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Stjernbrandt A, Pettersson H, Vihlborg P, Höper AC, Aminoff A, Wahlström J, Nilsson T. Raynaud's phenomenon in the feet of Arctic open-pit miners. Int J Circumpolar Health 2024; 83:2295576. [PMID: 38109321 PMCID: PMC10732197 DOI: 10.1080/22423982.2023.2295576] [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: 09/26/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023] Open
Abstract
The literature on Raynaud's phenomenon (RP) in the feet is scarce, especially in the occupational setting. The primary aim of our study was to investigate the occurrence of RP in the feet of miners. As part of the MineHealth project, written surveys and clinical examinations were completed by 260 Arctic open-pit miners working in northern Sweden and Norway (participation rate 53.6%). Data on RP were collected using standardised colour charts and questionnaire items. Clinical examination included assessing the perception of vibration and pain in both feet. There were eight women and three men who reported RP in the feet. Four also had RP in their hands but none acknowledged any first-degree relatives with the condition. Nine reported exposure to foot-transmitted vibration and one to hand-arm vibration. Seven showed signs of neurosensory injury in the feet. To conclude, the occurrence of RP in the feet of miners was 4.4%. Most cases with RP in the feet did not report the condition in the hands and were exposed to vibration transmitted directly to the feet. There were no reports of a hereditary component. Most cases with RP in the feet also had clinical findings suggestive of peripheral neuropathy in the feet.
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Affiliation(s)
- Albin Stjernbrandt
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Hans Pettersson
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Per Vihlborg
- Department of Geriatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anje Christina Höper
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anna Aminoff
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jens Wahlström
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tohr Nilsson
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Levac B, Kerber J, Wagner E, Molitor JA, Saliterman SS. An Experimental Phototherapy Device for Studying the Effects of Blue Light on Patients with Raynaud's Phenomenon. Ann Biomed Eng 2024; 52:1732-1743. [PMID: 38530533 DOI: 10.1007/s10439-024-03487-z] [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: 10/25/2023] [Accepted: 02/28/2024] [Indexed: 03/28/2024]
Abstract
Raynaud's phenomenon (RP) is a condition that causes decreased blood flow to areas perfused by small blood vessels (e.g., fingers, toes). In severe cases, ulceration, gangrene, and loss of fingers may occur. Most treatments focus on inducing vasorelaxation in affected areas by the way of pharmaceuticals. Recently, animal studies have shown that vasorelaxation can be induced by non-coherent blue light (wavelength ~ 430-460 nm) through the actions of melanopsin, a photoreceptive opsin protein encoded by the OPN4 gene. To study this effect in humans, a reliable phototherapy device (PTD) is needed. We outline the construction of a PTD to be used in studying blue light effects on Raynaud's patients. Our design addresses user safety, calibration, electromagnetic compatibility/interference (EMC/EMI), and techniques for measuring physiological responses (temperature sensors, laser Doppler flow sensors, infrared thermal imaging of the hands). We tested our device to ensure (1) safe operating conditions, (2) predictable, user-controlled irradiance output levels, (3) an ability for measuring physiological responses, and (4) features necessary to enable a double-blinded crossover study for a clinical trial. We also include in the Methods an approved research protocol utilizing our device that may serve as a starting point for clinical study. We introduced a reliable PTD for studying the effects of blue light therapy for patients suffering from Raynaud's phenomenon and showed that our device is safe and reliable and includes the required measurement vectors for tracking treatment effects throughout the duration of a clinical study.
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Affiliation(s)
- Brett Levac
- Electrical and Computer Engineering, University of Texas at Austin, 2501 Speedway, Austin, 78712, USA.
| | - James Kerber
- University of Minnesota Law School, 229 S 19th Ave, Minneapolis, MN, 55455, USA
| | - Emily Wagner
- University of New England, Public Health, 716 Stevens Ave, Portland, ME, 04103, USA
| | - Jerry A Molitor
- University of Minnesota, Scleroderma Clinic, 717 Delaware St. SE, Minneapolis, MN, 55414, USA
| | - Steven S Saliterman
- Biomedical Engineering, University of Minnesota, 312 Church St. S.E. Ste 7-105, Minneapolis, MN, 55455, USA
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Özpınar Ş, Bornaun H, Sönmez HE, Doğan S, Sönmez S, Harman H. Pediatric Primary Raynaud's Phenomenon: A Comprehensive Cardiovascular Analysis. Pediatr Cardiol 2024:10.1007/s00246-024-03514-9. [PMID: 38739175 DOI: 10.1007/s00246-024-03514-9] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
Our aim in this study is to evaluate the cardiovascular findings of pediatric patients with primary Raynaud's phenomenon (RP) and to determine if there are any pathological findings. Our study included 42 pediatric patients aged between 7 and 18 who were diagnosed with primary RP and did not have any additional underlying structural vascular disease or secondary rheumatological conditions. The control group consisted of 30 healthy volunteers aged 7-18 years, matched by age and sex, without any additional diseases. We evaluated demographic, clinical, and laboratory findings, echocardiographic and capillaroscopic features, as well as carotid intima-media thickness. Compared to the control group, pediatric patients with primary RP showed increased A wave velocity and E/E' ratio parameters in the left ventricle, indicating diastolic dysfunction of the heart. The isovolumetric relaxation time (IVRT) was prolonged in both the left and right ventricles, and the E/A ratio decreased in the left ventricle. The myocardial performance index (MPI), indicating both systolic and diastolic dysfunction, increased in both ventricles. Additionally, the aortic stiffness index, aortic elastic modulus (Ep), and left carotid intima-media thickness (CIMT) significantly increased, while distensibility decreased in pediatric patients with primary RP compared to the control group. The cardiovascular evaluation of pediatric patients with primary RP revealed that diastolic dysfunction is likely present in both the left and right heart. Additionally, based on the aorta and carotid intima measurements, it is suggested that pediatric patients with primary RP are at risk for developing atherosclerosis.
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Affiliation(s)
- Şeyma Özpınar
- Department of Pediatrics, Faculty of Health Sciences, Kanuni Sultan Süleyman Education and Research Hospital, Istanbul, Turkey.
| | - Helen Bornaun
- Department of Pediatric Cardiology, Faculty of Health Sciences, Kanuni Sultan Süleyman Education and Research Hospital, Istanbul, Turkey
| | | | - Sümeyra Doğan
- Department of Radiology, Faculty of Health Sciences, Kanuni Sultan Süleyman Education and Research Hospital, Istanbul, Turkey
| | - Süleyman Sönmez
- Department of Radiology, Faculty of Health Sciences, Kanuni Sultan Süleyman Education and Research Hospital, Istanbul, Turkey
| | - Halil Harman
- Department of Rheumatology, Faculty of Health Sciences, Kanuni Sultan Süleyman Education and Research Hospital, Istanbul, Turkey
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Cheung MY, Aggarwala S, French J, Hsieh F, Soliman B. The effect of CREST syndrome in planning a DIEP flap reconstruction. ANZ J Surg 2024; 94:474-475. [PMID: 38054306 DOI: 10.1111/ans.18773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Michael Y Cheung
- Department of Burns, Reconstructive and Plastic Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Shivani Aggarwala
- Department of Burns, Reconstructive and Plastic Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - James French
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Frank Hsieh
- Department of Plastic and Reconstructive Surgery, Westmead Hospital, Sydney, New South Wales, Australia
- Department of Plastic & Reconstructive Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
| | - Bishoy Soliman
- Department of Burns, Reconstructive and Plastic Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Department of Plastic and Reconstructive Surgery, Westmead Hospital, Sydney, New South Wales, Australia
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Tekavec E, Nilsson T, Dahlin LB, Huynh E, Axmon A, Nordander C, Riddar J, Kåredal M. Serum biomarkers in patients with hand-arm vibration injury and in controls. Sci Rep 2024; 14:2719. [PMID: 38302542 PMCID: PMC10834969 DOI: 10.1038/s41598-024-52782-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024] Open
Abstract
Hand-arm vibration injury is a well-known occupational disorder that affects many workers globally. The diagnosis is based mainly on quantitative psychophysical tests and medical history. Typical manifestations of hand-arm vibration injury entail episodes of finger blanching, Raynaud's phenomenon (RP) and sensorineural symptoms from affected nerve fibres and mechanoreceptors in the skin. Differences in serum levels of 17 different biomarkers between 92 patients with hand-arm vibration injury and 51 controls were analysed. Patients with hand-arm vibration injury entailing RP and sensorineural manifestations showed elevated levels of biomarkers associated with endothelial injury or dysfunction, inflammation, vaso- or neuroprotective compensatory, or apoptotic mechanisms: intercellular adhesion molecule-1 (ICAM-1), monocyte chemoattractant protein-1 (MCP-1); thrombomodulin (TM), heat shock protein 27 (HSP27); von Willebrand factor, calcitonin gene-related peptide (CGRP) and caspase-3. This study adds important knowledge on pathophysiological mechanisms that can contribute to the implementation of a more objective method for diagnosis of hand-arm vibration injury.
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Affiliation(s)
- Eva Tekavec
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00, Lund, Sweden.
| | - Tohr Nilsson
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden
| | - Lars B Dahlin
- Department of Translational Medicine-Hand Surgery, Lund University, 221 00, Lund, Sweden
| | - Elizabeth Huynh
- Occupational and Environmental Medicine, Region Skåne, 223 63, Lund, Sweden
| | - Anna Axmon
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00, Lund, Sweden
| | - Catarina Nordander
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00, Lund, Sweden
| | - Jakob Riddar
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00, Lund, Sweden
| | - Monica Kåredal
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00, Lund, Sweden
- Occupational and Environmental Medicine, Region Skåne, 223 63, Lund, Sweden
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6
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Curtiss P, Svigos K, Schwager Z, Lo Sicco K, Franks AG. Part II: The treatment of primary and secondary Raynaud's phenomenon. J Am Acad Dermatol 2024; 90:237-248. [PMID: 35809802 DOI: 10.1016/j.jaad.2022.05.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/15/2022] [Accepted: 05/25/2022] [Indexed: 10/17/2022]
Abstract
Raynaud phenomenon (RP) presents with either primary or secondary disease, and both have the potential to negatively impact patient quality of life. First-line management of RP should include lifestyle modifications in all patients. Some patients with primary RP and most with secondary RP require pharmacologic therapies, which may include calcium channel blockers, topical nitrates, phosphodiesterase 5 inhibitors, or endothelin antagonists. Additional approaches to treatment for those with signs of critical ischemia or those who fail pharmacologic therapy include botulinum toxin injection and digital sympathectomy. Herein, we describe in detail the treatment options for patients with RP as well as provide treatment algorithms for each RP subtype.
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Affiliation(s)
- Paul Curtiss
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Katerina Svigos
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Zachary Schwager
- Department of Dermatology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Kristen Lo Sicco
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York.
| | - Anrdew G Franks
- Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York; Division of Rheumatology, Department of Internal Medicine, New York University Grossman School of Medicine, New York, New York
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Curtiss P, Svigos K, Schwager Z, Lo Sicco K, Franks AG. Part I: Epidemiology, pathophysiology, and clinical considerations of primary and secondary Raynaud's phenomenon. J Am Acad Dermatol 2024; 90:223-234. [PMID: 35809798 DOI: 10.1016/j.jaad.2022.06.1199] [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: 03/04/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/24/2022]
Abstract
Raynaud's phenomenon (RP) is a relatively common disease with both primary and secondary forms. It is well understood as a vasospastic condition affecting the acral and digital arteries, resulting in characteristic, well-demarcated color changes typically in the hands and feet in response to cold or stress. Secondary RP (SRP) has been described in association with a variety of rheumatologic and nonrheumatologic diseases, environmental exposures, and/or medications. While both primary RP and SRP may impact the quality of life, SRP may lead to permanent and potentially devastating tissue destruction when undiagnosed and untreated. It is therefore crucial for dermatologists to distinguish between primary and secondary disease forms early in clinical evaluation, investigate potential underlying causes, and risk stratify SRP patients for the development of associated autoimmune connective tissue disease. The epidemiology, pathogenesis, and clinical presentation and diagnosis of both forms of RP are described in detail in this review article.
