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Chung MP, Mecoli CA, Perin J, Richardson C, McMahan ZH. Perifollicular Hypopigmentation in Systemic Sclerosis: Associations With Clinical Features and Internal Organ Involvement. J Rheumatol 2022; 49:475-481. [PMID: 35169054 PMCID: PMC9064889 DOI: 10.3899/jrheum.210983] [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] [Accepted: 01/25/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine whether perifollicular hypopigmentation in systemic sclerosis (SSc) is associated with demographics, distinct clinical features, and autoantibody profiles. METHODS Patients with SSc were prospectively enrolled, with a standardized data form used to collect anatomic distribution of perifollicular hypopigmentation. Associations between hypopigmentation and features of SSc were assessed. RESULTS Of 179 adult patients with SSc, 36 (20%) patients had perifollicular hypopigmentation. Of these 36 patients, 94% (n = 34) were female and 33% (n = 12) had limited cutaneous SSc. In univariable logistic regression, Black race (odds ratio [OR] 15.63, 95% CI 6.6-37.20, P < 0.001), diffuse cutaneous SSc (dcSSc; OR 4.62, 95% CI 2.11-10.09, P < 0.001), higher maximum modified Rodnan skin score (mRSS; OR 1.05, 95% CI 1.02-1.08, P = 0.003), myopathy (OR 3.92, 95% CI 1.80-8.57, P < 0.001), pulmonary fibrosis (OR 2.69, 95% CI 1.20-6.02, P = 0.02), lower minimum forced vital capacity % predicted (OR 0.96, 95% CI 0.94-0.99, P = 0.001), and lower minimum diffusing capacity for carbon monoxide % predicted (OR 0.97, 95% CI 0.95-0.99, P = 0.009) were associated with hypopigmentation. Anticentromere antibodies inversely associated with hypopigmentation (OR 0.24, 95% CI 0.07-0.86, P = 0.03). After adjusting for age, race, and disease duration, dcSSc (OR 4.28, 95% CI 1.46-12.53, P = 0.008) and increased mRSS (OR 1.07, 95% CI 1.02-1.12, P = 0.009) were significantly associated with hypopigmentation. CONCLUSION Perifollicular hypopigmentation is observed in a subset of patients with SSc and associated with diffuse subtype. Larger prospective studies determining whether perifollicular hypopigmentation precedes end-organ involvement and whether specific patterns associate with internal organ involvement are needed.
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Affiliation(s)
- Melody P Chung
- M.P. Chung, MD, MS, C.A. Mecoli, MD, MHS, Z.H. McMahan, MD, MHS, Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland
| | - Christopher A Mecoli
- M.P. Chung, MD, MS, C.A. Mecoli, MD, MHS, Z.H. McMahan, MD, MHS, Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland
| | - Jamie Perin
- J. Perin, PhD, MS, Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Carrie Richardson
- C. Richardson, MD, MHS, Division of Rheumatology, Rush University, Chicago, Illinois, USA
| | - Zsuzsanna H McMahan
- M.P. Chung, MD, MS, C.A. Mecoli, MD, MHS, Z.H. McMahan, MD, MHS, Division of Rheumatology, Johns Hopkins University, Baltimore, Maryland
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Arneson LC, Varga J. Scleroderma Renal Crisis Complicating Male-to-Female Transgender Hormonal Therapy in a Patient With Long-Standing and Stable Limited Cutaneous Systemic Sclerosis. J Clin Rheumatol 2021; 27:S355-S356. [PMID: 32956156 DOI: 10.1097/rhu.0000000000001579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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3
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Fairchild R, Chung M, Yang D, Sharpless L, Li S, Chung L. Development and Assessment of Novel Lung Ultrasound Interpretation Criteria for the Detection of Interstitial Lung Disease in Systemic Sclerosis. Arthritis Care Res (Hoboken) 2021; 73:1338-1342. [PMID: 32475026 PMCID: PMC9176687 DOI: 10.1002/acr.24338] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 02/27/2020] [Accepted: 05/22/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Interstitial lung disease (ILD) is a frequent complication of systemic sclerosis (SSc), and ILD screening, characterization, and monitoring are important for therapeutic decision-making and prognostication. Lung ultrasonography (US) is a potential alternative imaging modality for ILD detection. In this study, our objective was to develop and test a novel lung US examination technique and interpretation criteria for detecting SSc-ILD. METHODS Lung US acquisition was performed by collecting short US movies at 14 lung positions. Lung US interpretation criteria for SSc-ILD detection focused on visualized pleural changes. To assess the performance of our methodology for SSc-ILD detection, we prospectively enrolled SSc patients with high-resolution computed tomography (HRCT) imaging within 3 months of lung US. Lung US examinations were scored independently by 2 blinded readers (1 ultrasonographer and 1 nonultrasonographer). The sensitivity and specificity for SSc-ILD detection were assessed, and agreement was measured with Cohen's kappa statistic. RESULTS To test the performance of our lung US acquisition technique and interpretation criteria, 20 SSc patients were evaluated by lung US (278 lung zones) and HRCT. HRCT confirmed ILD in 9 patients (45%). Lung US was positive for SSc-ILD in 11 patients (55%) with a sensitivity of 100% and specificity of 82% versus HRCT, with perfect agreement between the 2 readers (κ = 1). Analysis by individual lung zones found excellent agreement between readers, with 93.8% concordance and κ = 0.82. CONCLUSION We developed a novel lung US examination technique and interpretation criteria that are highly sensitive and specific for SSc-ILD detection in an SSc cohort, affording perfect agreement between ultrasonographer and nonultrasonographer readers.
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Affiliation(s)
- Robert Fairchild
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Melody Chung
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Diana Yang
- Santa Clara Valley Medical Center, Santa Clara, CA, USA
| | - Laurel Sharpless
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Shufeng Li
- Department of Dermatology and Urology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
- Division of Immunology and Rheumatology, VA Palo Alto Health Care System, Palo Alto, CA, USA
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Zalewski S, Brasington R, Zickuhr L. Calcinosis Cutis as the Initial Manifestation of Limited Scleroderma. J Clin Rheumatol 2021; 27:e100-e101. [PMID: 31985726 DOI: 10.1097/rhu.0000000000001275] [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] [Indexed: 11/26/2022]
Affiliation(s)
- Shannon Zalewski
- From the Center for Outpatient Health, Department of Medicine, Barnes-Jewish Hospital
| | - Richard Brasington
- Division of Rheumatology, Washington University School of Medicine, St Louis, MO
| | - Lisa Zickuhr
- Division of Rheumatology, Washington University School of Medicine, St Louis, MO
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Ozasa M, Fujikawa K, Ozasa S, Sakaguchi R, Furukawa K, Ueki N, Uchida T, Nakashima M, Mizokami A. Limited cutaneous systemic sclerosis with gangrene: an autopsy case. Mod Rheumatol Case Rep 2020; 4:243-247. [PMID: 33087012 DOI: 10.1080/24725625.2019.1702495] [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: 09/26/2019] [Accepted: 11/13/2019] [Indexed: 06/11/2023]
Abstract
We describe an autopsy case of a 75-year-old female with limited cutaneous systemic sclerosis (lcSSc) and gangrene due to macrovascular involvement. She was diagnosed with lcSSc complicated with pulmonary arterial hypertension and digital ulcers 9 years before admission. She had recurrent and refractory lower limb ulcers (LLUs), and died because of sepsis caused by gangrene infection. Autopsy findings revealed severely thickened arterial walls of the visceral organs, consistent with vascular involvement of SSc. Systemic vascular involvement in lcSSc may progress in patients with LLUs who harbour several risk factors for vascular involvement.
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Affiliation(s)
- Mutsumi Ozasa
- Department of Internal Medicine, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Keita Fujikawa
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Soichiro Ozasa
- Department of Internal Medicine, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Ryuki Sakaguchi
- Department of Internal Medicine, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Kentaro Furukawa
- Department of Internal Medicine, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Nozomi Ueki
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Tomohisa Uchida
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
| | - Masahiro Nakashima
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Akinari Mizokami
- Department of Rheumatology, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya, Japan
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Nokes BT, Raza HA, Cartin-Ceba R, Lyng PJ, Krahn LE, Wesselius L, Jokerst CE, Umar SB, Griffing WL, Neville MR, Malhotra A, Parish JM. Individuals With Scleroderma May Have Increased Risk of Sleep-Disordered Breathing. J Clin Sleep Med 2019; 15:1665-1669. [PMID: 31739857 PMCID: PMC6853384 DOI: 10.5664/jcsm.8036] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 11/30/2018] [Revised: 07/18/2019] [Accepted: 07/19/2019] [Indexed: 12/13/2022]
Abstract
STUDY OBJECTIVES Scleroderma is associated with abnormal skin thickening, interstitial lung disease, pulmonary hypertension, and abnormalities of the upper airway. These changes can cause cardiopulmonary complications, potentially including sleep-disordered breathing. The objective of this study is to examine the risk of sleep-disordered breathing in patients with scleroderma. METHODS We retrospectively identified patients with documented scleroderma. We abstracted data from their electronic health records, including findings from antibody tests, serial pulmonary function tests, transthoracic echocardiography, high-resolution computed tomography, and overnight forehead oximetry. RESULTS We identified 171 patients with scleroderma. Mean age at the time of initial consult was 56.5 years (range, 18-96 years), and 150 (86.7%) were women. Scleroderma was categorized as limited disease for 108 (62.4%), diffuse disease for 59 (34.1%), and mixed connective tissue disease for 6 (3.5%). Fifty-four patients (31.2%) had abnormal overnight forehead oximetry results, defined as an oxygen desaturation index greater than 5 or a baseline mean arterial oxygen saturation level less than 90%. CONCLUSIONS Cardiopulmonary complications are common in patients with scleroderma, one of which may be sleep-disordered breathing. In our cohort, approximately one-third of individuals with scleroderma had evidence of sleep-disordered breathing. Moreover, the rate of sleep-disordered breathing in our population of scleroderma patients was twice the rate of pulmonary hypertension and was approximately the same as the rate of interstitial lung disease. Future prospective studies are needed to further assess the role of sleep-disordered breathing in scleroderma clinical outcomes.
