
Abstract
The lungs are frequently involved in Connective Tissue Diseases (CTDs). Interstitial lung disease (ILD) is one of the most common pleuropulmonary manifestations that affects prognosis significantly. In practice, rheumatologists and other physicians tend to underestimate the impact of CTD-ILDs and diagnose respiratory impairment when it has reached an irreversible fibrotic stage. Early investigation, through clinical evidence, imaging and - in certain cases - lung biopsy, is therefore warranted in order to detect a possible ILD at a reversible initial inflammatory stage. In this review, we focus on lung injury during CTDs, with particular attention to ILDs, and examine their prevalence, clinical manifestations and histological patterns, as well as therapeutic approaches and known complications till date. Although several therapeutic agents have been approved, the best treatment is still not certain and additional trials are required, which demand more knowledge of pulmonary involvement in CTDs. Our central aim is therefore to document the impact that lung damage has on CTDs. We will mainly focus on Rheumatoid Arthritis (RA), which - unlike other rheumatic disorders - resembles Idiopathic Pulmonary Fibrosis (IPF) in numerous aspects.
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Affiliation(s)
- Benedetta Marigliano
- Department of Clinical Medicine and Rheumatology, University Campus Bio-Medico of Rome, Italy
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49
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Gabay C, So A. [Connective tissue diseases, a matter for specialists?]. Rev Med Suisse 2013; 9:539-540. [PMID: 23534239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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50
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Zufferey P. [Family physician and connective tissue disorders]. Rev Med Suisse 2013; 9:564-568. [PMID: 23534243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The exact place of the family physician in the diagnosis and management of connective tissue disease is poorly studied moreover will essentially depend on the health system and the organization of medical network of each country. Connective tissue diseases are rare and complex diseases that require in all cases referral to specialists for their diagnosis as well as monitoring. All patients must still keep a family doctor whose importance increases more and more as our specialized treatments prolong survival of patients who become chronically ill with multi-organic sequelae. A closely interaction between the various specialists and family physicians is necessary to ensure a good long-term follow-up.
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Affiliation(s)
- P Zufferey
- Service de rhumatologie, médecine physique et réhabilitation, Département de l'appareil locomoteur CHUV, 1011 Lausanne.
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