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Affiliation(s)
- Paul Curtiss
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Katerina Svigos
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Zachary Schwager
- Department of Dermatology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Kristen Lo Sicco
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York.
| | - Andrew G Franks
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York; Department of Internal Medicine, Division of Rheumatology, New York University School of Medicine, New York, New York
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8
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Fardoun M, Kobeissy F, Eid AH. Estrogen Receptor and the Gender Bias in Raynaud's Phenomenon. Curr Med Chem 2024; 31:133-137. [PMID: 36803760 DOI: 10.2174/0929867330666230220123237] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/15/2023] [Accepted: 01/25/2023] [Indexed: 02/22/2023]
Affiliation(s)
- Manal Fardoun
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Firas Kobeissy
- Department of Neurobiology and Neuroscience, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Ali H Eid
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
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9
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Persson PB, Hillmeister P, Buschmann IR, Bondke Persson A. Vessels in motion. Acta Physiol (Oxf) 2024; 240:e14067. [PMID: 38093597 DOI: 10.1111/apha.14067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/30/2023]
Affiliation(s)
- Pontus B Persson
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Translational Physiology, Berlin, Germany
| | - Philipp Hillmeister
- Department for Angiology, Faculty of Health Sciences (FGW), Center for Internal Medicine 1, Deutsches Angiologie Zentrum (DAZB), Brandenburg Medical School (MHB) Theodor Fontane, University Clinic Brandenburg, Brandenburg/Havel, Germany
| | - Ivo R Buschmann
- Department for Angiology, Faculty of Health Sciences (FGW), Center for Internal Medicine 1, Deutsches Angiologie Zentrum (DAZB), Brandenburg Medical School (MHB) Theodor Fontane, University Clinic Brandenburg, Brandenburg/Havel, Germany
| | - Anja Bondke Persson
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Shamsadini A, Motamed S, Vares Vazirian M. Raynaud's Phenomenon as a Presenting Feature of Hypothyroidism: Case Report. Indian J Otolaryngol Head Neck Surg 2023; 75:3855-3857. [PMID: 37974815 PMCID: PMC10646134 DOI: 10.1007/s12070-023-03895-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/22/2023] [Indexed: 11/19/2023] Open
Abstract
Raynaud's phenomenon is manifested clinically by demarcated color changes the skin of the digits or extremities, typically may be an early clue to the diagnosis of hypothyroidism. In this report, we describe the 8-year-old patient with diagnosed primary hypothyroidism presenting with ceasing the treatment for 1 month that presenting with Raynaud phenomenon.
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Affiliation(s)
- Ayeh Shamsadini
- Department of Otorhinolaryngology, Kerman University of Medical Sciences, Kerman, Iran
| | - Soheil Motamed
- Department of Otorhinolaryngology, Kerman University of Medical Sciences, Kerman, Iran
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
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Liu L, Gu W, Teng L, Xu Y, Zheng F, Hu M, Lu M, Xu X. Kaposiform hemangioendothelioma presented with raynaud phenomenon: a case report. BMC Pediatr 2023; 23:574. [PMID: 37978357 PMCID: PMC10655467 DOI: 10.1186/s12887-023-04407-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Kaposiform hemangioendothelioma (KHE) is a rare vascular neoplasm affecting infants or young children. KHE includes a spectrum of lesions, ranging from small and superficial tumors to large and invasive lesions with Kasabach-Merritt phenomenon (KMP). Currently, no published studies have reported a KHE presenting as thrombocytopenia and Raynaud phenomenon. CASE PRESENTATION A 2-year-old boy with right hand swelling and thrombocytopenia was admitted to our hospital. His right hand turned swelling and red, even occasionally cyanotic. This condition became worse in response to cool environments and improved with warming, and platelet counts were between 50 ~ 80 × 10^9/L. Physical examination on admission revealed the swelling and frostbite-like rash of the right-hand fingers, and the skin temperature of the right hand was lower than the left. On day 3 of admission, chest CT results showed an irregular mass on the right side of the spine. The puncture biopsy demonstrated positive CD31, D2-40, and FLI1 immunohistochemical staining, but negative GLUT1 staining, confirming the diagnosis of KHE. Furthermore, endothelin-1 (ET1) expression levels significantly increased, and eNOS and A20 expression levels significantly decreased comparing with control patients. The patient received methylprednisolone and sirolimus treatments, and his condition gradually improved during the follow-up. CONCLUSIONS We reported the first case of KHE presenting with thrombocytopenia and Raynaud phenomenon. The development of Raynaud phenomenon could be associated with increased ET-1 and reduced eNOS and A20 expressions. Careful differential diagnosis of hidden KHE should be considered in children with thrombocytopenia and Raynaud phenomenon.
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Affiliation(s)
- Lingke Liu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
- Pediatrics, The Affiliated Hospital of Shaoxing University, Shaoxing, 312000, PR China
| | - Weizhong Gu
- Pathology, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Liping Teng
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
| | - Yiping Xu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
| | - Fei Zheng
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
| | - Minfei Hu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
| | - Meiping Lu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
| | - Xuefeng Xu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China.
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12
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Yoo J, Cheon M. Dynamic blood flow imaging with 99mTc-hydroxymethylene diphosphonate as a therapeutic response marker in patients with Raynaud's phenomenon. Sci Rep 2023; 13:19751. [PMID: 37957209 PMCID: PMC10643549 DOI: 10.1038/s41598-023-47197-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/10/2023] [Indexed: 11/15/2023] Open
Abstract
We evaluated the predictive value of dynamic blood flow scintigraphy with 99mTc-HDP (hydroxymethylene diphosphonate) for therapeutic response in patients with Raynaud's phenomenon (RP). Eighty patients who underwent dynamic blood flow scintigraphy using the one-hand chilling method were enrolled. We analyzed the quantitative variables as the ratio of chilled fingers to ambient fingers (CAfinger), that of the chilled hand to ambient hand (CAhand), and that of chilled fingers to ambient palm (FPR) (CAFPR) at 15 and 30 s after 99mTc-HDP bolus injection. Total cumulative radioactivity counts for 180 s were obtained. We evaluated the clinical utility of these quantitative parameters with other clinical variables, including RP severity, therapeutic compliance, types of RP, and scintigraphic interpretation of findings in patients with RP. Fifty-two patients showed poor therapeutic response. There were significant differences between good- and poor-therapeutic responder groups in RP intensity (p = 0.003), CAfinger15s (p = 0.008), CAfinger30s (p = 0.002), CAfinger180s (p = 0.011), CAhand15s (p = 0.008), CAhand30s (p = 0.007), CAhand180s (p = 0.017), CAFPR30s (p = 0.004), and CAFPR180s (p = 0.002). After multivariate logistic regression analysis, only CAfinger30s (p = 0.002) had an independent predictive value of the therapeutic response. 99mTc-HDP dynamic blood flow scintigraphy could be helpful in predicting the therapeutic response in patients with RP.
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Affiliation(s)
- Jang Yoo
- Department of Nuclear Medicine, Veterans Health Service Medical Center, Seoul, South Korea.
| | - Miju Cheon
- Department of Nuclear Medicine, Veterans Health Service Medical Center, Seoul, South Korea
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Hartmann S, Yasmeen S, Jacobs BM, Denaxas S, Pirmohamed M, Gamazon ER, Caulfield MJ, Hemingway H, Pietzner M, Langenberg C. ADRA2A and IRX1 are putative risk genes for Raynaud's phenomenon. Nat Commun 2023; 14:6156. [PMID: 37828025 PMCID: PMC10570309 DOI: 10.1038/s41467-023-41876-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 01/06/2023] [Accepted: 09/21/2023] [Indexed: 10/14/2023] Open
Abstract
Raynaud's phenomenon (RP) is a common vasospastic disorder that causes severe pain and ulcers, but despite its high reported heritability, no causal genes have been robustly identified. We conducted a genome-wide association study including 5,147 RP cases and 439,294 controls, based on diagnoses from electronic health records, and identified three unreported genomic regions associated with the risk of RP (p < 5 × 10-8). We prioritized ADRA2A (rs7090046, odds ratio (OR) per allele: 1.26; 95%-CI: 1.20-1.31; p < 9.6 × 10-27) and IRX1 (rs12653958, OR: 1.17; 95%-CI: 1.12-1.22, p < 4.8 × 10-13) as candidate causal genes through integration of gene expression in disease relevant tissues. We further identified a likely causal detrimental effect of low fasting glucose levels on RP risk (rG = -0.21; p-value = 2.3 × 10-3), and systematically highlighted drug repurposing opportunities, like the antidepressant mirtazapine. Our results provide the first robust evidence for a strong genetic contribution to RP and highlight a so far underrated role of α2A-adrenoreceptor signalling, encoded at ADRA2A, as a possible mechanism for hypersensitivity to catecholamine-induced vasospasms.
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Affiliation(s)
- Sylvia Hartmann
- Computational Medicine, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Summaira Yasmeen
- Computational Medicine, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Benjamin M Jacobs
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
- British Heart Foundation Data Science Centre, London, UK
- National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Munir Pirmohamed
- Department of Pharmacology and Therapeutics, The Wolfson Centre for Personalised Medicine, University Liverpool, Liverpool, UK
| | - Eric R Gamazon
- Division of Genetic Medicine and Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, 37232, USA
| | - Mark J Caulfield
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, UK
- Health Data Research UK, London, UK
- National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Maik Pietzner
- Computational Medicine, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany.
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
- Precision Healthcare University Research Institute, Queen Mary University of London, London, UK.
| | - Claudia Langenberg
- Computational Medicine, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany.
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
- Precision Healthcare University Research Institute, Queen Mary University of London, London, UK.
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14
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Zinenko O, Durkin DM, Carter RW, Ritter B, Lewin MR. Cold Finger: Raynaud Phenomenon Following Snakebite Envenoming by Nikolsky's Viper ( Vipera berus nikolskii). Toxins (Basel) 2023; 15:598. [PMID: 37888629 PMCID: PMC10610580 DOI: 10.3390/toxins15100598] [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: 08/09/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/28/2023] Open
Abstract
A field biologist was bitten by a female Nikolsky's viper (Vipera berus nikolskii) in Kharkiv Oblast, Ukraine. Two months later, the patient began to experience cold-induced vasospasm of the affected digit diagnosed as acquired Raynaud phenomenon. The patient had more than 30 occurrences during the single winter following the bite, but the signs and symptoms of Raynaud phenomenon disappeared with the end of winter. This report describes the case and puts it into context with the literature on the topic of toxin-induced peripheral vasospastic disorders and their potential importance in snakebite envenoming.
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Affiliation(s)
- Oleksandr Zinenko
- V. N. Karazin Kharkiv University, 61058 Kharkiv, Ukraine;
- California Academy of Sciences, San Francisco, CA 94118, USA;
| | | | | | - Brandi Ritter
- Ophirex, Inc., Corte Madera, CA 94925, USA; (R.W.C.); (B.R.)
| | - Matthew R. Lewin
- California Academy of Sciences, San Francisco, CA 94118, USA;
- Ophirex, Inc., Corte Madera, CA 94925, USA; (R.W.C.); (B.R.)
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15
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Abstract
Magnetic resonance angiography (MRA) is a powerful tool for assessing upper and lower extremity artery pathologies. In addition to the classic advantages of MRA, such as the absence of radiation and iodinated contrast exposure, it can provide high temporal resolution/dynamic images of the arteries with high soft tissue contrast. Although it has a relatively lower spatial resolution than computed tomography angiography, MRA does not cause blooming artifacts in heavily calcified vessels, which is crucial in small vessel assessment. Although contrast-enhanced MRA is the most preferred technique to assess extremity vascular pathologies, recent advances in non-contrast MRA protocols provide an alternative imaging technique for patients with chronic kidney disease.