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Affiliation(s)
- Brandon T. Nokes
- Department of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, California
| | - Hassan A. Raza
- Division of Pulmonary Medicine, Mayo Clinic Hospital, Phoenix, Arizona
| | | | - Phillip J. Lyng
- Division of Pulmonary Medicine, Mayo Clinic Hospital, Phoenix, Arizona
| | - Lois E. Krahn
- Division of Pulmonary Medicine, Mayo Clinic Hospital, Phoenix, Arizona
- Division of Adult Psychiatry, Mayo Clinic Hospital, Phoenix, Arizona
| | - Lewis Wesselius
- Division of Pulmonary Medicine, Mayo Clinic, Scottsdale, Arizona
| | | | - Sarah B. Umar
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona
| | | | | | - Atul Malhotra
- Department of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, California
| | - James M. Parish
- Division of Pulmonary Medicine, Mayo Clinic Hospital, Phoenix, Arizona
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Velasco FG, Sluzevich JC. Chronic Eroded Perianal Plaque in a Patient with Limited Systemic Scleroderma. Skinmed 2019; 17:338-339. [PMID: 31782710] [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] [Indexed: 06/10/2023]
Abstract
A 58-year-old African-American woman presented with a variably painful perianal eruption for 5 years (Figure 1). Prior treatment with topical zinc oxide, oral fluconazole, and Amoxicillin/clavulanic acid resulted in no improvement. She denied chronic diarrhea or cutaneous blistering. Past medical history included limited scleroderma and autoimmune hemolytic anemia treated with daily azathioprine; however, the eruption preceded iatrogenic immunosuppression. Physical examination revealed a well-defined glistening red, ovoid focally eroded plaque involving the intergluteal cleft. The vulva was uninvolved. Oral mucosa was also clear.
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Tran MMA. An indurated, longitudinal plaque on the arm of a seven-year-old girl. Aust J Gen Pract 2018; 47:688-690. [PMID: 31256498 DOI: 10.31128/ajgp-06-18-4605] [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] [Indexed: 11/19/2022]
Affiliation(s)
- Michael MA Tran
- MBBS, BSc (Med) (Hons), DCH, FRACGP, General Practitioner, Sydney, NSW.
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Kawashiri SY, Nishino A, Igawa T, Takatani A, Shimizu T, Umeda M, Fukui S, Okada A, Suzuki T, Koga T, Iwamoto N, Ichinose K, Tamai M, Nakashima M, Mizokami A, Matsuoka N, Migita K, Ogawa F, Ikeda S, Maemura K, Nakamura H, Origuchi T, Maeda T, Kawakami A. Prediction of organ involvement in systemic sclerosis by serum biomarkers and peripheral endothelial function. Clin Exp Rheumatol 2018; 36 Suppl 113:102-108. [PMID: 29652651] [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: 09/12/2017] [Accepted: 03/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To identify prognostic factors among serum biomarkers and endothelial vasodilator function findings in patients with systemic sclerosis (SSc). METHODS This is a clinical observational study. We assessed 60 consecutive SSc patients (44 limited cutaneous-type, 16 diffuse cutaneous-type). Circulating growth differentiation factor-15 (GDF-15), placenta growth factor (PlGF), endostatin, vascular endothelial growth factor (VEGF), and pentraxin 3 (PTX3) were measured by ELISA. Peripheral endothelial function was measured by forearm blood dilatation response to brachial artery occlusion using noninvasive plethysmography (EndoPAT2000), which is associated with nitric-oxide-dependent vasodilatation and yields a reactive hyperemia index (RHI). We evaluated whether abnormalities in these values were associated with type of SSc - namely, diffuse cutaneous SSc (dcSSc) or limited cutaneous SSc (lcSSc) - or organ involvement including interstitial lung disease (ILD), digital ulcer (DU) and estimated right ventricular systolic pressure (RVSP) by echocardiography >30 mmHg. RESULTS SSc patients showed significantly elevated serum GDF-15, PlGF, endostatin and VEGF but not PTX3 compared with controls. GDF-15 and PlGF were high in dcSSc patients. EndoPAT-RHI was low, and incidence of RVSP >30 mmHg was high in dcSSc. Multivariate analysis revealed that elevated GDF-15 was highly predictive of dcSSc, ILD or RVSP >30 mmHg. PlGF for DU was also found. Conversely, a low EndoPAT-RHI value was predictive of the presence of dcSSc, ILD or DU. CONCLUSIONS This is the first study to inclusively investigate the relationships among biomarkers, EndoPAT-RHI and organ involvement in patients with SSc. Our data suggest a complex pathological progression of SSc through fibrotic impairment and microvascular damage.
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MESH Headings
- Aged
- Biomarkers/blood
- Brachial Artery/physiopathology
- Disease Progression
- Endostatins/blood
- Female
- Growth Differentiation Factor 15/blood
- Humans
- Lung Diseases, Interstitial/diagnosis
- Lung Diseases, Interstitial/etiology
- Male
- Middle Aged
- Placenta Growth Factor/blood
- Predictive Value of Tests
- Risk Factors
- Scleroderma, Diffuse/blood
- Scleroderma, Diffuse/complications
- Scleroderma, Diffuse/diagnosis
- Scleroderma, Diffuse/physiopathology
- Scleroderma, Limited/blood
- Scleroderma, Limited/complications
- Scleroderma, Limited/diagnosis
- Scleroderma, Limited/physiopathology
- Skin Ulcer/diagnosis
- Skin Ulcer/etiology
- Vascular Endothelial Growth Factor A/blood
- Vasodilation
- Ventricular Dysfunction, Right/diagnosis
- Ventricular Dysfunction, Right/etiology
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Affiliation(s)
- Shin-Ya Kawashiri
- Departments of Community Medicine and Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Ayako Nishino
- Department of Immunology and Rheumatology, and Center for Comprehensive Community Care Education, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takashi Igawa
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ayuko Takatani
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshimasa Shimizu
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masataka Umeda
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shoichi Fukui
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akitomo Okada
- Department of Internal Medicine, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Takahisa Suzuki
- Department of Internal Medicine, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoki Iwamoto
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mami Tamai
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Munetoshi Nakashima
- Centre for Rheumatic Diseases, Kurume University Medical Centre, Kurume, Japan
| | - Akinari Mizokami
- Department of Rheumatology, Isahaya General Hospital, Isahaya, Japan
| | - Naoki Matsuoka
- Nagasaki Medical Hospital of Rheumatology, Nagasaki, Japan
| | - Kiyoshi Migita
- Department of Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | | | - Satoshi Ikeda
- Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Koji Maemura
- Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoki Origuchi
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takahiro Maeda
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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10
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Carreira PE, Carmona L, Joven BE, Loza E, Andreu JL, Riemekasten G, Vettori S, Balbir-Gurman A, Airò P, Walker UA, Damjanov N, Matucci-Cerinic M, Ananieva LP, Rednic S, Czirják L, Distler O, Farge D, Hesselstrand R, Corrado A, Caramaschi P, Tikly M, Allanore Y. Gender differences in early systemic sclerosis patients: a report from the EULAR scleroderma trials and research group (EUSTAR) database. Clin Exp Rheumatol 2018; 36 Suppl 113:68-75. [PMID: 30277860] [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: 04/21/2017] [Accepted: 03/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To describe differences in clinical presentation between men and women in a large group of patients with early (<3 years' duration) systemic sclerosis (SSc) according to disease subsets. METHODS A cross-sectional analysis of the prospective EULAR Scleroderma Trial and Research database (EUSTAR) was performed. Patients fulfilling preliminary ACR 1980 classification criteria for SSc, with less than 3 years from the first non-Raynaud's symptom at first entry, were selected. A group of patients with less than 3 years from the first SSc symptom, including Raynaud's phenomenon, was also analysed. SSc related variables, including antibodies, SSc subsets, disease activity and organ involvement were included. Descriptive and bivariate analyses were performed. RESULTS A total of 1,027 patients were included, 90% Caucasian, 80% women, and 40% with diffuse cutaneous disease. In early stages of SSc, men showed more frequently than women active disease, diffuse cutaneous subset, anti-Scl-70 antibodies, elevated acute phase reactants, muscular and pulmonary involvement. Differences between men and women were confirmed in the limited, but not in the diffuse SSc subset. The results were similar when 650 patients with less than three years from the first SSc symptom, including Raynaud's phenomenon, were analysed. CONCLUSIONS In early stages of SSc, men present signs and symptoms of more severe disease. In the limited disease subset, men might appear with clinical features and organ involvement similar to those of the diffuse subgroup. In clinical practice, the identification of such differences might help to select the appropriate management for each particular patient.
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MESH Headings
- Acute-Phase Proteins/analysis
- Autoantibodies/blood
- Biomarkers/blood
- Cross-Sectional Studies
- DNA Topoisomerases, Type I
- Databases, Factual
- Disease Progression
- Female
- Health Status Disparities
- Humans
- Lung Diseases/diagnosis
- Lung Diseases/etiology
- Male
- Nuclear Proteins/immunology
- Prognosis
- Raynaud Disease/diagnosis
- Raynaud Disease/etiology
- Risk Factors
- Scleroderma, Diffuse/blood
- Scleroderma, Diffuse/complications
- Scleroderma, Diffuse/diagnosis
- Scleroderma, Diffuse/immunology
- Scleroderma, Limited/blood
- Scleroderma, Limited/complications
- Scleroderma, Limited/diagnosis
- Scleroderma, Limited/immunology
- Severity of Illness Index
- Sex Factors
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Affiliation(s)
- Patricia E Carreira
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain.