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Affiliation(s)
- Ayaz Aghayev
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Michael Steigner
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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16
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Marini E, Sodano F, Rolando B, Chegaev K, Maresca DC, Ianaro A, Ercolano G, Lazzarato L. New lipophilic organic nitrates: candidates for chronic skin disease therapy. Biol Chem 2023; 404:601-606. [PMID: 36867068 DOI: 10.1515/hsz-2022-0324] [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: 11/09/2022] [Accepted: 02/17/2023] [Indexed: 03/04/2023]
Abstract
Organic nitrates are widely used, but their chronic efficacy is blunted due to the development of tolerance. The properties of new tolerance free organic nitrates were studied. Their lipophilicity profile and passive diffusion across polydimethylsiloxane membrane and pig ear-skin, and their efficacy in tissue regeneration using HaCaT keratinocytes were evaluated. The permeation results show that these nitrates have a suitable profile for NO topical administration on the skin. Furthermore, the derivatives with higher NO release exerted a pro-healing effect on HaCaT cells. This new class of organic nitrates might be a promising strategy for the chronic treatment of skin pathologies.
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Affiliation(s)
- Elisabetta Marini
- Department of Drug Science and Technology, University of Turin, I-10125 Turin, Italy
| | - Federica Sodano
- Department of Pharmacy, University of Naples «Federico II», I-80131 Naples, Italy
| | - Barbara Rolando
- Department of Drug Science and Technology, University of Turin, I-10125 Turin, Italy
| | - Konstantin Chegaev
- Department of Drug Science and Technology, University of Turin, I-10125 Turin, Italy
| | | | - Angela Ianaro
- Department of Pharmacy, University of Naples «Federico II», I-80131 Naples, Italy
| | - Giuseppe Ercolano
- Department of Pharmacy, University of Naples «Federico II», I-80131 Naples, Italy
| | - Loretta Lazzarato
- Department of Drug Science and Technology, University of Turin, I-10125 Turin, Italy
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17
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Zhao K, Kong C, Shi N, Jiang J, Li P. Potential angiogenic, immunomodulatory, and antifibrotic effects of mesenchymal stem cell-derived extracellular vesicles in systemic sclerosis. Front Immunol 2023; 14:1125257. [PMID: 37251412 PMCID: PMC10213547 DOI: 10.3389/fimmu.2023.1125257] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Systemic sclerosis (SSc) is an intricate systemic autoimmune disease with pathological features such as vascular injury, immune dysregulation, and extensive fibrosis of the skin and multiple organs. Treatment options are limited; however, recently, mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) have been acknowledged in preclinical and clinical trials as being useful in treating autoimmune diseases and are likely superior to MSCs alone. Recent research has also shown that MSC-EVs can ameliorate SSc and the pathological changes in vasculopathy, immune dysfunction, and fibrosis. This review summarizes the therapeutic effects of MSC-EVs on SSc and the mechanisms that have been discovered to provide a theoretical basis for future studies on the role of MSC-EVs in treating SSc.
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Affiliation(s)
- Kelin Zhao
- Department of Rheumatology and Immunology, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Chenfei Kong
- Scientific Research Center, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Naixu Shi
- Department of Stomatology, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Jinlan Jiang
- Scientific Research Center, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Ping Li
- Department of Rheumatology and Immunology, China-Japan Union Hospital, Jilin University, Changchun, China
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18
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Senet P, Maillard H, Diot E, Lazareth I, Blaise S, Arnault JP, Pistorius MA, Boulon C, Cogrel O, Warzocha U, Rivière S, Malloizel-Delaunay J, Servettaz A, Sassolas B, Viguier M, Monfort JB, Janique S, Vicaut E. Efficacy and Safety of Botulinum Toxin in Adults with Raynaud's Phenomenon Secondary to Systemic Sclerosis: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study. Arthritis Rheumatol 2023; 75:459-467. [PMID: 36066501 DOI: 10.1002/art.42342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/10/2022] [Accepted: 08/31/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine whether a single session of botulinum toxin type A (BTA) injections into both hands more effectively decreases the frequency of systemic sclerosis-associated Raynaud's phenomenon (SSc-RP) episodes than placebo. METHODS This multicenter, randomized, double-blind, placebo-controlled, parallel-group phase III trial in patients with SSc-RP assessed the effect of 50-unit BTA or placebo injections into the palms of both hands around each neurovascular bundle during 1 session in winter. The primary end point was the between-group difference in the median change in the number of RP episodes from baseline (day 0) to 4 weeks postinjection. Values between the groups were compared with the Wilcoxon rank-sum test. RESULTS The intent-to-treat analysis included 46 BTA-treated patients and 44 placebo recipients. At 4 weeks after assigned treatment injections, the median number of daily RP episodes decreased comparably in the BTA and placebo groups (median change -1 episode/day [interquartile range (IQR) -1.5, 0 episodes/day] and -1 episode/day [IQR -2.5, 0 episodes/day], respectively) (P = 0.77 versus placebo). Moreover, change in Raynaud's Condition Score, quality of life assessed by Health Assessment Questionnaire disability index, and hand function assessed by shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Cochin Hand Function Scale from baseline to follow-up weeks 4, 12, and 24 did not differ significantly between groups. The BTA group experienced transient hand muscle weakness significantly more frequently (P = 0.003). CONCLUSION Neither the primary nor secondary end points were reached, and our results do not support any beneficial effect of palmar BTA injections to treat SSc-RP.
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Affiliation(s)
- Patricia Senet
- Assistance Publique-Hôpitaux de Paris, and Service de Dermatologie, Centre Hospitalier Universitaire Tenon, Groupe Hospitalier Sorbonne Université, Paris, France
| | - Hervé Maillard
- Service de Dermatologie, Centre Hospitalier Le Mans, Le Mans, France
| | - Elisabeth Diot
- Service de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire Bretonneau-Tours, Tours, France
| | | | - Sophie Blaise
- Université Grenoble Alpes, Inserm, HP2, Grenoble, France
| | - Jean-Philippe Arnault
- Service de Dermatologie, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | | | - Carine Boulon
- Service de Médecine Vasculaire, Centre Hospitalier Universitaire St-André, Bordeaux, France
| | - Olivier Cogrel
- Unité de Dermatologie Interventionnelle, Service de Dermatologie, Centre Hospitalier Universitaire, Bordeaux, France
| | - Ursula Warzocha
- Assistance Publique-Hôpitaux de Paris, and Service de Médecine Interne, Centre Hospitalier Universitaire Avicenne, Bobigny, France
| | - Sébastien Rivière
- Assistance Publique-Hôpitaux de Paris, and Service de Médecine Interne, Centre Hospitalier Universitaire Saint-Antoine, Groupe Hospitalier Sorbonne Université, Paris, France
| | | | - Amélie Servettaz
- Service de Médecine Interne, Maladies Infectieuses, Immunologie Clinique, Hôpital Robert-Debré, Centre Hospitalier Universitaire, Reims, France
| | - Bruno Sassolas
- Département de Médecine Interne et Pneumologie, Hôpital de la Cavale Blanche, Centre Hospitalier Régional Universitaire, Brest, France
| | - Manuelle Viguier
- Service de Dermatologie-Vénéréologie, Hôpital Robert-Debré, Université Reims Champagne Ardenne, IRMAIC, EA7509, Reims, France
| | - Jean-Benoit Monfort
- Assistance Publique-Hôpitaux de Paris, and Service de Dermatologie, Centre Hospitalier Universitaire Tenon, Groupe Hospitalier Sorbonne Université, Paris, France
| | - Solène Janique
- Assistance Publique-Hôpitaux de Paris, Unité de Recherche Clinique, Centre Hospitalier Universitaire Fernand-Widal, Paris, France
| | - Eric Vicaut
- Assistance Publique-Hôpitaux de Paris, Unité de Recherche Clinique, Centre Hospitalier Universitaire Fernand-Widal, Paris, France
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19
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Abstract
Nailfold capillaroscopy is a safe and well-established method for the assessment of structural alterations of the microcirculation. It is a crucial tool in the investigation and monitoring of patients presenting with Raynaud's phenomenon. Detection of the characteristic "scleroderma pattern" on capillaroscopy may indicate an underlying rheumatic disease, particularly systemic sclerosis (SSc). Herein, we highlight the practical aspects of videocapillaroscopy, including image acquisition and analysis, with mention of dermoscopy. Special emphasis is placed on standardized use of terminology to describe capillary characteristics. Systematic evaluation of images in discerning the normal from the abnormal using the validated European Alliance of Associations for Rheumatology (EULAR) Study Group consensus reporting framework is paramount. In addition to the relevance of capillaroscopy in the (very) early diagnosis of SSc, its emerging predictive value (especially capillary loss) for new organ involvement and disease progression is underscored. We further provide capillaroscopic findings in selected other rheumatic diseases.
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Affiliation(s)
- Vanessa Smith
- Department of Internal Medicine, Ghent University, Ghent, Belgium; Department of Rheumatology, Ghent University Hospital, Ghent, Belgium; Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium.
| | - Claudia Ickinger
- Division of Rheumatology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elvis Hysa
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS San Martino Polyclinic, Genoa, Italy
| | - Marcus Snow
- Department of Internal Medicine, Division of Rheumatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tracy Frech
- Internal Medicine, Vanderbilt University Medical Center and Tennessee Valley Healthcare System Nashville, TN, USA
| | - Alberto Sulli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS San Martino Polyclinic, Genoa, Italy
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Italy - IRCCS San Martino Polyclinic, Genoa, Italy
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20
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Mueller M, Gschwandtner ME, Emminger W, Kiener H, Schnaubelt S, Giurgea GA, Ristl R, Perkmann T, Koppensteiner R, Schlager O. Associations between nailfold capillary aberrations and autoantibodies in children and adults with Raynaud's phenomenon. RMD Open 2023; 9:rmdopen-2023-003077. [PMID: 36972928 PMCID: PMC10069575 DOI: 10.1136/rmdopen-2023-003077] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE To characterise associations between individual nailfold capillary aberrations with autoantibodies in a cross-sectional study on children and adults with Raynaud's phenomenon (RP). METHODS Consecutive children and adults with RP and without previously known connective tissue disease (CTD) systemically underwent nailfold capillaroscopy and laboratory tests for the presence of antinuclear antibodies (ANA). The prevalence of individual nailfold capillary aberrations and ANA was assessed, and the associations between individual nailfold capillary aberrations and ANA were analysed separately in children and adolescents. RESULTS In total, 113 children (median age 15 years) and 2858 adults (median age 48 years) with RP and without previously known CTD were assessed. At least one nailfold capillary aberration was detected in 72 (64%) of included children and in 2154 (75%) of included adults with RP (children vs adults p<0.05). An ANA titre ≥1:80, ≥1:160 or≥1:320 was observed in 29%, 21% or 16% of included children, and in 37%, 27% or 24% of screened adults, respectively. While the occurrence of individual nailfold capillary aberrations was related to the presence of an ANA titre of ≥1:80 in adults (reduced capillary density, avascular fields, haemorrhages, oedema, ramifications, dilations and giant capillaries: each p<0.001), no comparable association between nailfold capillary aberrations and ANA was observed in children with RP without previously known CTD. CONCLUSION In contrast to adults, the association between nailfold capillary aberrations and ANA might be less pronounced in children. Further studies are warranted to validate these observations in children with RP.