| | | | - Beatriz E Joven
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Spain
| | | | - Jose Luis Andreu
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - Serena Vettori
- U.O.C. di Reumatologia, Dipartimento di Internistica Clinica e Sperimentale "F.Magrassi-A-Lanzara", Seconda Università degli Studi di Napoli, Italy
| | - Alexandra Balbir-Gurman
- B. Shine Rheumatology Unit, Rambam Health Care Campus and Rappaport Faculty of Medicine-Technion, Haifa, Israel
| | - Paolo Airò
- U.O. Reumatologia e Immunologia Clinica. Spedali Civili, Brescia, Italy
| | - Ulrich A Walker
- Rheumatologische Universitätsklinik, Felix Platter Spital, Basel, Switzerland
| | - Nemanja Damjanov
- University of Belgrade School of Medicine, Institute of Rheumatology Belgrade, Serbia
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Florence, Italy
| | - Lidia P Ananieva
- Institute of Rheumatology, Russian Academy of Medical Science, Moscow, Russia
| | - Simona Rednic
- Clinica Reumatologie, University of Medicine & Pharmacy 'Iuliu Hatieganu', Cluj-Napoca, Romania
| | - László Czirják
- Department of Immunology and Rheumatology, Faculty of Medicine, University of Pécs, Hungary
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zürich, Switzerland
| | - Dominique Farge
- Department of Internal Medicine, Hopital Saint-Louis, Paris, France
| | | | - Ada Corrado
- U.O. Reumatologia-Università degli Studi di Foggia, Ospedale 'Col. D'Avanzo', Foggia, Italy
| | | | - Mohammed Tikly
- Rheumatology Unit, Department of Medicine Chris Hani Bardgwanath, Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - Yannick Allanore
- Rheumatology A Department, Cochin Hospital, APHP, Paris Descartes University, Paris, France
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11
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Korman BD, Marangoni RG, Hinchcliff M, Shah SJ, Carns M, Hoffmann A, Ramsey-Goldman R, Varga J. Brief Report: Association of Elevated Adipsin Levels With Pulmonary Arterial Hypertension in Systemic Sclerosis. Arthritis Rheumatol 2017. [PMID: 28651038 DOI: 10.1002/art.40193] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Adipose tissues secrete adipokines, peptides with potent effects modulating fibrosis, inflammation, and vascular homeostasis. Dysregulated adipose tissue biology and adipokine balance have recently been implicated in systemic sclerosis (SSc). This study was undertaken to determine whether altered circulating adipokine levels correlate with SSc disease subsets or clinical manifestations. METHODS Multiplex assays were used to measure circulating adipokine levels in 198 patients with SSc and 33 healthy controls. Data were evaluated for correlations between serum adipokine levels and demographic and clinical features, including pulmonary arterial hypertension (PAH). To assess the relevance of adipsin, an adipokine involved in complement pathway activation, in SSc, we analyzed publicly available genetic and transcriptomic data. RESULTS Levels of adiponectin and adipsin differed significantly between controls and patients. Adipsin was significantly elevated in patients with limited cutaneous SSc (odds ratio [OR] 28.3 [95% confidence interval (95% CI) 7.0-113.8]; P < 0.0001), and its levels were associated with serum autoantibody status, pulmonary function and cardiovascular parameters, and PAH (OR 3.3 [95% CI 1.3-8.7]; P = 0.02). Elevated adipsin was more strongly associated with PAH than B-type natriuretic peptide was. Moreover, in SSc patients, adipsin gene single-nucleotide polymorphisms were associated with PAH. Transcriptome data set analysis demonstrated elevated adipsin expression in patients with SSc-related PAH. CONCLUSION We identify adipsin as a novel adipose tissue-derived marker of SSc-related PAH. Circulating adipsin levels might serve as predictive biomarkers in SSc. Mechanistically, adipsin might represent a pathogenic link between adipocyte dysfunction and complement pathway activation and play an important role in the pathogenesis of SSc-related PAH.
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MESH Headings
- Adiponectin/metabolism
- Adult
- Aged
- Autoantibodies/immunology
- Complement Factor D/genetics
- Complement Factor D/metabolism
- Cytokines/metabolism
- Female
- Gene Expression Profiling
- Humans
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/genetics
- Hypertension, Pulmonary/metabolism
- Leptin/metabolism
- Male
- Middle Aged
- Natriuretic Peptide, Brain/metabolism
- Nicotinamide Phosphoribosyltransferase/metabolism
- Odds Ratio
- Polymorphism, Single Nucleotide
- Resistin/metabolism
- Scleroderma, Diffuse/complications
- Scleroderma, Diffuse/genetics
- Scleroderma, Diffuse/immunology
- Scleroderma, Diffuse/metabolism
- Scleroderma, Limited/complications
- Scleroderma, Limited/genetics
- Scleroderma, Limited/immunology
- Scleroderma, Limited/metabolism
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Affiliation(s)
| | | | | | | | - Mary Carns
- Northwestern University, Chicago, Illinois
| | | | | | - John Varga
- Northwestern University, Chicago, Illinois
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12
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Ahrens HC, Siegert E, Tomsitz D, Mattat K, March C, Worm M, Riemekasten G. Digital ulcers score: a scoring system to assess digital ulcers in patients suffering from systemic sclerosis. Clin Exp Rheumatol 2016; 34 Suppl 100:142-147. [PMID: 27749240] [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: 10/07/2015] [Accepted: 02/15/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To develop a standardized scoring system to assess the severity of DUs in SSc patients and correlate it with functional outcomes. METHODS In this cross-sectional, longitudinal study in SSc patients with DUs (n=65) we developed a digital ulcers score (DUS) for the assessment of DUs. DUS and the ABILHAND score were measured at each visit and differences were analysed using Tamhane's T2 test. Spearman's Rho test was applied for correlational analysis of DUS and functional outcomes. We calculated a linear regression model using clustered standard errors for correlation analysis between DUS and ABILHAND over time. RESULTS 117 assessments of DUS were performed in 65 SSc patients. Mean DUS was 11.6±1.9 (range: 0-68). Subgroup analyses showed a higher DUS in patients suffering from diffuse cutaneous SSc when compared to patients with limited cutaneous SSc (12.8±3.0 vs. 9.7±2.2 p=0.18). There was no correlation between the DUS and manual ability using the ABILHAND score (overall: n=106 r=-0.138, p=0.22). We observed a small but significant linear correlation between the DUS and the ABILHAND score for a single patient over time (n=14, R2=0.31, r=0.06, p=0.02). CONCLUSIONS The DUS is a feasible scoring instrument to assess severity of DUs in SSc patients. In accordance with the literature the severity of DUs correlates with clinical parameters but also severity of the disease. Further study is needed to establish the DUS as a standardized tool for the assessment of DUs.
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Affiliation(s)
- Hannah Clara Ahrens
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Germany
| | - Elise Siegert
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Germany
| | - Dirk Tomsitz
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Germany
| | - Kathrin Mattat
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Germany
| | - Christine March
- Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Germany
| | - Margitta Worm
- Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Germany.
| | - Gabriela Riemekasten
- 4Department of Rheumatology, University Hospital of Schleswig-Holstein, Lübeck, Germany
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13
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Rubin AG, Fox LP, Sako EY, Young LC. Sclerodermoid lesions in a patient with multiple transplants and porphyria cutanea tarda. Dermatol Online J 2015; 21:13030/qt5969167b. [PMID: 26158360] [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: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 06/04/2023] Open
Abstract
Patients with chronic graft versus host disease may exhibit a range of sclerotic features. Herein we present a patient with confirmed porphyria cutanea tarda who subsequently developed chronic graft versus host disease.
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Affiliation(s)
| | | | | | - Lorraine C Young
- David Geffen School of Medicine at the University of California, Los Angeles
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14
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Manoria P, Joshi P, Sharma P, Jha RK. Systemic Sclerosis Sine Scleroderma. J Assoc Physicians India 2014; 62:54-56. [PMID: 26259425] [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: 06/04/2023]
Abstract
Systemic sclerosis sine scleroderma is a rare form of limited systemic sclerosis. These patients are without skin involvement, but do not differ in its clinical or laboratory features and prognosis from classical systemic sclerosis. In the absence of cutaneous signs/symptoms, its diagnosis is delayed leading to significant morbidity and mortality. We report a case of sixty year old female who presented to us with dyspnoea on exertion and Raynaud's phenomenon. She was investigated and was found to have this disorder with pulmonary artery hypertension.
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15
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Delisle VC, Hudson M, Baron M, Thombs BD, And The Canadian Scleroderma Research Group A. Sex and time to diagnosis in systemic sclerosis: an updated analysis of 1,129 patients from the Canadian scleroderma research group registry. Clin Exp Rheumatol 2014; 32:S-10-4. [PMID: 24144459] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 07/19/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES A previous study found that time to diagnosis was significantly longer from onset of Raynaud's phenomenon for women compared to men with diffuse systemic sclerosis (SSc) and that, in limited SSc, it was more than twice as long for women than men. That study was limited, however, by the small number of men in disease subtype subgroups. The objective of the present study was to investigate the association of sex with time to diagnosis of SSc using a substantially larger patient sample. METHODS Association between sex and time to diagnosis was assessed overall and stratified based on diffuse versus limited disease using Kaplan-Meier curves and Cox proportional hazards models. RESULTS There were 1,129 patients in the study (median age=56.0 years; 978 [86.6%] women). Time to diagnosis was significantly longer for women (median=1.1 years) than men (median 0.8= years; p=0.037) with diffuse SSc following onset of Raynaud's phenomenon. There were no significant or substantive sex differences in time to diagnosis after Raynaud's onset in limited SSc or from onset of first non-Raynaud's disease manifestation in diffuse or limited SSc. CONCLUSIONS Time to diagnosis was significantly longer for women compared to men with diffuse SSc following onset of Raynaud's phenomenon, but the difference was small and unlikely to be clinically significant. There were no differences in time to diagnosis following Raynaud's onset in limited disease or following onset of first non-Raynaud's disease manifestation in diffuse or limited disease. Overall, sex does not appear to influence time to diagnosis meaningfully.
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Affiliation(s)
- V C Delisle
- Department of Educational and Counselling Psychology, McGill University and Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada.
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16
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Willems LM, Kwakkenbos L, Leite CC, Thombs BD, van den Hoogen FHJ, Maia AC, Vliet Vlieland TPM, van den Ende CHM. Frequency and impact of disease symptoms experienced by patients with systemic sclerosis from five European countries. Clin Exp Rheumatol 2014; 32:S-88-93. [PMID: 25372793] [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: 03/28/2014] [Accepted: 05/26/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Knowledge about the nature and impact of symptoms faced by patients with systemic sclerosis (SSc) is needed to identify targets for research and treatment. The aim of this study was to assess and compare the frequency and impact on everyday activities of SSc symptoms among patients from five European countries. METHODS European patients with SSc were invited through announcements by patient associations to complete an online survey. The survey included items assessing the frequency of 40 SSc symptoms and the impact on daily activities, if present. Chi-square tests were utilised to assess the differences in frequency and impact of symptoms across countries. RESULTS In total, 537 patients were included from France (n=111), the Netherlands (n=229), Spain (n=61), Switzerland (n=50), and the United Kingdom (n=86). Symptoms experienced by ≥ 70% of patients in all countries were fatigue, Raynaud's phenomenon, joint pain, and muscle pain. Twenty symptoms were experienced by ≥ 50% of patients in all countries. Thirty symptoms had an impact on daily activities in ≥ 50% of patients who reported that the symptom was present in all countries. There were significant differences among countries in the prevalence of 17 out of 40 symptoms. Furthermore, in 24 out of 40 symptoms significant differences in the proportion of patients reporting impact of a specific symptom on everyday activities were observed. CONCLUSIONS European patients with SSc experience a broad range of symptoms that have an impact on everyday activities. International research initiatives should target common SSc symptoms cooperatively. Further research is needed to better understand the differences in SSc symptoms among countries.