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Affiliation(s)
- Markus Mueller
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Austria, Medical University of Vienna, Vienna, Austria
| | - Michael E Gschwandtner
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Austria, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Emminger
- Department of Pediatrics, University Children's Hospital, Wien, Austria
| | - Hans Kiener
- Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | | | - Georgiana-Aura Giurgea
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Austria, Medical University of Vienna, Vienna, Austria
| | - Robin Ristl
- Center of Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Thomas Perkmann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Renate Koppensteiner
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Austria, Medical University of Vienna, Vienna, Austria
| | - Oliver Schlager
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Austria, Medical University of Vienna, Vienna, Austria
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21
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İncekalan TK, Ekinci RMK, Naz Şimdivar GH, Celik Ü. Cold-induced Vascular Changes in the Macula, Optic Disc and Choroid in Children with Raynaud's Phenomena. Ocul Immunol Inflamm 2023; 31:277-285. [PMID: 35081004 DOI: 10.1080/09273948.2022.2026411] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM To investigate changes in retinal and choroidal vessels in children with primary and secondary raynaud's phenomena(RP). METHODS Measurements were performed by optic coherence tomography angiography before as well as during and 10 minutes after the immersion of one hand in ice water. RESULTS Primary RP patients exhibited enlargement of the foveal avascular region and decrease in vessel density in the parafoveal superficial capillary plexus (SCP) during cold exposure, but values returned to normal when the hands were removed from the cold water. In children with secondary RP, there were decreases in choroidal thickness and vessel density in the SCP and radial peripapillary capillary plexus (RPCP) during cold exposure. Changes in choroid and peripapillary RPCP were still significant 10 minutes after removal from cold water. CONCLUSION Ocular arteriolar vasospasm seems to be more pronounced in patients with secondary RP, particularly in the choroid and the peripapillary area of the RPCP. CLINICAL TRIAL REGISTRATION NUMBER AND DATE: DECISION NUMBER 76/1315 - 10.03.2021.
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Affiliation(s)
- Tuğba Kurumoğlu İncekalan
- Department of Opthalmology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Rabia Miray Kisla Ekinci
- Pediatric Rheumatology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Göksu Hande Naz Şimdivar
- Department of Opthalmology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Ümit Celik
- Pediatric Infectious Diseases, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
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22
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Romero-Karam LA, Honan KA, Arain SA, Mayes MD. Percutaneous revascularization for the treatment of refractory digital ischemia in systemic sclerosis. J Scleroderma Relat Disord 2023; 8:36-42. [PMID: 36743810 PMCID: PMC9896190 DOI: 10.1177/23971983221116669] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/10/2022] [Indexed: 11/17/2022]
Abstract
Objective The objective of this study is to explore the role of adjunctive percutaneous revascularization of the hand in the management of patients with systemic sclerosis-associated refractory digital ischemia. Methods We present our initial experience of using percutaneous upper extremity interventions to treat patients with systemic sclerosis and symptomatic Raynaud's phenomenon who presented with either refractory digital ischemia or non-healing ulcers. We discuss patient characteristics, procedural findings, and short-term clinical outcomes of these interventions. Results We performed 14 interventions in 6 patients with non-healing digital ulcers or refractory ischemia secondary to systemic sclerosis. Angioplasty was performed at or below the wrist in conjunction with intravenous prostaglandin therapy, started prior to or immediately after the revascularization procedure. All patients experienced symptomatic relief and demonstrated accelerated wound healing. Two patients required an additional procedure to treat recurrent ischemia (without new ulceration) in the treated digit. Three of the patients underwent multiple procedures during the study period to treat new ischemic lesions or Raynaud's phenomenon symptoms, highlighting the progressive nature of the vascular occlusions in systemic sclerosis. There were no adverse events related to the interventions. Conclusions Our retrospective analysis suggests that percutaneous revascularization in combination with vasodilator therapy in systemic sclerosis-associated digital ischemia is safe and can facilitate the healing of long-standing ulcers. Its role in the management of refractory digital ischemia in patients with systemic sclerosis should be explored further.
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Affiliation(s)
- Lily A Romero-Karam
- Division of Rheumatology, University of
Texas Health Science Center at Houston, Houston, TX, USA
| | - Kevin A Honan
- Department of Internal Medicine,
University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Salman A Arain
- Division of Cardiology, University of
Texas Health Science Center at Houston, TX, USA
| | - Maureen D. Mayes
- Division of Rheumatology, University of
Texas Health Science Center at Houston, Houston, TX, USA
- Maureen D. Mayes, Division of Rheumatology,
McGovern Medical School, The University of Texas Health Science Center at
Houston, 6431 Fannin St, MSB 5.262, Houston, TX 77030, USA.
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23
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Shen YH, Lee YH, Leong PY. Botulinum toxin injection for refractory Raynaud phenomenon and digital ulcers in systemic sclerosis. Int J Rheum Dis 2023; 26:187-189. [PMID: 36703271 DOI: 10.1111/1756-185x.14487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/19/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Yi-Hsuan Shen
- National Taiwan University Hospital, Taipei City, Taiwan
| | - Yung-Heng Lee
- Department of Orthopedics, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan.,Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan.,Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan.,Department of Recreation and Sport Management, Shu-Te University, Kaohsiung, Taiwan
| | - Pui-Ying Leong
- Division of Allergy, Immunology & Rheumatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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24
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Greene BHC, Gudimella R, Corkum JP, Boone H, Samargandi OA, Williams J. Managing cold intolerance after hand injury: A systematic review. Hand Surg Rehabil 2023; 42:109-114. [PMID: 36720347 DOI: 10.1016/j.hansur.2023.01.007] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 01/30/2023]
Abstract
OBJECTIVES This systematic review seeks to understand whether cold intolerance (CI) improves with time and if there is any role for management strategies such as behavioural therapy, surgery, or pharmacotherapy. METHODS Two independent reviewers used a predefined search strategy to query MEDLINE, PubMed, Embase, CINAHL, Cochrane Library, Web of Science and Google Scholar databases. Articles written in English, Studies of interventions (such as pharmacotherapy or behavioural therapy) for cold intolerance in adult patients with a history of hand injury along with prevalence over time were included for review. RESULTS Seventeen studies were included, with twelve prognostic studies of the effect of time on CI, four studies of self management/behavioural therapies, and a single study of surgical treatment of neuromas. No studies of pharmacotherapies were identified for inclusion in the hand injury literature. Most studies (76.4%) were either prevalence or prospective cohort studies; no level I or II evidence studies were included. CONCLUSIONS Cold intolerance does not resolve over time for the vast majority of patients. Behavioral and self-management studies have low efficacy and studies presented had a high risk of bias. There is a lack of evidence for the use of pharmacotherapy in CI and this could be considered for future studies.
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Affiliation(s)
- Bradley H C Greene
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Rakesh Gudimella
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joseph P Corkum
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hannah Boone
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Osama A Samargandi
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, King Abduaziz University, Jeddah, Saudi Arabia
| | - Jason Williams
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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25
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Teaw S, Gupta A, Williams A, Wilson FP, Sumpio BJ, Sumpio BE, Hinchcliff M. Hyperspectral imaging in systemic sclerosis-associated Raynaud phenomenon. Arthritis Res Ther 2023; 25:10. [PMID: 36670487 PMCID: PMC9854186 DOI: 10.1186/s13075-023-02990-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 01/06/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND/PURPOSE Lack of robust, feasible, and quantitative outcomes impedes Raynaud phenomenon (RP) clinical trials in systemic sclerosis (SSc) patients. Hyperspectral imaging (HSI) non-invasively measures oxygenated and deoxygenated hemoglobin (oxyHb and deoxyHb) concentrations and oxygen saturation (O2 sat) in the skin and depicts data as oxygenation heatmaps. This study explored the potential role of HSI in quantifying SSc-RP disease severity and activity. METHODS Patients with SSc-RP (n = 13) and healthy control participants (HC; n = 12) were prospectively recruited in the clinic setting. Using a hand-held camera, bilateral hand HSI (HyperMed™, Waltham, MA) was performed in a temperature-controlled room (22 °C). OxyHb, deoxyHb, and O2 sat values were calculated for 78-mm2 regions of interest for the ventral fingertips and palm (for normalization). Subjects underwent a cold provocation challenge (gloved hand submersion in 15 °C water bath for 1 min), and repeated HSI was performed at 0, 10, and 20 min. Patients completed two patient-reported outcome (PRO) instruments: the Raynaud Condition Score (RCS) and the Cochin Hand Function Scale (CHFS) for symptom burden assessment. Statistical analyses were performed using the Mann-Whitney U test and a mixed effects model (Stata, College Station, TX). RESULTS Ninety-two percent of participants were women in their 40s. For SSc-RP patients, 69% had limited cutaneous SSc, the mean ± SD SSc duration was 11 ± 5 years, and 38% had prior digital ulcers-none currently. Baseline deoxyHb was higher, and O2 sat was lower, in SSc patients versus HC (p < 0.05). SSc patients had a greater decline in oxyHb and O2 sat from baseline to time 0 (after cold challenge) with distinct rewarming oxyHb, O2 sat, and deoxyHb trajectories versus HCs (p < 0.01). There were no significant correlations between oxyHb, deoxyHb, and O2 sat level changes following cold challenge and RCS or CHFS scores. CONCLUSION Hyperspectral imaging is a feasible approach for SSc-RP quantification in the clinic setting. The RCS and CHFS values did not correlate with HSI parameters. Our data suggest that HSI technology for the assessment of SSc-RP at baseline and in response to cold provocation is a potential quantitative measure for SSc-RP severity and activity, though longitudinal studies that assess sensitivity to change are needed.
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Affiliation(s)
- Shannon Teaw
- Section of Rheumatology, Allergy & Immunology, Department of Medicine, Yale School of Medicine, 300 Cedar Street, The Anlyan Center PO Box 208031, New Haven, CT, 06520, USA
| | - Akash Gupta
- Section of Rheumatology, Allergy & Immunology, Department of Medicine, Yale School of Medicine, 300 Cedar Street, The Anlyan Center PO Box 208031, New Haven, CT, 06520, USA
| | - Alyssa Williams
- Section of Rheumatology, Allergy & Immunology, Department of Medicine, Yale School of Medicine, 300 Cedar Street, The Anlyan Center PO Box 208031, New Haven, CT, 06520, USA
| | - F Perry Wilson
- Clinical and Translational Research Accelerator, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Internal Medicine, Section of Nephrology, Yale School of Medicine, New Haven, CT, USA
| | - Brandon J Sumpio
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Bauer E Sumpio
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Monique Hinchcliff
- Section of Rheumatology, Allergy & Immunology, Department of Medicine, Yale School of Medicine, 300 Cedar Street, The Anlyan Center PO Box 208031, New Haven, CT, 06520, USA.
- Clinical and Translational Research Accelerator, Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
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Brown CR, Crouser NJ, Speeckaert AL. Considerations for Hand Surgery in Patients With Scleroderma. Hand (N Y) 2023; 18:32-39. [PMID: 34053315 PMCID: PMC9806536 DOI: 10.1177/15589447211017211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Systemic sclerosis (scleroderma, SSc) is an autoimmune disease that causes significant dysfunction to multiple organ systems, including the musculoskeletal system. It poses significant challenges to the hand surgeon, including calcinosis, ischemic changes, Raynaud phenomenon, tendinopathies, synovitis, and joint contractures. Patients with SSc also suffer from multiorgan dysfunction, which makes them high-risk surgical patients. The hand surgeon must understand the pathophysiology, treatment strategies, and special operative considerations required in this population to avoid complications and help maintain or improve hand function.