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Affiliation(s)
- L M Willems
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
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17
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Simeón-Aznar CP, Tolosa-Vilella C, Gabarró-Juliá L, Campillo-Grau M, Guillén Del Castillo A, Fonollosa-Plá V, Vilardell-Tarrés M. Systemic sclerosis sine scleroderma and limited cutaneous systemic sclerosis: similarities and differences. Clin Exp Rheumatol 2014; 32:S-33-40. [PMID: 24776173] [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: 07/11/2013] [Accepted: 11/15/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To compare a cohort of patients with systemic sclerosis sine scleroderma (ssSSc) vs. patients with limited cutaneous systemic sclerosis (lcSSc). METHODS Forty-five patients with ssSSc and 186 patients with lcSSc were investigated. Demographic, clinical and immunologic features and survival were compared. RESULTS There were no significant differences between ssSSc and lcSSc in gender, age at onset and interval between onset and diagnosis. ssSSc patients fulfilled the ACR criteria for SSc less than lcSSc patients (13%/77%, p<0.0001). There were no significant differences in articular involvement, myopathy, tendon friction rubs and gastrointestinal, pulmonary, cardiac and renal involvements. There was a trend to higher prevalence of pulmonary arterial hypertension (PAH) in ssSSc patients (29%/19%) but not reach significant difference. The prevalence of antinuclear and anticentromere antibodies and slow capilaroscopic pattern was similar. Sicca syndrome (13%/30%; p=0.024), digital ulcers (16%/50%; p<0.0001), calcinosis (11%/26%; p=0.047) and acroosteolysis (0% /10%; p=0.028) were more frequently in lcSSc. Survival at 5, 10, and 15 yr was not different in ssSSc and lcSSc patients (100%/98%, 100%/98%, and 92%/89%, respectively). CONCLUSIONS ssSSc and lcSSc patients share demographic, clinical and immunologic features. Survival is also similar in both groups. Differences are mainly due to peripheral vascular manifestations. However, despite great similarities, we believe that ssSSc patients should be considered as a different subset in order to avoid misdiagnosis. ssSSc patients should be truly differentiated from early SSc using sensitive and specific studies looking for any asymptomatic organ involvement.
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MESH Headings
- Acro-Osteolysis/etiology
- Adult
- Aged
- Calcinosis/etiology
- Esophageal Motility Disorders/etiology
- Female
- Hand Dermatoses/etiology
- Humans
- Hypertension, Pulmonary/etiology
- Lung Diseases, Interstitial/etiology
- Male
- Middle Aged
- Scleroderma, Diffuse/classification
- Scleroderma, Diffuse/complications
- Scleroderma, Diffuse/physiopathology
- Scleroderma, Limited/classification
- Scleroderma, Limited/complications
- Scleroderma, Limited/physiopathology
- Scleroderma, Systemic/classification
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/physiopathology
- Sjogren's Syndrome/etiology
- Skin Ulcer/etiology
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Affiliation(s)
- C P Simeón-Aznar
- Internal Medicine Department, Hospital Vall d´Hebron, Barcelona, Spain.
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18
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Fischer A, Swigris JJ, Bolster MB, Chung L, Csuka ME, Domsic R, Frech T, Hinchcliff M, Hsu V, Hummers LK, Gomberg-Maitland M, Mathai SC, Simms R, Steen VD. Pulmonary hypertension and interstitial lung disease within PHAROS: impact of extent of fibrosis and pulmonary physiology on cardiac haemodynamic parameters. Clin Exp Rheumatol 2014; 32:S-109-14. [PMID: 25372796] [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: 04/07/2014] [Accepted: 08/04/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES We sought to examine the relationship between measures of ILD severity and PH in patients with SSc. METHODS We identified 55 subjects from 12 PHAROS sites with RHC-proven PH and HRCT evidence of ILD. Subjects with PH due to left heart disease were excluded. Baseline HRCT scans were scored by a standardised system that graded severity of ILD. Summary statistics were generated for baseline characteristics. Spearman correlation and linear regression were used to examine relationships between ILD and PH severity variables. RESULTS The majority of subjects were white women; nearly half had limited cutaneous SSc. Most subjects were New York Heart Association functional class II or III. Pulmonary function testing revealed moderate restriction (mean FVC 64.3 ± 17.2% predicted) with severe reduction in diffusing capacity (mean DLco 34.2 ± 13.3% predicted). RHC demonstrated mild to moderate PH (mean PAP 35 ± 9 mmHg, mean PVR 5.1 ± 3.7 WU). There was no correlation between severity of ILD (by either HRCT or PFT) and cardiac haemodynamic parameters of PH. CONCLUSIONS No association between severity of ILD and cardiac haemodynamic profiles were identified in this cohort. We believe this underscores the complex nature of PH and ILD in individuals with SSc. We do suspect that some individuals with SSc-ILD will also have concomitant pulmonary vascular disease but simple assessments to grade severity of ILD - by PFT or HRCT estimates of ILD extent - are likely not enough to reliably distinguish between PAH versus PH-ILD. Further research into how to distinguish and manage these subsets is warranted.
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MESH Headings
- Aged
- Exercise Test
- Female
- Humans
- Hypertension, Pulmonary/diagnostic imaging
- Hypertension, Pulmonary/etiology
- Hypertension, Pulmonary/physiopathology
- Lung/diagnostic imaging
- Lung/physiopathology
- Lung Diseases, Interstitial/diagnostic imaging
- Lung Diseases, Interstitial/etiology
- Lung Diseases, Interstitial/physiopathology
- Male
- Middle Aged
- Pulmonary Diffusing Capacity
- Scleroderma, Diffuse/complications
- Scleroderma, Diffuse/diagnostic imaging
- Scleroderma, Diffuse/physiopathology
- Scleroderma, Limited/complications
- Scleroderma, Limited/diagnostic imaging
- Scleroderma, Limited/physiopathology
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/diagnostic imaging
- Severity of Illness Index
- Tomography, X-Ray Computed
- Vital Capacity
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Affiliation(s)
- A Fischer
- National Jewish Health and University of Colorado School of Medicine, Denver, CO, USA.
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19
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Bálint Z, Farkas H, Farkas N, Minier T, Kumánovics G, Horváth K, Solyom AI, Czirják L, Varjú C. A three-year follow-up study of the development of joint contractures in 131 patients with systemic sclerosis. Clin Exp Rheumatol 2014; 32:S-68-74. [PMID: 25152080] [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: 11/09/2013] [Accepted: 03/19/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To analyse the correlation between the number of joint-contractures and other major clinical findings in a follow-up study of 131 patients with systemic sclerosis (SSc). METHODS The range of motion of joints (ROM), HAQ-DI, and the major clinical characteristics were assessed. RESULTS A high frequency of contractures (ROM<75% of the normal) were present at baseline in small joints of the hand (82%), wrists (75%), and shoulders (50%). ROM of the dominant side hand was significantly more decreased compared to the non-dominant side. The number of the upper extremity contractures correlated positively with ESR (p<0.01), CRP (p<0.01), HAQ-DI (p<0.01), and negatively with forced vital capacity (FVC) (p<0.05). The number of contractures was not significantly different in cases with early (≤ 4 years) and late disease duration in both the limited and diffuse subgroups. During the three-year follow-up period, an increase in the number of joint contractures (ROM<75%) was associated with an increase of ESR, modified Rodnan's skin score, and the European Scleroderma Study Group Activity Index by multiple linear regression analysis. Univariate analysis over a six-year period demonstrated poor outcome in patients with more than ten contractures, or more than four contractures of unilateral hand-joints. CONCLUSIONS Contractures predominantly develop during the early years following disease onset in both SSc subgroups. Inflammation and skin-involvement are significant contributing factors for the development of contractures. The dominant hand may be more pronouncedly impaired compared to the non-dominant side. A high number of joint-contractures might be an unfavourable prognostic factor in SSc.
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MESH Headings
- Adult
- Aged
- Ankle Joint/physiopathology
- Blood Sedimentation
- C-Reactive Protein/metabolism
- Cohort Studies
- Contracture/etiology
- Contracture/physiopathology
- Echocardiography
- Electrocardiography
- Female
- Follow-Up Studies
- Hand Joints/physiopathology
- Hip Contracture/etiology
- Hip Contracture/physiopathology
- Humans
- Knee Joint/physiopathology
- Linear Models
- Lung Diseases, Interstitial/etiology
- Lung Diseases, Interstitial/physiopathology
- Male
- Middle Aged
- Range of Motion, Articular/physiology
- Scleroderma, Diffuse/complications
- Scleroderma, Diffuse/metabolism
- Scleroderma, Diffuse/physiopathology
- Scleroderma, Limited/complications
- Scleroderma, Limited/metabolism
- Scleroderma, Limited/physiopathology
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/metabolism
- Scleroderma, Systemic/physiopathology
- Shoulder Joint/physiopathology
- Vital Capacity
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Affiliation(s)
- Z Bálint
- Department of Rheumatology and Immunology Clinic Centre, University of Pécs, Hungary.