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Piera-Velazquez S, Dillon ST, Gu X, Libermann TA, Jimenez SA. Aptamer proteomics of serum exosomes from patients with Primary Raynaud's and patients with Raynaud's at risk of evolving into Systemic Sclerosis. PLoS One 2022; 17:e0279461. [PMID: 36548367 PMCID: PMC9779033 DOI: 10.1371/journal.pone.0279461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A major unmet need for Systemic Sclerosis (SSc) clinical management is the lack of biomarkers for the early diagnosis of patients with Raynaud's Phenomenon at high risk of evolving into SSc. OBJECTIVE To identify proteins contained within serum exosomes employing an aptamer proteomic analysis that may serve to reveal patients with Raynaud's Phenomenon at risk of developing SSc. METHODS Exosomes were isolated from serum samples from patients with Primary Raynaud's Phenomenon and from patients with Raynaud's Phenomenon harbouring serum antinuclear antibodies (ANA) who may be at high risk of evolving into SSc. The expression of 1,305 proteins was quantified using SOMAscan aptamer proteomics, and associations of the differentially elevated or reduced proteins with the clinical subsets of Raynaud's Phenomenon were assessed. RESULTS Twenty one differentially elevated and one differentially reduced (absolute fold change >|1.3|) proteins were identified. Principal component analysis using these 22 most differentially expressed proteins resulted in excellent separation of the two Raynaud's Phenomenon clinical subsets. Remarkably, the most differentially elevated proteins are involved in enhanced inflammatory responses, immune cell activation and cell migration, and abnormal vascular functions. CONCLUSION Aptamer proteomic analysis of circulating exosomes identified differentially elevated or reduced proteins between Raynaud's Phenomenon at high risk of evolving into SSc and Primary Raynaud's Phenomenon patients. Some of these proteins are involved in relevant biological pathways that may play a role in SSc pathogenesis including enhanced inflammatory responses, immune cell activation, and endothelial cell and vascular abnormalities.
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Affiliation(s)
- Sonsoles Piera-Velazquez
- Jefferson Institute of Molecular Medicine, Scleroderma Center of Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Simon T. Dillon
- Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Genomics, Proteomics, Bioinformatics and Systems Biology Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Xuesong Gu
- Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Genomics, Proteomics, Bioinformatics and Systems Biology Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Towia A. Libermann
- Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Genomics, Proteomics, Bioinformatics and Systems Biology Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail: (SAJ); (TAL)
| | - Sergio A. Jimenez
- Jefferson Institute of Molecular Medicine, Scleroderma Center of Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
- * E-mail: (SAJ); (TAL)
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Rana I, Kataria S, Tan TL, Hajam EY, Kashyap DK, Saha D, Ajnabi J, Paul S, Jayappa S, Ananthan ASHP, Kumar P, Zaarour RF, Haarshaadri J, Kansagara G, Rizvi A, Zirmire RK, Badarinath K, Khedkar SU, Chandra Y, Samuel R, George R, Danda D, Jacob PM, Dey R, Dhandapany PS, He YW, Varga J, Varghese S, Jamora C. Mindin (SPON2) Is Essential for Cutaneous Fibrogenesis in a Mouse Model of Systemic Sclerosis. J Invest Dermatol 2022; 143:699-710.e10. [PMID: 36528128 DOI: 10.1016/j.jid.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/02/2022] [Accepted: 10/04/2022] [Indexed: 12/16/2022]
Abstract
Systemic sclerosis is a fibrotic disease that initiates in the skin and progresses to internal organs, leading to a poor prognosis. Unraveling the etiology of a chronic, multifactorial disease such as systemic sclerosis has been aided by various animal models that recapitulate certain aspects of the human pathology. We found that the transcription factor SNAI1 is overexpressed in the epidermis of patients with systemic sclerosis, and a transgenic mouse recapitulating this expression pattern is sufficient to induce many clinical features of the human disease. Using this mouse model as a discovery platform, we have uncovered a critical role for the matricellular protein Mindin (SPON2) in fibrogenesis. Mindin is produced by SNAI1 transgenic skin keratinocytes and aids fibrogenesis by inducing early inflammatory cytokine production and collagen secretion in resident dermal fibroblasts. Given the dispensability of Mindin in normal tissue physiology, targeting this protein holds promise as an effective therapy for fibrosis.
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Affiliation(s)
- Isha Rana
- IFOM-inStem Joint Research Laboratory, Centre for Inflammation and Tissue Homeostasis, Institute for Stem Cell Science & Regenerative Medicine, Bangalore, India; School of Chemical and Biotechnology, Shanmugha Arts, Science, Technology and Research Academy (SASTRA) Deemed University, Thanjavur, India
| | - Sunny Kataria
- IFOM-inStem Joint Research Laboratory, Centre for Inflammation and Tissue Homeostasis, Institute for Stem Cell Science & Regenerative Medicine, Bangalore, India; National Centre for Biological Sciences, Bangalore, India
| | - Tuan Lin Tan
- Department of Bioengineering, Jacobs School of Engineering, University of California San Diego, San Diego, California, USA; School of Chemical & Life Sciences, Singapore Polytechnic, Singapore, Singapore
| | - Edries Yousaf Hajam
- IFOM-inStem Joint Research Laboratory, Centre for Inflammation and Tissue Homeostasis, Institute for Stem Cell Science & Regenerative Medicine, Bangalore, India; School of Chemical and Biotechnology, Shanmugha Arts, Science, Technology and Research Academy (SASTRA) Deemed University, Thanjavur, India
| | - Deepak Kumar Kashyap
- Centre for Cardiovascular Biology and Disease, Institute for Stem Cell Science and Regenerative Medicine, Bangalore, India; Centre for Cellular and Molecular Biology, Hyderabad, India
| | - Dyuti Saha
- IFOM-inStem Joint Research Laboratory, Centre for Inflammation and Tissue Homeostasis, Institute for Stem Cell Science & Regenerative Medicine, Bangalore, India; Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Johan Ajnabi
- IFOM-inStem Joint Research Laboratory, Centre for Inflammation and Tissue Homeostasis, Institute for Stem Cell Science & Regenerative Medicine, Bangalore, India
| | - Sayan Paul
- Centre for Cardiovascular Biology and Disease, Institute for Stem Cell Science and Regenerative Medicine, Bangalore, India
| | - Shashank Jayappa
- Centre for Cardiovascular Biology and Disease, Institute for Stem Cell Science and Regenerative Medicine, Bangalore, India
| | - Akhil S H P Ananthan
- IFOM-inStem Joint Research Laboratory, Centre for Inflammation and Tissue Homeostasis, Institute for Stem Cell Science & Regenerative Medicine, Bangalore, India
| | - Pankaj Kumar
- IFOM-inStem Joint Research Laboratory, Centre for Inflammation and Tissue Homeostasis, Institute for Stem Cell Science & Regenerative Medicine, Bangalore, India
| | - Rania F Zaarour
- IFOM-inStem Joint Research Laboratory, Centre for Inflammation and Tissue Homeostasis, Institute for Stem Cell Science & Regenerative Medicine, Bangalore, India; Thumbay Research Institute for Precision Medicine (TRIPM), Gulf Medical University, Ajman, United Arab Emirates
| | - J Haarshaadri
- IFOM-inStem Joint Research Laboratory, Centre for Inflammation and Tissue Homeostasis, Institute for Stem Cell Science & Regenerative Medicine, Bangalore, India
| | - Gaurav Kansagara
- IFOM-inStem Joint Research Laboratory, Centre for Inflammation and Tissue Homeostasis, Institute for Stem Cell Science & Regenerative Medicine, Bangalore, India; Animal Care and Resource Centre (ACRC), Bangalore Life Science Cluster, Bangalore, India
| | - Abrar Rizvi
- IFOM-inStem Joint Research Laboratory, Centre for Inflammation and Tissue Homeostasis, Institute for Stem Cell Science & Regenerative Medicine, Bangalore, India
| | - Ravindra K Zirmire
- IFOM-inStem Joint Research Laboratory, Centre for Inflammation and Tissue Homeostasis, Institute for Stem Cell Science & Regenerative Medicine, Bangalore, India; School of Chemical and Biotechnology, Shanmugha Arts, Science, Technology and Research Academy (SASTRA) Deemed University, Thanjavur, India
| | - Krithika Badarinath
- IFOM-inStem Joint Research Laboratory, Centre for Inflammation and Tissue Homeostasis, Institute for Stem Cell Science & Regenerative Medicine, Bangalore, India; National Centre for Biological Sciences, Bangalore, India
| | - Sneha Uday Khedkar
- IFOM-inStem Joint Research Laboratory, Centre for Inflammation and Tissue Homeostasis, Institute for Stem Cell Science & Regenerative Medicine, Bangalore, India
| | - Yogesh Chandra
- Animal Care and Resource Centre (ACRC), Bangalore Life Science Cluster, Bangalore, India
| | - Rekha Samuel
- Centre for Stem Cell Research (CSCR), Christian Medical College Vellore, Vellore, India; Department of Pathology, Manipal - Tata Medical College Jamshedpur, Jamshedpur, India
| | - Renu George
- Department of Dermatology, Venereology and Leprosy, Christian Medical College Vellore, Vellore, India
| | - Debashish Danda
- Department of Clinical Immunology & Rheumatology, Christian Medical College Vellore, Vellore, India
| | | | - Rakesh Dey
- IFOM-inStem Joint Research Laboratory, Centre for Inflammation and Tissue Homeostasis, Institute for Stem Cell Science & Regenerative Medicine, Bangalore, India
| | | | - You-Wen He
- Department of Immunology, Duke University School of Medicine, Durham, North Carolina, USA
| | - John Varga
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Shyni Varghese
- Department of Bioengineering, Jacobs School of Engineering, University of California San Diego, San Diego, California, USA; Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA; Department of Mechanical Engineering & Materials Science, Duke University, Durham, North Carolina, USA; Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Colin Jamora
- IFOM-inStem Joint Research Laboratory, Centre for Inflammation and Tissue Homeostasis, Institute for Stem Cell Science & Regenerative Medicine, Bangalore, India.
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Wilkinson S, Cummings J, Zafar S, Kozar M, Manning J, Dinsdale G, Berks M, Taylor C, Dickinson M, Herrick AL, Murray AK. Photoacoustic imaging is a novel tool to measure finger artery structure and oxygenation in patients with SSc. Sci Rep 2022; 12:20446. [PMID: 36443311 PMCID: PMC9705533 DOI: 10.1038/s41598-022-23826-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/07/2022] [Indexed: 11/29/2022] Open
Abstract
Systemic sclerosis (SSc)-related digital ischaemia is a major cause of morbidity, resulting from a combination of microvascular and digital artery disease. Photoacoustic imaging offers a newly available, non-invasive method of imaging digital artery structure and oxygenation. The aim of this study was to establish whether photoacoustic imaging could detect and measure vasculopathy in digital arteries, including the level of oxygenation, in patients with SSc and healthy controls. 22 patients with SSc and 32 healthy controls (HC) underwent photoacoustic imaging of the fingers. Vascular volume and oxygenation were assessed across eight fingers at the middle phalanx. In addition, oxygenation change during finger occlusion was measured at the non-dominant ring finger and the vascular network was imaged along the length of one finger for qualitative assessment. There was no statistically significant difference in vascular volume between patients with SSc and HC (mean of eight fingers; SSc, median 118.6 IQR [95.0-130.5] vs. HC 115.6 [97.8-158.9]) mm3. However, baseline oxygenation (mean 8 fingers) was lower in SSc vs. HC (0.373 [0.361-0.381] vs. 0.381 [0.373-0.385] arbitrary sO2 units respectively; p = 0.03). Hyperaemic oxygenation response following occlusion release was significantly lower in SSc compared to HC (0.379 [0.376-0.381] vs. 0.382 [0.377-0.385]; p = 0.03). Whilst vascular volume was similar between groups, digital artery oxygenation was decreased in patients with SSc as compared to HC, indicative of functional deficit. Photoacoustic imaging offers an exciting new method to image the vascular network in patients with SSc and the possibility to capture oxygenation as a functional measure.
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Affiliation(s)
- Sarah Wilkinson
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - James Cummings
- Department of Physics and Astronomy, University of Manchester, Manchester, UK
| | - Sakif Zafar
- Department of Physics and Astronomy, University of Manchester, Manchester, UK
| | - Martin Kozar
- Department of Physics and Astronomy, University of Manchester, Manchester, UK
| | - Joanne Manning
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - Graham Dinsdale
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
| | - Michael Berks
- Centre for Imaging Sciences, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Christopher Taylor
- Centre for Imaging Sciences, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Mark Dickinson
- Department of Physics and Astronomy, University of Manchester, Manchester, UK
- Photon Science Institute, University of Manchester, Manchester, UK
| | - Ariane L Herrick
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK
- NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
| | - Andrea K Murray
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK.
- Department of Rheumatology, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK.
- Photon Science Institute, University of Manchester, Manchester, UK.
- NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK.
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Bellocchi C, Chung A, Volkmann ER. Predicting the Progression of Very Early Systemic Sclerosis: Current Insights. Open Access Rheumatol 2022; 14:171-186. [PMID: 36133926 PMCID: PMC9484572 DOI: 10.2147/oarrr.s285409] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/06/2022] [Indexed: 11/28/2022] Open
Abstract
Systemic sclerosis (SSc) is a complex autoimmune connective tissue disease with distinct pathological hallmarks (ie, inflammation, vasculopathy, fibrosis) that may predominate at different stages in the disease course with varying severity. Initial efforts to classify patients with SSc identified a subset of patients with very early SSc. These patients possessed signs of SSc (eg, Raynaud phenomenon, SSc specific autoantibodies and/or nailfold capillary abnormalities) without fulfilling complete SSc classification criteria. Recognizing the inherent value in early diagnosis and intervention in SSc, researchers have endeavored to identify risk factors for progression from very early SSc to definite SSc. The present review summarizes the clinical phenotype of patients with very early and early SSc. Through a scoping review of recent literature, this review also describes risk factors for progression to definite SSc with a focus on the specific clinical features that arise early in the SSc disease course (eg, diffuse cutaneous sclerosis, interstitial lung disease, esophageal dysfunction, renal crisis, cardiac involvement). In addition to clinical risk factors, this review provides evidence for how biological data (ie, serological, genomic, proteomic profiles, skin bioengineering methods) can be integrated into risk assessment models in the future. Furthering our understanding of biological features of very early SSc will undoubtedly provide novel insights into SSc pathogenesis and may illuminate new therapeutic targets to prevent progression of SSc.
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Affiliation(s)
- Chiara Bellocchi
- Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Augustine Chung
- Division of Pulmonary and Critical Care, Department of Medicine, University of California, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Elizabeth R Volkmann
- Division of Rheumatology, Department of Medicine, University of California, David Geffen School of Medicine, Los Angeles, CA, USA
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McNamara CT, Greyson M. Digital ischemia after lidocaine with epinephrine injection in a patient with primary Raynaud's phenomena. Case Reports Plast Surg Hand Surg 2022; 9:193-196. [PMID: 36082186 PMCID: PMC9448404 DOI: 10.1080/23320885.2022.2117702] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/21/2022] [Indexed: 06/15/2023]
Abstract
Lidocaine with epinephrine is ubiquitous in hand procedures. Although existing literature supports the overall safety of this, significant physiologic changes accompanying epinephrine can disproportionately affect vascularly compromised patients, such as in Raynaud's phenomenon. The literature is reviewed and a case presented regarding the dangers of epinephrine injection in this population.
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Affiliation(s)
- Colin T. McNamara
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Mark Greyson
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA
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Mahmud SA, Bullock DR, Correll CK, Hobday PM, Riskalla MM, Vehe RK, Binstadt BA. Non-criteria antiphospholipid antibodies and pediatric rheumatic disease: a case series. Pediatr Rheumatol Online J 2022; 20:70. [PMID: 35987646 PMCID: PMC9392300 DOI: 10.1186/s12969-022-00732-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/15/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Non-criteria antiphospholipid antibodies (NC-aPL) are a relatively undefined subgroup of antiphospholipid antibodies (aPL). Knowledge about NC-aPL in adults is limited and even less is known in pediatric patients. Routine tests for antiphospholipid syndrome (APS)-a clinical state marked by the presence of aPL in association with vascular thrombosis-usually include lupus anticoagulant (LAC), anti-cardiolipin (aCL) and -beta-2 glycoprotein I (aβ2GPI). LAC is a functional screen for prothrombotic aPL, while the latter tests identify specific autoantibodies. Specific targets of NC-aPL include, but are not limited to, phosphatidylethanolamine, phosphatidylserine, and prothrombin. PRESENTATION OF CASES We present single-center data from eight pediatric patients with NC-aPL identified during a three-year period. All patients had presenting features raising suspicion for APS. Most patients were female with a primary rheumatic disease. One patient had a stroke. Another patient had alveolar hemorrhage and pulmonary hypertension. Raynaud's phenomenon, rashes involving distal extremities, and headaches were common. Most patients had a positive LAC, yet their routine aPL tests were negative, prompting testing for NC-aPL. CONCLUSIONS Our findings suggest NC-aPL are associated with typical signs and symptoms of APS in pediatric patients. Pediatricians and pediatric subspecialists should consider NC-aPL when clinical suspicion is high and routine aPL tests are negative, particularly when LAC is positive. While guidelines for NC-aPL do not yet exist for children or adults, these autoantibodies have pathogenic potential. Actionable items could include evaluation for the presence of other (primary) rheumatic diseases, and consultation with hematologists and/or obstetricians regarding anticoagulation/platelet inhibition and thrombosis education. Future guidelines regarding NC-aPL will only be generated by gathering more data, ideally prospectively.
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Affiliation(s)
- Shawn A. Mahmud
- grid.17635.360000000419368657Department of Pediatrics, Division of Pediatric Rheumatology, Allergy & Immunology, University of Minnesota, AO-10 Academic Office Building, 2414 S. 7th Street, Minneapolis, MN USA ,grid.17635.360000000419368657Center for Immunology, University of Minnesota, Minneapolis, MN USA
| | - Danielle R. Bullock
- grid.17635.360000000419368657Department of Pediatrics, Division of Pediatric Rheumatology, Allergy & Immunology, University of Minnesota, AO-10 Academic Office Building, 2414 S. 7th Street, Minneapolis, MN USA
| | - Colleen K. Correll
- grid.17635.360000000419368657Department of Pediatrics, Division of Pediatric Rheumatology, Allergy & Immunology, University of Minnesota, AO-10 Academic Office Building, 2414 S. 7th Street, Minneapolis, MN USA
| | - Patricia M. Hobday
- grid.17635.360000000419368657Department of Pediatrics, Division of Pediatric Rheumatology, Allergy & Immunology, University of Minnesota, AO-10 Academic Office Building, 2414 S. 7th Street, Minneapolis, MN USA
| | - Mona M. Riskalla
- grid.17635.360000000419368657Department of Pediatrics, Division of Pediatric Rheumatology, Allergy & Immunology, University of Minnesota, AO-10 Academic Office Building, 2414 S. 7th Street, Minneapolis, MN USA
| | - Richard K. Vehe
- grid.17635.360000000419368657Department of Pediatrics, Division of Pediatric Rheumatology, Allergy & Immunology, University of Minnesota, AO-10 Academic Office Building, 2414 S. 7th Street, Minneapolis, MN USA
| | - Bryce A. Binstadt
- grid.17635.360000000419368657Department of Pediatrics, Division of Pediatric Rheumatology, Allergy & Immunology, University of Minnesota, AO-10 Academic Office Building, 2414 S. 7th Street, Minneapolis, MN USA ,grid.17635.360000000419368657Center for Immunology, University of Minnesota, Minneapolis, MN USA
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Senet P. [Paroxysmal vascular acrosyndromes: Practical approach to diagnosis and management]. Rev Med Interne 2022; 43:596-602. [PMID: 35835622 DOI: 10.1016/j.revmed.2022.03.338] [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: 02/07/2022] [Accepted: 03/20/2022] [Indexed: 11/19/2022]
Abstract
Paroxysmal vascular acrosyndromes are related to a peripheral vasomotor disorder and presented as paroxysmal color changes of the fingers. They include primary Raynaud's phenomenon (RP), which is the most common, secondary RP and erythermalgia. They are to be distinguished from non-paroxysmal acrosyndromes such as acrocyanosis and chilblains, which are very frequent and often associated with RP, digital ischemia and necrosis, spontaneous digital hematoma and acrocholosis. The challenge of a consultation for a vascular acrosyndrome is to make positive diagnosis through history and clinical examination, and to specify its nature, to prescribe complementary exams. In any patient consulting for RP, assessment includes at least an antinuclear antibody test and capillaroscopy. For erythermalgia, a blood count and even a search for JAK2 mutation are required. A thryoid-stimulating hormon assay, a test for antinuclear antibodies, and a search for small fiber neuropathy are also performed. The treatment of RP is essentially documented for secondary RP where calcium channel blockers are indicated in first line, and iloprost in severe cases. The treatment of primitive erythermalgia is based on sodium channel blockers such as mexiletine or lidocaine infusions, and on drugs effective on neuropathic pain, such as gabapentin or amitryptiline, in case of erythermalgia associated with small fiber neuropathy. The treatment of erythermalgia associated with myeloproliferative syndromes is based on etiological treatment and aspirin.
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Affiliation(s)
- P Senet
- Service de dermatologie, hôpital Tenon, 4, rue de la Chine, 75970 Paris cedex 20, France.
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Matsuno K, Sonoda T, Tanaka Y. Ischemic change in gastric mucosa due to gastric wall expansion with air supply: Real-time capture in upper gastrointestinal endoscopy. Dig Endosc 2022; 34:e113-e114. [PMID: 35645005 DOI: 10.1111/den.14337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Kenshi Matsuno
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takayoshi Sonoda
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuhito Tanaka
- Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Ramahi A, Hughes M, Khanna D. Practical management of Raynaud's phenomenon - a primer for practicing physicians. Curr Opin Rheumatol 2022; 34:235-244. [PMID: 35699336 PMCID: PMC9246963 DOI: 10.1097/bor.0000000000000877] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Raynaud's phenomenon (RP) is a common vasospastic condition that results in digital hypoperfusion in response to cold and/or emotional stress and is associated with significant pain and disability. The aim of our review is to provide a practical approach for clinicians to inform assessment and management of patients with RP. RECENT FINDINGS Autoantibodies and nailfold capillaroscopy are key investigations to stratify the risk of progression to systemic sclerosis (SSc) in patients RP, which was recently confirmed in the multicenter, very early diagnosis of systemic sclerosis (VEDOSS) project. Research has explored the complex lived-patient experience of RP including digital vasculopathy in SSc and has highlighted the need for outcome measure development to facilitate research in the field. Pharmacological treatment strategies vary significantly internationally and there is continued interest in developing surgical approaches. SUMMARY We provide a practical and up-to-date approach to inform the assessment and management of patients with RP including guidance on drug initiation and escalation. Calcium channel blockers are first-line treatment and can be initiated by primary care physicians. We also highlight second-line drug therapies used for refractory RP and the potential role for surgical intervention.