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20
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Marini C, Formichi B, Bauleo C, Michelassi C, Pancani R, Prediletto R, Miniati M, Catapano G, Monti S, Mannucci F, Tavoni A, D'Ascanio A, Pastormerlo LE, Giannoni A, Giuntini C. Improved survival in limited scleroderma-related pulmonary artery hypertension. Intern Emerg Med 2014; 9:385-96. [PMID: 23361526 DOI: 10.1007/s11739-013-0900-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 05/31/2012] [Accepted: 01/02/2013] [Indexed: 11/28/2022]
Abstract
Reportedly, patients with scleroderma-related pulmonary hypertension (SSc-PAH) respond poorly to new vasoactive drugs (NVD). Forty-nine SSc-PAH patients underwent right heart catheterization (RHC) and, according to NVD availability, divided as follows: Group 1 (n = 23, from 1999 to 2004, poor availability), and Group 2 (n = 26, from 2005 to 2010, good availability). Before diagnostic RHC, NVD had been given to 30 % of the patients in Group 1, and 58 % of those in Group 2 (p = 0.049). At diagnosis, patients in Group 1 had greater heart dilatation (p < 0.01), higher mean pulmonary artery pressure (p < 0.05), lower pulmonary artery capacitance (p < 0.05), and lower carbon monoxide lung diffusing capacity (DLco, p < 0.05) than those in Group 2. At a median follow-up time of 15.5 months, DLco further decreased in Group 1 (p < 0.05), whereas cardiac index increased in Group 2 (p < 0.05). At 36 months of follow-up, 72.4 % of the patients in Group 2 were still alive as opposed to 30.4 % in Group 1 (p = 0.02). In multivariate analysis, DLco and mixed venous oxygen saturation (SvO2) were independent predictors of survival. A value of DLco <7.2 mL/mmHg/min was associated with a hazard ratio (HR) of 5.3 (p < 0.001); for SvO2 <63.8 %, the HR was 3.7 (p < 0.01).NVD have beneficial effects in patients with SSc-PAH. Both DLco and SvO2 are predictors of survival and may assist in planning treatment.
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Affiliation(s)
- Carlo Marini
- Fondazione Regione Toscana "G. Monasterio", Via G. Moruzzi 1, Ghezzano, 56124, Pisa, Italy,
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21
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Faccini A, Franchini S, Sabbadini MG, Camici PG. [Cardiac involvement at rest in patients with systemic sclerosis: differences between the limited and the diffuse form of the disease]. G Ital Cardiol (Rome) 2014; 15:44-50. [PMID: 24503734 DOI: 10.1714/1394.15518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Heart involvement confers a poor prognosis in patients affected by systemic sclerosis (SSc). Nevertheless, the prevalence of heart involvement in these patients is not fully known. In this study we analyzed the most frequent manifestations of heart involvement at rest in a cohort of patients with SSc, comparing their prevalence in patients with the limited form (lcSSc) and in patients with the diffuse form (dcSSc) of the disease, taking also into account the duration of the disease. METHODS We thoroughly evaluated with electrocardiographic and echocardiographic examinations 174 patients affected by SSc who were followed at our hospital between 2001 and 2011. They were divided according to the disease subtype (dcSSc vs lcSSc) and information about the disease duration was available for 121 of them (calculated from the onset of the Raynaud's phenomenon). RESULTS Patients with dcSSc had a greater prevalence of heart involvement at rest when evaluated within 5 and 10 years after the onset of the Raynaud's phenomenon (p=0.0051 within 5 years and p=0.035 within 10 years). Indeed, patients with dcSSc had a greater prevalence of atrioventricular conduction abnormalities within 20 years after the onset of the Raynaud's phenomenon (p=0.03 within 10 years and p=0.04 within 20 years) and a greater prevalence of valvular abnormalities within 5 years (p=0.04). In dcSSc there was a greater prevalence of rhythm disturbances in patients with a disease duration ≤20 or >20 years (p=0.04 within 20 years and p=0.04 after 20 years), but not in those with a disease duration ≤5 and ≤10 years. Left ventricular hypertrophy had a greater prevalence in dcSSc after 20 years of disease duration (p=0.02). CONCLUSIONS Cardiac manifestation occurs earlier and more frequently in patients affected by dcSSc than in patients with lcSSc.
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Prasad M, Wilson ME, McGoon MD. 69-year-old woman with ascites, hypoxia, and weight loss. Mayo Clin Proc 2013; 88:1475-9. [PMID: 24290122 DOI: 10.1016/j.mayocp.2013.04.028] [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: 01/23/2013] [Revised: 04/01/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Megha Prasad
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
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Labrador S, Gonzalez-Gay MA. Images in clinical medicine. Cold hands associated with scleroderma. N Engl J Med 2013; 369:1638. [PMID: 24152263 DOI: 10.1056/nejmicm1304702] [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] [Indexed: 11/19/2022]
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Abstract
Connective tissue disorders increase the risk of malignancy; conversely, they may manifest as rheumatological paraneoplastic syndromes due to an underlying malignancy. We describe the case of a patient with limited scleroderma whose rapid disease progression coincided with the discovery of a renal tumor. A woman, age 75 years, presented with a 3-month history of progressive difficulty grasping objects, unsteadiness, dyspnea, xerostomia, xerophthalmia, and significant weight loss. She had a 10-year history of gastroesophageal reflux and Raynaud's phenomenon. Pertinent physical examination findings included facial telangiectasias, bibasilar inspiratory rales, sclerodactyly, and absent pinprick and vibratory sensation in her toes. She also had swelling and tenderness in several metacarpophalangeal and interphalangeal joints and in both ankles. A renal mass was demonstrated on abdominal computed tomography. A left partial nephrectomy was performed, confirming an unclassified type of renal cell carcinoma, along with a focal proliferative crescentic pauci-immune glomerulonephritis. Medical therapy with rituximab, pulse methylprednisolone, and prednisone led to improvement in her symptoms. The patient's presentation is consistent with a rapid progression of pre-existing limited scleroderma with the development of new rheumatological symptoms, including vasculitis. We propose that this progression was secondary to paraneoplastic stimulation by the renal cell carcinoma. Clinicians should consider looking for a malignancy in patients with connective tissue disorders who present with a myriad of new symptoms.
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Affiliation(s)
- Victor Abrich
- Corresponding Author: Victor Abrich, Marshfield Clinic, Department of Internal Medicine, 1000 North Oak Avenue, Marshfield, WI 54449 USA.
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Bae S, Allanore Y, Furst DE, Bodukam V, Coustet B, Morgaceva O, Maranian P, Khanna D. Associations between a scleroderma-specific gastrointestinal instrument and objective tests of upper gastrointestinal involvements in systemic sclerosis. Clin Exp Rheumatol 2013; 31:57-63. [PMID: 23910611] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 05/30/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES UCLA-SCTC-GIT 2.0 is an instrument designed to evaluate gastrointestinal (GI) symptoms in systemic sclerosis (SSc). The objective of our study was to assess the associations between the upper GI (UGI) symptom scales (reflux and distention/bloating [D/B] scales) versus objective/laboratory studies. METHODS Fifty-five patients with SSc were enrolled at 2 centres. Each patient completed the GIT 2.0 and had objective and laboratory tests. Correlations were assessed using the Spearman's test. We also assessed the average scores in patients with positive vs. negative tests and compared them using the t-test and Wilcoxon test. RESULTS The mean (SD) age was 53.6 (11.8), 90% were women and 49% had limited SSc. The mean reflux and D/B scores were 0.82 and 1.25, respectively (moderate severity). The reflux scale had moderate correlations with upper GI objective evaluations (correlation coefficient ≥0.40) and was able to differentiate between patients with endoscopy proven esophagitis and manometric abnormalities (p=0.01 for both). D/B scores were numerically higher in patients with abnormal objective tests. The GIT 2.0 reflux and D/B scales had a high sensitivity ranging from 80% to 94% but very low specificity (range; 0-20%) based on objective gold standard GI measures. CONCLUSIONS The GIT 2.0 reflux and D/B scales have a high sensitivity (range 80-94%) for UGI involvement. The GIT 2.0 instrument complements the objective tests for assessment of the UGI.
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Affiliation(s)
- Sangmee Bae
- University of California Medical Center, Los Angeles, USA.
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Iwanaga Y, Hayashi S, Kawamura N, Ohyagi Y, Kira JI. [A case of neuromyelitis optica spectrum disorder associated with a limited cutaneous systemic sclerosis and Sjögren syndrome]. Rinsho Shinkeigaku 2013; 53:695-700. [PMID: 24097316 DOI: 10.5692/clinicalneurol.53.695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 06/02/2023]
Abstract
A 51-year-old woman was referred to our department for a precise examination of her neuromyelitis optica spectrum disorder (NMOSD) symptoms. She had recurrent attacks of consciousness disturbance, cerebellar ataxia and diplopia (10 years ago), paraparesis and dysesthesia in four limbs (7 years ago), and consciousness disturbance and paraparesis (4 years ago). Neurological examination disclosed bilateral temporal pallor of the optic disc, atrophy and fasciculation of the right side of the tongue, dysesthesia in four limbs, mild motor weakness of both lower limbs, hyperreflexia in the right leg, pathological reflexes in bilateral lower limbs, and spastic bladder. T2-weighted cranial MRI showed lesions in the bilateral hypothalami and the dorsal portion of the medulla oblongata on the right side. T2-weighted spinal MRI revealed longitudinally extensive spinal cord lesions at T2-T8. A visual-evoked potential study disclosed prolonged latency of P100 bilaterally. During the examination, slight skin changes on the lower extremities indicative of scleroderma were observed, with no evidence of organ involvement. Skin biopsy showed increased numbers and swelling of collagen fibers. Thus, the patient was diagnosed with limited cutaneous systemic sclerosis (lcSSc). She also clinically manifested Sjögren syndrome. Her serum was positive for anti-nuclear, anti-centromere, and anti-aquaporin-4 antibodies. Following the administration of corticosteroids (25 mg/alternative day) the patient became stable. A variety of collagen diseases or autoimmune disorders have been reported to be major complications of NMOSD; however, the coexistence of lcSSc and NMOSD is extremely rare. To the best of our knowledge, this is the first description of a case with the coexistence of both conditions. Physicians should be aware of scleroderma in patients with NMOSD, even if patients do not complain of skin symptoms.