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Affiliation(s)
- Ahmad Ramahi
- Division of Rheumatology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
| | - Michael Hughes
- Tameside Hospital, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, United Kingdom
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Dinesh Khanna
- Division of Rheumatology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Scleroderma Program, University of Michigan, Ann Arbor, MI, USA
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Yeo J, Park EA, Lee EB, Park JK. Angiographic characteristics of vasculopathy in patients with idiopathic inflammatory myopathies and systemic sclerosis. Sci Rep 2022; 12:9051. [PMID: 35641535 DOI: 10.1038/s41598-022-12991-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 05/11/2022] [Indexed: 11/28/2022] Open
Abstract
To describe the peripheral angiographic features of vasculopathy in idiopathic inflammatory myopathies (IIM) and systemic sclerosis (SSc) in comparison to polyarteritis nodosa (PAN). Angiograms of 47 extremities (24 upper and 23 lower) of 11 patients with IIM (n = 5) and SSc (n = 6), and 12 patients with PAN who presented with critical limb ischemia were retrospectively analyzed with regards to the presence of stenosis, occlusion, aneurysms and delayed distal flow, and degree of neovascularization. Diffuse narrowing was more frequent (66.1 vs. 38.0%, p = 0.001), whereas multifocal stenosis (6.5% vs. 26.8%, p = 0.002), abrupt occlusion (11.3% vs. 29.6%, p = 0.010) and aneurysm formation (1.6% vs. 11.3%, p = 0.037) were less frequent in IIM/SSc than PAN. In distal arteries, tapered occlusion (95.5% vs. 76.0%, p = ns) and delayed flow (77.3% vs. 48.0%, p = 0.039) were more common in IIM/SSc than PAN. After 1 year, auto- or surgical amputation tended to be more frequent in IIM/SSc than PAN (36.4% vs. 16.7%, p = ns). In conclusion, diffuse narrowing, tapered occlusion and delayed distal flow on conventional angiograms tend to be more frequent in IIM/SSc than PAN. Further studies are needed to verify these findings in a larger prospective cohort.
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Hughes M, Huang S, Pauling JD, Sabbagh M, Khanna D. The clinical relevance of Raynaud's phenomenon symptom characteristics in systemic sclerosis. Clin Rheumatol 2022; 41:3049-3054. [PMID: 35583625 DOI: 10.1007/s10067-022-06206-y] [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: 04/11/2022] [Revised: 05/06/2022] [Accepted: 05/08/2022] [Indexed: 11/25/2022]
Abstract
Raynaud's phenomenon (RP) is a cardinal feature of systemic sclerosis (SSc) and manifests with pain, digital colour change, sensory symptoms, and impaired function. SSc-RP is exacerbated by cold exposure (RP 'attacks') but many patients report persistent symptoms of background digital ischaemia. The aim of our study was to examine the significance of RP with digital colour change with or without symptoms, and persistent colour change in between attacks. Patients with SSc responses were obtained from the Patient Survey of experiences of Raynaud's Phenomenon (PASRAP). We enquired about symptoms associated with Raynaud's attacks, and persistent symptoms in between attacks. Data were analysed as descriptive statistics with appropriate parametric/non-parametric testing. Relevant PASRAP survey question data from 747 evaluable SSc patients from across three continents were analysed. Isolated colour change was rare (29/484, 6%). Digital ulcers were more common in SSc-RP associated with other sensory symptoms (42.1% vs. 24.1%, P=0.057) and more readily treated with phosphodiesterase-type 5 inhibitors (22.5% vs. 10.3%%, P=0.124). Over one-third of patients (n=92/239, 38%) reported persistent colour change in between Raynaud's attacks. Patients with persistent colour change were more likely to have pulmonary arterial hypertension (15.2% vs. 7.5%, P=0.057) and be treated with calcium channel blockers (54.3% vs. 39.0%, P=0.021). SSc-RP with colour change and other symptoms and/or or persistent decolourisation in between attacks were more likely to have vascular complications of SSc and be treated with vascular therapies. Future research should explore the judicious use of vascular therapies as a potential form of disease modification in SSc. Key Points • Isolated colour change without other symptoms is rare in SSc patients. • SSc patients often identify persistent symptoms in between attacks of RP. • SSc-RP with colour change and other symptoms, or persistent decolourisation, may have greater disease severity and be treated with vascular therapies.
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Affiliation(s)
- Michael Hughes
- Department of Rheumatology, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK.
- Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK.
| | - Suiyuan Huang
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - John D Pauling
- Department of Rheumatology, North Bristol NHS Trust, Bristol, UK
| | - Maya Sabbagh
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Dinesh Khanna
- Department of Internal Medicine, Division of Rheumatology, Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
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Medina-Bielski S, Mohan S, Makol A. 72-Year-Old Man With Puffy Fingers and Raynaud Phenomenon. Mayo Clin Proc 2022; 97:1014-1019. [PMID: 35512871 DOI: 10.1016/j.mayocp.2021.10.029] [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: 04/30/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Sara Medina-Bielski
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Sneha Mohan
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Ashima Makol
- Advisor to residents and Consultant in Rheumatology, Mayo Clinic, Rochester, MN.
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Maciejewska M, Sikora M, Maciejewski C, Alda-Malicka R, Czuwara J, Rudnicka L. Raynaud's Phenomenon with Focus on Systemic Sclerosis. J Clin Med 2022; 11:jcm11092490. [PMID: 35566614 PMCID: PMC9105786 DOI: 10.3390/jcm11092490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 02/01/2023] Open
Abstract
Raynaud’s phenomenon is a painful vascular condition in which abnormal vasoconstriction of the digital arteries causes blanching of the skin. The treatment approach can vary depending on the underlying cause of disease. Raynaud’s phenomenon can present as a primary symptom, in which there is no evidence of underlying disease, or secondary to a range of medical conditions or therapies. Systemic sclerosis is one of the most frequent causes of secondary Raynaud’s phenomenon; its appearance may occur long before other signs and symptoms. Timely, accurate identification of secondary Raynaud’s phenomenon may accelerate a final diagnosis and positively alter prognosis. Capillaroscopy is fundamental in the diagnosis and differentiation of primary and secondary Raynaud’s phenomenon. It is helpful in the very early stages of systemic sclerosis, along with its role in disease monitoring. An extensive range of pharmacotherapies with various routes of administration are available for Raynaud’s phenomenon but a standardized therapeutic plan is still lacking. This review provides insight into recent advances in the understanding of Raynaud’s phenomenon pathophysiology, diagnostic methods, and treatment approaches.
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Affiliation(s)
- Magdalena Maciejewska
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; (M.M.); (R.A.-M.); (J.C.); (L.R.)
| | - Mariusz Sikora
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637 Warsaw, Poland
- Correspondence:
| | - Cezary Maciejewski
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Rosanna Alda-Malicka
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; (M.M.); (R.A.-M.); (J.C.); (L.R.)
| | - Joanna Czuwara
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; (M.M.); (R.A.-M.); (J.C.); (L.R.)
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland; (M.M.); (R.A.-M.); (J.C.); (L.R.)
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Liem SIE, Hoekstra EM, Bonte-Mineur F, Magro Checa C, Schouffoer A, Allaart CF, Huizinga TWJ, Bergstra SA, de Vries-Bouwstra JK. The effect of silver fibre gloves on Raynaud's phenomenon in patients with systemic sclerosis: a double-blind randomized crossover trial. Rheumatology (Oxford) 2022; 62:SI74-SI81. [PMID: 35441683 PMCID: PMC9910564 DOI: 10.1093/rheumatology/keac243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Silver fibre gloves transport heat from the palm to the fingers, possibly reducing the burden of RP in SSc patients. We aim to evaluate the clinical efficiency of this intervention. METHODS A multicentre, double-blind, randomized trial was performed, accounting for interindividual differences and external factors using a crossover design. Patients were randomized in two groups: group 1 wore 8% silver fibre gloves in period 1 and normal gloves in period 2 and group 2 vice versa. Each period lasted 6 weeks. The primary outcome was the Raynaud Condition Score (RCS) over time (minimal clinical important difference 1.4), assessed three times per week using an online questionnaire. Secondary outcomes included vascular complications and Scleroderma-Health Assessment Questionnaire (SHAQ). Outcomes were evaluated before unblinding using linear mixed models. RESULTS A total of 85 SSc patients were included, with 76 completing the study. The mean RCS during 2 weeks before the study (i.e. without gloves) was 6.4 (s.d. 1.6). Both with silver fibre gloves and normal gloves the mean RCS decreased to 3.9 (s.d. 2.3) with a similar course over time. There was no difference in mean RCS over time between the type of gloves [β = 0.067 (95% CI -0.006, 0.19)]. Of secondary outcomes, total SHAQ [β = 0.036 (95% CI 0.026, 0.046)] was slightly higher with silver fibre gloves, which is clinically irrelevant. Three patients developed new digital ulcers with normal gloves vs one patient with silver fibre gloves [odds ratio 3.2 (95% CI 0.32, 31.1)]. CONCLUSIONS Wearing gloves in SSc patients clearly decreases the RP burden. Our results do not support the hypothesis that increased heat transport of 8% silver fibre gloves is associated with less disease burden as measured in this study by the RCS compared with normal gloves. CLINICAL TRIAL REGISTRATION NUMBER Netherlands Trial register (https://www.trialregister.nl/) NL7904.
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Affiliation(s)
- Sophie I E Liem
- Correspondence to: Sophie Liem, Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. E-mail:
| | - Eva M Hoekstra
- Department of Rheumatology, Leiden University Medical Center, Leiden
| | - Femke Bonte-Mineur
- Department of Rheumatology and Clinical Immunology, Maasstad Ziekenhuis, Rotterdam
| | | | - Anne Schouffoer
- Department of Rheumatology, Haga Ziekenhuis, The Hague, The Netherlands
| | | | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden
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Bubnis MA, Hulsopple C. Human Performance and Injury Prevention in Cold Weather Environments. Curr Sports Med Rep 2022; 21:112-116. [PMID: 35394951 DOI: 10.1249/jsr.0000000000000946] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT This article serves as a primer for those practitioners who serve as subject matter experts in cold weather medicine, whether it be medical planning for an outdoor event, making the determination "it is too cold to exercise," or investigating why an athlete is struggling to compete in a frigid environment. Cold weather exercise physiology is reviewed, and medical conditions that may impact performance at cold temperatures are briefly examined. Guidelines for cold weather risk assessment, injury prevention, and performance optimization also are discussed.
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Affiliation(s)
- Matthew A Bubnis
- National Capital Consortium Military Primary Care Sports Medicine Fellowship, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD
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42
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Todd NL, Bowling S, Jengo M, Jones M. Achenbach Syndrome: Case Report and Discussion. Cureus 2022; 14:e23448. [PMID: 35481314 PMCID: PMC9034735 DOI: 10.7759/cureus.23448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 11/05/2022] Open
Abstract
Achenbach syndrome is a rare, benign, self-limiting condition characterized by spontaneous, recurrent bruising of the digits without evidence of systemic disease or predisposing factors. We report a middle-aged Caucasian female that presented to the outpatient clinic with spontaneous bruising on the dorsal aspect of her left first metacarpal. Diagnosis of Achenbach syndrome was made through history and physical examination findings, and the patient was discharged with instructions to follow up as needed. It is important for providers to consider Achenbach syndrome to reassure patients and prevent an expensive or invasive workup.
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Jahn AM, Wolf M, Herrmann J, Singer D, Jürgens J. [Transient Ischemia of One Leg in a Very Low Birthweight Infant]. Z Geburtshilfe Neonatol 2022; 226:278-281. [PMID: 35148543 DOI: 10.1055/a-1745-9258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Ischemias in the extremities are rather rare in the neonatal period. Both intrauterine and postnatal factors can cause ischemias. We present the diagnostic procedure and the course in a female very low birthweight (VLBW) infant with transient ischemia in the lower extremity.