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Affiliation(s)
- Yasutaka Iwanaga
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
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Sharma A, Sharma V. Medical image. Limited systemic sclerosis. N Z Med J 2012; 125:96-98. [PMID: 22382262] [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: 05/31/2023]
Affiliation(s)
- Alka Sharma
- Department of Medicine, Government Medical College and Hospital, Chandigarh, India
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Hasebe N, Kawasaki A, Ito I, Kawamoto M, Hasegawa M, Fujimoto M, Furukawa H, Tohma S, Sumida T, Takehara K, Sato S, Kawaguchi Y, Tsuchiya N. Association of UBE2L3 polymorphisms with diffuse cutaneous systemic sclerosis in a Japanese population. Ann Rheum Dis 2012; 71:1259-60. [PMID: 22294623 DOI: 10.1136/annrheumdis-2011-201091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Moinzadeh P, Krieg T, Hellmich M, Brinckmann J, Neumann E, Müller-Ladner U, Kreuter A, Dumitrescu D, Rosenkranz S, Hunzelmann N. Elevated MMP-7 levels in patients with systemic sclerosis: correlation with pulmonary involvement. Exp Dermatol 2011; 20:770-3. [PMID: 21707759 DOI: 10.1111/j.1600-0625.2011.01321.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Fibrosis is characterized by an excessive accumulation of connective tissue because of an imbalance between synthesis and degradation of extracellular matrix proteins. Systemic sclerosis (SSc) is a prototypic chronic inflammatory disease leading to a severe fibrosis of the skin and many internal organs. QUESTIONS ADDRESSED: We investigated whether serum MMP-7 levels reflect the activity of the fibrotic reaction in systemic sclerosis. EXPERIMENTAL DESIGN Serum samples were obtained from 123 patients with systemic sclerosis. MMP-serum levels of all patients with SSc were compared with age-matched healthy controls. RESULTS Significantly increased median serum MMP-7 levels were found in patients with SSc when compared with controls. The median MMP-7 serum level of patients with lung fibrosis (LF) was significantly higher compared with those without LF. Accordingly, patients with dyspnea and DLCO (diffusion capacity of the lung for carbon monoxide) levels below 60% showed significantly higher median MMP-7 levels. CONCLUSIONS Elevated MMP-7 levels are associated with an advanced stage of SSc and LF. These data suggest that in SSc MMP-7 is involved in the process of fibrotic tissue remodelling.
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Azam J, Caperon A, Lawson CA, Gough A. Medical versus laser therapy for gastric antral vascular ectasia: comment on the clinical images by Thonhofer et al. Arthritis Rheum 2010; 62:3517-3518. [PMID: 20669281 DOI: 10.1002/art.27681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Bandinelli F, Kaloudi O, Candelieri A, Conforti ML, Casale R, Cammarata S, Grassiri G, Miniati I, Melchiorre D, Matucci-Cerinic M. Early detection of median nerve syndrome at the carpal tunnel with high-resolution 18 MHz ultrasonography in systemic sclerosis patients. Clin Exp Rheumatol 2010; 28:S15-S18. [PMID: 21050540] [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: 02/23/2010] [Accepted: 07/02/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To investigate carpal tunnel syndrome (CTS) with ultrasound (US) in asymptomatic SSc patients and to seek out the relationship between CTS and SSc clinical variables METHODS In 64 SSc patients (55 women and 9 men, mean age 57±14 years) and in 30 healthy controls, area (MNA), transverse (MNT) and anteroposterior (MNAP) diameters of MN at carpal tunnel were studied with US (My Lab 25 XVG US Esaote 18 MHz). MN flattening ratio (MNFR) was calculated. Duration of disease, subset (limited, diffuse), phase of skin involvement (oedematous, atrophic, fibrotic), modified Rodnan skin score (mRSS) and friction tendon rub were also recorded. RESULTS MNA (p<0.001), MNT (p<0.005) and MNFR (p<0.005) were significantly higher in the SSc patients than in controls, while no difference in MNAP was found. There was no correlation between median nerve (MN) and SSc clinical features (only lower MNAP correlated inversely with longer disease duration; Spearman coefficient -0.2). CONCLUSIONS MN involvement is frequently present in all phases of asymptomatic SSc patients, independently to clinical variables.
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Affiliation(s)
- F Bandinelli
- Department of Medicine, DENOThe Centre, Division of Rheumatology AOUC, University of Florence, Florence, Italy.
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Wielosz E, Borys O, Zychowska I, Majdan M. Gastrointestinal involvement in patients with systemic sclerosis. Pol Arch Med Wewn 2010; 120:132-136. [PMID: 20424538] [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: 05/29/2023]
Abstract
INTRODUCTION Gastrointestinal (GI) involvement is a serious complication of systemic sclerosis (SSc). OBJECTIVES The aim of the study was to determine the incidence of GI manifestations in SSc. PATIENTS AND METHODS We studied 73 patients with SSc (60 women and 13 men). Diffuse cutaneous SSc (dcSSc) was diagnosed in 30 patients and limited cutaneous SSc (lcSSc) in 43 patients. Upper GI involvement was assessed based on clinical symptoms such as dysphagia and gastroesophageal reflux-related complications. The majority of patients underwent radiographic examination including a barium swallow. Lower GI involvement was evaluated on the basis of such clinical symptoms as constipation and diarrhea. RESULTS GI symptoms were observed in 54 (74%) SSc patients. Upper GI symptoms were observed in 54 (74%) patients and lower GI symptoms in 22 (30%) patients. The presence of anticentromere antibodies is associated with a lower risk of GI involvement. There are no significant differences in the incidence of pulmonary involvement between SSc patients with and without GI symptoms. CONCLUSIONS GI involvement is observed in the majority of SSc patients. Clinical symptoms of GI involvement are significantly more common in patients with dcSSc. The incidence of upper GI symptoms is significantly higher than that of lower GI symptoms.
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Affiliation(s)
- Ewa Wielosz
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Lublin, Poland.
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Koumakis E, Wipff J, Kahan A, Allanore Y. Pulmonary arterial hypertension occurrence after liver transplant in systemic sclerosis: a report of 2 cases sustainably treated by sildenafil. Clin Exp Rheumatol 2010; 28:S53-S54. [PMID: 20576215] [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: 01/12/2010] [Accepted: 04/20/2010] [Indexed: 05/29/2023]
Abstract
We present the unusual cases of 2 systemic sclerosis patients with a history of liver transplant, who developed pulmonary hypertension in the course of their diseases. Sildenafil was the preferred pulmonary arterial hypertension drug because of its safety within this context. Clinical and functional responses were good, with a follow-up of more than 2 years.
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Affiliation(s)
- Eugénie Koumakis
- Paris Descartes University, Rheumatology Department A, Cochin Hospital, APHP, Paris, France
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Torok KS, Baker NA, Lucas M, Domsic RT, Boudreau R, Medsger TA. Reliability and validity of the delta finger-to-palm (FTP), a new measure of finger range of motion in systemic sclerosis. Clin Exp Rheumatol 2010; 28:S28-S36. [PMID: 20576211 PMCID: PMC2935276] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 04/20/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To determine the reliability and validity of a new measure of finger motion in patients with systemic sclerosis (SSc), the 'delta finger-topalm' (delta FTP) and compare its psychometric properties to the traditional measure of finger motion, the finger-topalm (FTP). METHODS Phase 1: The reliability of the delta FTP and FTP were examined in 39 patients with SSc. Phase 2: Criterion and convergent construct validity of both measures were examined in 17 patients with SSc by comparing them to other clinical measures: Total Active Range of Motion (TAROM), Hand Mobility in Scleroderma (HAMIS), the Duruoz Hand Index (DHI), Health Assessment Questionnaire (HAQ), and modified Rodnan skin score (mRSS). Phase 3: Sensitivity to change of the delta FTP was investigated in 24 patients with early diffuse cutaneous SSc. RESULTS Both measures had excellent intra-rater and inter-rater reliability (ICC 0.92 to 0.99). Fair to strong correlations (rs=0.49-0.94) were observed between the delta FTP and TAROM, HAMIS, and DHI. Fair to moderate correlations were observed between delta FTP and HAQ components related to hand function and upper extremity mRSS. Correlations of the traditional FTP with these measures were fair to strong, but most often the delta FTP outperformed the FTP. The effect size and standardised response mean for the mean delta FTP were 0.50 and 1.10 respectively, over a 2-8 month period. CONCLUSIONS The delta FTP is a valid and reliable measure of finger motion in patients with SSc which outperforms the FTP.
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Affiliation(s)
- Kathryn S. Torok
- Children’s Hospital of Pittsburgh, Department of Pediatrics, Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy A. Baker
- School of Health and Rehabilitation Sciences, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mary Lucas
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robyn T. Domsic
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert Boudreau
- Department of Epidemiology, Center for Aging and Population Health; University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Thomas A. Medsger
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Ferreira ELA, Christmann RB, Borba EF, Borges CTL, Siqueira JTT, Bonfa E. Mandibular function is severely impaired in systemic sclerosis patients. J Orofac Pain 2010; 24:197-202. [PMID: 20401358] [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: 05/29/2023]
Abstract
AIMS To evaluate the presence of temporomandibular disorders (TMD) in systemic sclerosis (SSc) patients and its possible association with the severity of skin involvement. METHODS The presence of TMD was evaluated in 35 SSc women and 30 age- and sex-matched healthy controls by means of the anamnestic (A(i)) and clinical (D(i)) Helkimo indices; the jaw mobility was further analyzed (M(I)). Skin involvement was scored by the Modified Rodnan Skin Score (MRSS). RESULTS Signs and symptoms of TMD were more frequent in SSc patients than in controls, the frequency distribution of the different clinical dysfunction indices differing significantly (P < .001) between patients (D(i)0 8.6%, D(i)I 48.6%, D(i)II 22.8%, and D(i)III 20%) and controls (D(i)0 50%, D(i)I 33.3%, and D(i)II 16.7%). Cyclophosphamide for severe and rapidly progressive cutaneous fibrosis was prescribed in six out of seven patients with severe signs (D(i)III), in contrast this treatment was indicated for only two out of 25 patients with mild to moderate signs (D(i)I and D(i)II, P < .001). Impaired jaw mobility was more frequent in SSc patients than controls (P < .001). It was severe in 77.1% (M(I)II) and mild in 22.9% (M(I)I) of the cases, in contrast to controls (M(I)0 33.4%, M(I)I 53.3%, and M(I)II 13.3%; P < .001). Approximately half of SSc patients with severe (M(I)II) but none of those with mild impairment were on cyclophosphamide treatment for severe cutaneous fibrosis (P = .02). CONCLUSION Severe signs of TMD according to the anamnestic and clinical Helkimo indices were very frequent in SSc patients.
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MESH Headings
- Adult
- Case-Control Studies
- Cyclophosphamide/therapeutic use
- Female
- Humans
- Immunosuppressive Agents/therapeutic use
- Mandible/physiopathology
- Radiography, Panoramic
- Range of Motion, Articular/physiology
- Scleroderma, Diffuse/complications
- Scleroderma, Diffuse/drug therapy
- Scleroderma, Diffuse/physiopathology
- Scleroderma, Limited/complications
- Scleroderma, Limited/drug therapy
- Scleroderma, Limited/physiopathology
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/drug therapy
- Scleroderma, Systemic/physiopathology
- Single-Blind Method
- Skin/physiopathology
- Temporomandibular Joint Disorders/etiology
- Temporomandibular Joint Disorders/physiopathology
- Time Factors
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Affiliation(s)
- Taoufik Amezyane
- Department of Internal Medicine, Mohammed V Military Teaching Hospital, Mohammed V-Souissi University, Rabat, Morocco.
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Nomoto T, Kikuchi T, Kusunoki Y, Akesaka K, Yano K, Fujii Y, Makino H. Acute right heart failure and achalasia-like syndrome in a patient with limited cutaneous systemic sclerosis and primary biliary cirrhosis. Intern Med 2010; 49:1779-82. [PMID: 20720358 DOI: 10.2169/internalmedicine.49.3640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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] [Indexed: 11/06/2022] Open
Abstract
We report a case of a 63-year-old woman who developed acute right heart failure and an achalasia-like syndrome with limited cutaneous systemic sclerosis (lcSSc) and primary biliary cirrhosis. Intravenous administration of diuretics improved her acute heart failure. Anti-centromere antibodies and anti-mitochondria antibodies were present. A coronary angiogram and a Swan-Ganz catheter revealed no abnormalities. Thallium-201 scan at rest demonstrated mild perfusion defects in both the apex and the anteroseptal and the inferior myocardium. A cine-esophagram revealed an achalasia-like syndrome. Though rare, physicians should be aware that some patients with lcSSc may develop acute right heart failure or achalasia-like syndrome.
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Affiliation(s)
- Takahiko Nomoto
- Department of Internal Medicine, Takanoko Hospital, Matsuyama, Japan
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Beretta L, Caronni M, Origgi L, Ponti A, Santaniello A, Scorza R. Hormone replacement therapy may prevent the development of isolated pulmonary hypertension in patients with systemic sclerosis and limited cutaneous involvement. Scand J Rheumatol 2009; 35:468-71. [PMID: 17343256 DOI: 10.1080/03009740600844498] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [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: 10/23/2022]
Abstract
BACKGROUND Isolated pulmonary hypertension (iPHT) is a near-fatal consequence of systemic sclerosis (SSc); in female patients, the risk of its development is increased during the post-menopausal period, when the protective effects of oestrogens on the endothelium decrease. In many animal and human models, hormone replacement therapy (HRT) and oestrogen administration proved efficacious in counteracting many mechanisms that might be implicated in the pathogenesis of iPHT. Accordingly, it has been hypothesized that HRT might help to prevent the development of iPHT. METHODS A retrospective cohort study was conducted on 61 SSc patients with the limited cutaneous form of the disease and no sign of pulmonary hypertension on echocardiogram (pulmonary artery pressure, PAP > 35 mmHg) at the time of menopause. All the patients had to be stably treated with calcium-channel blockers and not to have risk factors for secondary PHT throughout the duration of the observational period. RESULTS Twenty patients (32.8%) received HRT for a mean of 6.7 +/- 3.7 years. None of these patients developed iPHT after a mean of 7.2 +/- 3.5 years from menopause, whereas eight out of 41 patients not receiving HRT (19.5%) developed iPHT after a similar time period (7.5 +/- 3.9 years, p = 0.032). These rates were not explained by differences between the two groups with respect to autoantibodies, age, age at onset of SSc, diffusing capacity of the lung for carbon monoxide (DLCO) at menopause, or duration of therapy with calcium-channel blockers. CONCLUSION HRT administration may be effective in SSc post-menopausal women, preventing the development of iPHT.
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Affiliation(s)
- L Beretta
- Unit of Immunology, IRCCS Maggiore Policlinico Hospital, University of Milan, Milan, Italy
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Hettema ME, Zhang D, Stienstra Y, Smit AJ, Bootsma H, Kallenberg CGM. No effects of bosentan on microvasculature in patients with limited cutaneous systemic sclerosis. Clin Rheumatol 2009; 28:825-33. [PMID: 19350343 PMCID: PMC2686804 DOI: 10.1007/s10067-009-1157-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [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: 10/07/2008] [Revised: 12/11/2008] [Accepted: 03/05/2009] [Indexed: 11/26/2022]
Abstract
The endothelium-derived vasoconstrictor molecule endothelin-1 (ET-1) has been suggested to play a role in the pathogenesis of Raynaud’s phenomenon (RP) and systemic sclerosis (SSc). We studied the effect of bosentan on microvascular structure and function in patients with RP secondary to limited cutaneous SSc in a mechanistic pilot study. In this single center, open study, 15 patients with limited cutaneous SSc were treated with bosentan for 16 weeks with a follow-up period of 4 weeks. Changes in microvascular structure and function were studied with assessment of vasodilatory microvascular responses using laser Doppler fluxmetry combined with iontophoresis, capillary permeability using fluorescence videomicroscopy, nailfold capillary microscopy, and serological markers of endothelial activation. No significant changes were seen in vasodilator responses to acetylcholine and sodium nitroprusside following bosentan treatment. No effect was noted on capillary permeability during treatment. The number of nailfold capillaries remained unchanged. The endothelial activation marker vascular cell adhesion molecule did not change during treatment, but levels of thrombomodulin significantly decreased after 12 weeks of treatment. Bosentan did not induce significant changes in vasodilator responses, capillary permeability, and capillary density during treatment, so no evidence was obtained for structural improvement of microvascular structure and function in this short-time mechanistic pilot study in patients with lcSSc.
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Affiliation(s)
- Martha E Hettema
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
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Hummers LK. The importance of recognizing scleroderma-type disorders in clinical practice. Nat Clin Pract Rheumatol 2008; 4:638-640. [PMID: 18957945 DOI: 10.1038/ncprheum0937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 09/24/2008] [Indexed: 05/27/2023]
Affiliation(s)
- Laura K Hummers
- Johns Hopkins Scleroderma Center, Johns Hopkins University, Baltimore, MD 21224, USA.
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Baldini C, Giusti L, Bazzichi L, Ciregia F, Giannaccini G, Giacomelli C, Doveri M, Del Rosso M, Bombardieri S, Lucacchini A. Association of psoriasin (S100A7) with clinical manifestations of systemic sclerosis: is its presence in whole saliva a potential predictor of pulmonary involvement? J Rheumatol 2008; 35:1820-1824. [PMID: 18634149] [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] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To evaluate psoriasin (S100A7) expression in whole saliva (WS) of patients with diffuse systemic sclerosis (dSSc) and limited SSc (lSSc), and to correlate its presence with the different clinical manifestations of the disease. METHODS Forty-four patients with limited or diffuse SSc were enrolled for study. WS proteins were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and psoriasin was identified by Western blot analysis using a specific polyclonal antibody. Patients with other rheumatic diseases with and without lung involvement were enrolled as pathological controls. Statistical analysis was performed to correlate each clinical manifestation with the presence of psoriasin. RESULTS Three bands of 12, 24, and 50 kDa corresponding to monomeric and dimeric/multimeric forms of psoriasin were evidenced by immunoblot analysis in WS of 31 out of 44 patients with SSc (70.4%). In the other 13 WS samples, the 12 kDa band was totally absent, while the dimeric and multimeric bands were expressed at optical intensity (OD) levels comparable to the other samples. From a clinical point of view, the presence of 12 kDa monomeric psoriasin was significantly associated with SSc pulmonary involvement and with anti-Scl-70 antibody positivity. No control showed the psoriasin 12 kDa band. CONCLUSION Our results identified salivary 12 kDa psoriasin as a potential predictor of pulmonary involvement in SSc. Thus, a psoriasin assay might be considered as a rapid, noninvasive, useful salivary biomarker for the detection of pulmonary involvement in SSc.
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Affiliation(s)
- Chiara Baldini
- Department of Internal Medicine, University of Pisa, Pisa, Italy
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Bredemeier M, Chies JAB, Wieck A, Capobianco KG, Pitrez EH, Rohde LEP, Pinotti AFF, Brenol JCT, Xavier RM. TCRBV20S1 and TCRBV3S1 gene segment polymorphisms in systemic sclerosis. J Rheumatol 2008; 35:1058-1063. [PMID: 18412309] [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] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To compare the frequencies of variants of TCRBV20S1 and TCRBV3S1 gene segments in patients with systemic sclerosis (SSc) and in controls. The null allele (allele 2) of TCRBV20S1 is associated with reduced levels of Vbeta20+ T-cells in the peripheral blood, while allele 1 of TCRBV3S1 is related to a low frequency of Vbeta3.1+ T-cells. METHODS One hundred thirty patients with SSc and 118 healthy volunteer controls were genotyped for TCRBV20S1, and 117 patients and 85 controls were genotyped for TCRBV3S1 variants by PCR-RFLP. Patients underwent clinical evaluation, serology, pulmonary function tests, high resolution computed tomography, and Doppler echocardiography. RESULTS The genotypic frequencies of TCRBV20S1 were 0.46 (allele 1/allele 1), 0.43 (allele 1/allele 2), and 0.11 (allele 2/allele 2) in SSc patients; in controls the frequencies were 0.70, 0.26, and 0.04, respectively (p < 0.001). The Mantel-Haenszel odds ratio (stratified by race and sex) of the allele 2 carrier state was 3.88 (95% CI 1.94 to 7.75). The allelic and genotypic frequencies of the TCRBV3S1 gene segment did not differ significantly in patients and controls. However, among patients, allele 1 (TCRBV3S1) carriers had a higher prevalence of interstitial lung disease (adjusted p = 0.032). CONCLUSION The null allele of the TCRBV20S1 and the allele 1 of TCRBV3S1 gene segments may be considered risk factors for the development of SSc and interstitial lung disease, respectively, suggesting a protective role of Vbeta20+ and Vbeta3.1+ cells in the pathogenic immune responses in SSc.
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Affiliation(s)
- Markus Bredemeier
- Division of Rheumatology, Radiology, and Cardiology of the Hospital de Clínicas de Porto Alegre, RS, Brazil
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Wilson FC, Warrington KJ. Pneumatosis intestinalis in limited scleroderma. J Rheumatol 2008; 35:352-353. [PMID: 18260164] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Floranne C Wilson
- Division of Rheumatology, Mayo Graduate School of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Bezante GP, Rollando D, Sessarego M, Panico N, Setti M, Filaci G, Molinari G, Balbi M, Cutolo M, Barsotti A, Indiveri F, Ghio M. Cardiac magnetic resonance imaging detects subclinical right ventricular impairment in systemic sclerosis. J Rheumatol 2007; 34:2431-2437. [PMID: 17985401] [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] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To assess myocardial involvement in patients with systemic sclerosis (SSc) with no signs or symptoms of cardiac impairment (New York Heart Association functional class I). METHODS Fifty patients (45 women, 5 men, age 53.3 +/- 12.9 yrs) who did not complain of serious diseases other than SSc were recruited out of 119 consecutive patients with SSc. Thirty-three were found to have limited cutaneous SSc (lSSc) and 17 diffuse SSc (dSSc). All underwent cardiovascular magnetic resonance imaging (MRI) to determine right and left systolic and diastolic volumes and ventricular ejection fractions (RVEF and LVEF). Thirty-one healthy subjects matched for sex, age, and body surface area (BSA) were studied as controls. Diffusion lung capacity test (DLCO) and high resolution computed tomography were performed to evaluate lung involvement. RESULTS Disease duration between patients with lSSc (14.1 +/- 11.4 yrs) and those with dSSc (6.9 +/-4.4yrs) was found to be significantly different (p < 0.003). lSSc patients were older than those with dSSc (54.8 +/- 13.7 yrs vs 50.4 +/- 9.9 yrs, respectively; p < 0.04). Anticentromere antibodies and Scl-70 were positive in 23 (46%) and 17 patients (34%). Except for the left and right systolic volumes, all unadjusted cardiac MRI measures were significantly reduced in SSc compared to the controls (p < 0.001 and p < 0.009). These differences persisted after adjustment for subjects' height and BSA. Raw RVEF data and RVEF data matched for height and BSA were significantly reduced in dSSc patients in comparison to lSSc (p < 0.03). CONCLUSION Compromised RVF was found in patients with asymptomatic SSc. Unlike standard diagnostic techniques, cardiac MRI appears to be a rapid and noninvasive means of determining subclinical right myocardial involvement that is otherwise undetected in patients with SSc.
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Affiliation(s)
- Gian Paolo Bezante
- Division of Cardiology, Department of Internal Medicine, University of Genoa, Genoa, Italy.
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Perera A, Fertig N, Lucas M, Rodriguez-Reyna TS, Hu P, Steen VD, Medsger TA. Clinical subsets, skin thickness progression rate, and serum antibody levels in systemic sclerosis patients with anti-topoisomerase I antibody. ACTA ACUST UNITED AC 2007; 56:2740-6. [PMID: 17665460 DOI: 10.1002/art.22747] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe the clinical and laboratory features and natural history of the disease in systemic sclerosis (SSc; scleroderma) patients with anti-topoisomerase I (anti-topo I) antibody who have different skin thickness progression rates (STPRs). METHODS SSc patients (n = 212) who were anti-topo I antibody positive were divided into 5 subgroups based on STPRs. Skin thickness was measured using the modified Rodnan skin thickness score (MRSS). Anti-topo I IgG antibody levels were determined. RESULTS Sixty patients who were anti-topo I antibody positive had diffuse cutaneous SSc (dcSSc) with rapid progression, 82 had dcSSC with intermediate progression, and 29 had dcSSc with slow progression, 14 had limited cutaneous SSc (lcSSc) that became dcSSc, and 27 had lcSSc that did not change throughout. Patients beginning with lcSSc were younger at disease onset and had longer disease duration when diagnosed as having SSc. Interstitial lung disease was common and was equally distributed across the subgroups. Renal crisis occurred most often in patients with rapid progression (22%) and was absent in lcSSc patients. Cardiac involvement was most frequent in the dcSSc subgroups. Both kidney and heart disease occurred most often within 3 years after the onset of skin thickening. The 10-year cumulative survival rate was <40% for patients with rapid and intermediate progression. Renal and cardiac causes of death were disproportionately frequent in these 2 subgroups. Anti-topo I antibody levels correlated with the STPR and the MRSS. CONCLUSION Anti-topo I antibody-positive patients with SSc with a rapid STPR have reduced survival rates, primarily due to early and often fatal renal and cardiac involvement. Anti-topo I antibody levels parallel the MRSS at the first visit and the STPR. This information is important for managing physicians and researchers planning clinical trials involving patients with early dcSSc.
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MESH Headings
- Adolescent
- Adult
- Aged
- Child
- Child, Preschool
- DNA Topoisomerases, Type I/immunology
- DNA Topoisomerases, Type I/metabolism
- Disease Progression
- Female
- Heart Diseases/complications
- Heart Diseases/pathology
- Humans
- Lung Diseases, Interstitial/complications
- Lung Diseases, Interstitial/pathology
- Male
- Middle Aged
- Prospective Studies
- Renal Insufficiency/complications
- Renal Insufficiency/pathology
- Scleroderma, Diffuse/complications
- Scleroderma, Diffuse/immunology
- Scleroderma, Diffuse/mortality
- Scleroderma, Diffuse/pathology
- Scleroderma, Limited/complications
- Scleroderma, Limited/immunology
- Scleroderma, Limited/mortality
- Scleroderma, Limited/pathology
- Severity of Illness Index
- Skin/pathology
- Survival Rate
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Affiliation(s)
- Achini Perera
- University of Pittsburgh School of Medicine, 3500 Terrace Street, Pittsburgh, PA 15261, USA
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Yu EPK, Ostor AJK, Hall FC. Successful treatment with bosentan for severe digital ischaemia in limited cutaneous systemic sclerosis. Ann Rheum Dis 2007; 66:1122-3. [PMID: 17626973 PMCID: PMC1954684 DOI: 10.1136/ard.2006.057604] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Caramaschi P, Canestrini S, Martinelli N, Volpe A, Pieropan S, Ferrari M, Bambara LM, Carletto A, Biasi D. Scleroderma patients nailfold videocapillaroscopic patterns are associated with disease subset and disease severity. Rheumatology (Oxford) 2007; 46:1566-9. [PMID: 17693443 DOI: 10.1093/rheumatology/kem190] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [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: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate in a large group of scleroderma patients, the association of nailfold videocapillaroscopic patterns with both demographic and clinical features. METHODS One hundred and three Italian patients (91 women and 12 men, mean age 54.3 years, median disease duration 7 yrs, 68 with limited and 35 with diffuse subset of disease), consecutively enrolled for the study, underwent nailfold videocapillaroscopy; the microvascular alterations were classified into three different patterns, early, active and late. The nailfold videocapillaroscopic patterns were correlated with such numerous clinical features as sex, age, disease duration, disease subset, disease activity, haematochemical data, involvement of skin, heart, lung and peripheral vessels. RESULTS Nailfold videocapillaroscopic patterns were significantly associated with disease subsets (P = 0.018). Severity of skin, lung, heart and peripheral vascular involvement progressively increased across nailfold videocapillaroscopic patterns, from early to late pattern (P < 0.001 for cutaneous and peripheral vascular involvement; P = 0.003 and 0.002 for lung and heart involvement, respectively) as well as homocysteine plasma levels (P = 0.02). Patients with late pattern showed an increased risk to have an active disease [OR (odds ratio) 3.50; 95% CI (confidence interval) 1.31-9.39], to present digital ulcers (OR 5.74; 95% CI 2.08-15.89) and moderate to severe skin (OR 5.28; 95% CI 1.93-14.19), heart (OR 5.75; 95% CI 2.04-16.21) and lung involvement (OR 4.41; 95% CI 1.63-11.92). CONCLUSIONS Our study showed that scleroderma microangiopathy correlates with disease subset and severity of peripheral vascular, skin, heart and lung involvement; patients with late pattern showed an increased risk to have an active disease and to show a moderate/severe skin or visceral involvement compared to patients with early and active patterns. Therefore nailfold videocapillaroscopy, a simple, non-invasive and non-expensive investigation, is useful in staging scleroderma patients and also provides prognostic information.
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Affiliation(s)
- P Caramaschi
- Dipartimento di Medicina Clinica e Sperimentale, Policlinico G.B. Rossi, P.le Scuro, 37134 Verona, Italy.
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Wooten MD. Report of a rare case of pericardial effusion in a patient with limited systemic sclerosis. Rheumatol Int 2007; 28:305. [PMID: 17661049 DOI: 10.1007/s00296-007-0423-5] [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] [Accepted: 07/11/2007] [Indexed: 11/29/2022]
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Lam GK, Hummers LK, Woods A, Wigley FM. Efficacy and safety of etanercept in the treatment of scleroderma-associated joint disease. J Rheumatol 2007; 34:1636-7. [PMID: 17611970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Carreño M, Donaire A, Barceló MI, Rumià J, Falip M, Agudo R, Bargalló N, Setoain X, Boget T, Raspall A, Pintor L, Ribalta T. Parry Romberg syndrome and linear scleroderma in coup de sabre mimicking Rasmussen encephalitis. Neurology 2007; 68:1308-10. [PMID: 17438222 DOI: 10.1212/01.wnl.0000259523.09001.7a] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [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: 11/15/2022] Open
Abstract
We present one patient with Parry Romberg syndrome and another with linear scleroderma in coup de sabre, with focal neurologic deficits and intractable seizures arising from the hemisphere ipsilateral to the cutaneous lesion. Brain MRI showed progressive hemispheric atrophy. Pathology after functional hemispherectomy showed chronic inflammatory features suggestive of Rasmussen encephalitis.
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Affiliation(s)
- M Carreño
- Department of Neurology, Hospital Clínic, Barcelona, Spain.
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