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Affiliation(s)
- Andreas Matthias Jahn
- Sektion Neonatologie und Pädiatrische Intensivmedizin, Zentrum für Geburtshilfe, Kinder- und Jugendmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Wolf
- Sektion Neonatologie und Pädiatrische Intensivmedizin, Zentrum für Geburtshilfe, Kinder- und Jugendmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Herrmann
- Abteilung für Kinderradiologie, Zentrum für Radiologie und Endoskopie, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Dominique Singer
- Sektion Neonatologie und Pädiatrische Intensivmedizin, Zentrum für Geburtshilfe, Kinder- und Jugendmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Jürgens
- Abteilung für Kinderradiologie, Zentrum für Radiologie und Endoskopie, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Coskun Benlidayi I. What are the effects of vasodilators in patients with primary Raynaud's phenomenon? A Cochrane review summary with commentary. Int J Rheum Dis 2022; 25:232-235. [PMID: 34845840 DOI: 10.1111/1756-185x.14243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ilke Coskun Benlidayi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Cukurova University, Adana, Turkey
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Nawaz I, Nawaz Y, Nawaz E, Manan MR, Mahmood A. Raynaud's Phenomenon: Reviewing the Pathophysiology and Management Strategies. Cureus 2022; 14:e21681. [PMID: 35242466 PMCID: PMC8884459 DOI: 10.7759/cureus.21681] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/25/2022] [Indexed: 12/27/2022] Open
Abstract
Raynaud's phenomenon (RP) is a multifactorial vasospastic disorder characterized by a transient, recurrent, and reversible constriction of peripheral blood vessels. RP is documented to affect up to 5% of the general population, but variation in its prevalence is commonly recognized owing to many factors, including varied definitions, gender, genetics, hormones, and region. Furthermore, RP may be idiopathic or be a clinical manifestation of an underlying illness. Patients with RP classically describe a triphasic discoloration of the affected area, beginning with pallor, followed by cyanosis, and finally ending with erythema. This change in color spares the thumb and is often associated with pain. Each attack may persist from several minutes to hours. Moreover, the transient cessation of blood flow in RP is postulated to be mediated by neural and vascular mechanisms. Both structural and functional alterations observed in the blood vessels contribute to the vascular abnormalities documented in RP. However, functional impairment serves as a primary contributor to the pathophysiology of primary Raynaud's. Substances like endothelin-1, angiotensin, and angiopoietin-2 play a significant role in the vessel-mediated pathophysiology of RP. The role of nitric oxide in the development of this phenomenon is still complex. Neural abnormalities resulting in RP are recognized as either being concerned with central mechanisms or peripheral mechanisms. CNS involvement in RP may be suggested by the fact that emotional distress and low temperature serve as major triggers for an attack, but recent observations have highlighted the importance of locally produced factors in this regard as well. Impaired vasodilation, increased vasoconstriction, and several intravascular abnormalities have been documented as potential contributors to the development of this disorder. RP has also been observed to occur as a side effect of various drugs. Recent advances in understanding the mechanism of RP have yielded better pharmacological therapies. However, general lifestyle modifications along with other nonpharmacological interventions remain first-line in the management of these patients. Calcium channel blockers, alpha-1 adrenoreceptor antagonists, angiotensin-converting enzyme inhibitors, nitric oxide, prostaglandin analogs, and phosphodiesterase inhibitors are some of the common classes of drugs that have been found to be therapeutically significant in the management of RP. Additionally, anxiety management, measures to avoid colder temperatures, and smoking cessation, along with other simple modifications, have proven to be effective non-drug strategies in patients experiencing milder symptoms.
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Affiliation(s)
- Iqra Nawaz
- Medicine, Quaid-e-Azam Medical College, Bahawalpur, PAK
| | | | - Eisha Nawaz
- Medicine, Quaid-e-Azam Medical College, Bahawalpur, PAK
| | | | - Adil Mahmood
- Medicine, Bahawal Victoria Hospital, Bahawalpur, PAK
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Millan SH, Saardi KM, Nadimi AE, Norton SA. A dialysis patient with subungual hyperkeratosis and ulceration of the fingertips. JAAD Case Rep 2022; 22:5-7. [PMID: 35252522 PMCID: PMC8891813 DOI: 10.1016/j.jdcr.2021.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sarah H. Millan
- Department of Dermatology, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia
| | - Karl M. Saardi
- Department of Dermatology, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia
- Department of Dermatology, MedStar Washington Hospital Center/Georgetown University Hospital, Washington, District of Columbia
- Correspondence to: Karl M. Saardi, MD, Department of Dermatology, George Washington University, 2150 Pennsylvania Ave NW, 2S-103, Washington, DC 20037.
| | | | - Scott A. Norton
- Department of Dermatology, MedStar Washington Hospital Center/Georgetown University Hospital, Washington, District of Columbia
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Zhang D, Chang S, Jing B, Li X, Shi H, Zheng Y, Lin Y, Chen Z, Qian G, Pan Y, Zhao G. Reactive Oxygen Species Are Essential for Vasoconstriction upon Cold Exposure. Oxid Med Cell Longev 2021; 2021:8578452. [PMID: 34868457 DOI: 10.1155/2021/8578452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/20/2021] [Indexed: 12/02/2022]
Abstract
Purpose We explored the role of ROS in cold-induced vasoconstriction and corresponding mechanism. Methods Three experiments were performed. First, we measured blood flow in human hands before and after cold exposure. Second, 24 mice were randomly divided into 3 groups: 8 mice received saline injection, 8 received subcutaneous Tempol injection, and 8 received intrathecal Tempol injection. After 30 min, we determined blood flow in the skin before and after cold exposure. Finally, we used Tempol, CCG-1423, and Go 6983 to pretreat HAVSMCs and HUVECs for 24 h. Then, cells in the corresponding groups were exposed to cold (6 h, 4°C). After cold exposure, the cytoskeleton was stained. Intracellular Ca2+ and ROS levels were measured by flow cytometry and fluorescence microscopy. We measured protein expression via Western blotting. Results In the first experiment, after cold exposure, maximum skin blood flow decreased to 118.4 ± 50.97 flux units. Then, Tempol or normal saline pretreatment did not change skin blood flow. Unlike intrathecal Tempol injection, subcutaneous Tempol injection increased skin blood flow after cold exposure. Finally, cold exposure for 6 h shrank the cells, making them narrower, and increased intracellular Ca2+ and ROS levels in HUVECs and HAVSMCs. Tempol reduced cell shrinkage and decreased intracellular Ca2+ levels. In addition, Tempol decreased intracellular ROS levels. Cold exposure increased RhoA, Rock1, p-MLC-2, ET-1, iNOS, and p-PKC expression and decreased eNOS expression. Tempol or CCG-1423 pretreatment decreased RhoA, Rock1, and p-MLC-2 levels in HAVSMCs. Furthermore, Tempol or Go 6983 pretreatment decreased ET-1, iNOS, and p-PKC expression and increased eNOS expression in HUVECs. Conclusion ROS mediate the vasoconstrictor response within the cold-induced vascular response, and ROS in blood vessel tissues rather than nerve fibers are involved in vasoconstriction via the ROS/RhoA/ROCK1 and ROS/PKC/ET-1 pathways in VSMCs and endothelial cells.
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Ruaro B, Bruni C, Wade B, Baratella E, Confalonieri P, Antonaglia C, Geri P, Biolo M, Confalonieri M, Salton F. Laser Speckle Contrast Analysis: Functional Evaluation of Microvascular Damage in Connective Tissue Diseases. Is There Evidence of Correlations With Organ Involvement, Such as Pulmonary Damage? Front Physiol 2021; 12:710298. [PMID: 34707506 PMCID: PMC8542764 DOI: 10.3389/fphys.2021.710298] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Laser speckle contrast analysis (LASCA) is a non-contact technique able to quantify peripheral blood perfusion (PBP) over large skin areas. LASCA has been used to study hand PBP in several clinical conditions. These include systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) and LASCA showed that PBP was significantly lower in these conditions than in healthy subjects (HS). Moreover, it has been demonstrated that LASCA is a safe technique also able to monitor digital ulcer perfusion and their evolution in SSc patients, during systemic and local treatment. The use of LASCA, coupled with reactivity tests is commonplace in the field of microvascular function research. Post-occlusive hyperemia reactivity (POHR) and local thermal hyperemia, associated with laser techniques are reliable tests in the evaluation of perfusion in SSc patients. Other studies used laser speckled techniques, together with acetylcholine and sodium nitroprusside iontophoresis, as specific tests of endothelium function. In conclusion, LASCA is a safe, non-contact reliable instrument for the quantification of PBP at skin level and can also be associated with reactivity tests to monitor disease progression and response to treatment in different connective tissue diseases.
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Affiliation(s)
- Barbara Ruaro
- Unit of Pulmonology, University Hospital of Trieste, Trieste, Italy
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, Division of Rheumatology, Careggi University Hospital, University of Florence, Florence, Italy
| | - Barbara Wade
- AOU City of Health and Science of Turin, Department of Science of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Elisa Baratella
- Department of Radiology, Department of Medicine, Surgery and Health Science, University of Trieste, Trieste, Italy
| | | | | | - Pietro Geri
- Unit of Pulmonology, University Hospital of Trieste, Trieste, Italy
| | - Marco Biolo
- Unit of Pulmonology, University Hospital of Trieste, Trieste, Italy
| | | | - Francesco Salton
- Unit of Pulmonology, University Hospital of Trieste, Trieste, Italy
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Frech TM, Murtaugh MA, Amuan M, Pugh MJ. The frequency of Raynaud's phenomenon, very early diagnosis of systemic sclerosis, and systemic sclerosis in a large Veteran Health Administration database. BMC Rheumatol 2021; 5:42. [PMID: 34649624 PMCID: PMC8518247 DOI: 10.1186/s41927-021-00209-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We describe Raynauds phenomenon (RP), potential very early diagnosis of systemic sclerosis (VEDOSS), and systemic sclerosis (SSc) in Veterans deployed in support of Post-9/11 operations. We sought to describe the military occupation specialty, clinical features, and vasodilator use across the three diagnoses. METHODS Individual Veterans medical records were assessed for RP (ICD-9443.0), VEDOSS with swelling of hands (ICD-9729.81) and RP (ICD-9443.0), and SSc (ICD-9710.1). The distribution of sociodemographic, military service branch, job classification, vasodilator use, and comorbidities were examined across the three classifications of disease. The chi-squared test and Fisher's exact compared frequency of these categorical variables. Logistic regression assessed the likelihood of characteristics of the three classifications. RESULTS In this population of 607,665 individual Veteran medical records, 857 had RP, 45 met possible VEDOSS criteria, and 71 had a diagnosis of SSc. The majority of RP, potential VEDOSS and SSc cases were white males. Those in craftworks, engineering or maintenance, and healthcare had a greater likelihood of RP. Less than half of RP and VEDOSS patients were on vasodilators. The most common comorbidities in this population were the diagnostic code for pain (highest in the potential VEDOSS group [81.6%]), followed by depression in all groups. CONCLUSION This is a unique Veteran population of predominately-male patients. Our data suggests that vasodilator medications are potentially being under-utilized for RP and potential VEDOSS. Our data highlights mood and pain management as an important aspect of SSc care.
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Affiliation(s)
- Tracy M Frech
- Department of Internal Medicine, Division of Rheumatology, University of Utah and Salt Lake Veterans Affair Medical Center, 1900 E 30 N, SOM 4b200, Salt Lake City, UT, 84132, USA.
| | - Maureen A Murtaugh
- Department of Internal Medicine, University of Utah and Salt Lake Veterans Affair Medical Center, Division of Epidemiology, Salt Lake City, UT, USA
| | - Megan Amuan
- Department of Internal Medicine, University of Utah and Salt Lake Veterans Affair Medical Center, Division of Epidemiology, Salt Lake City, UT, USA
| | - Mary Jo Pugh
- Department of Internal Medicine, University of Utah and Salt Lake Veterans Affair Medical Center, Division of Epidemiology, Salt Lake City, UT, USA
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Laboe C, Batchelder E, Vasireddy D. Persistent Raynaud's Phenomenon Following Methylphenidate Hydrochloride Use During the COVID-19 Pandemic. Cureus 2021; 13:e17647. [PMID: 34646694 PMCID: PMC8486148 DOI: 10.7759/cureus.17647] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/13/2022] Open
Abstract
Raynaud's phenomenon (RP) is a medical condition characterized by vasospasm of the digital vessels in the fingers and toes. The prevalence of RP in the general population is estimated at 3-5% and can vary based on climate. It is classified into primary and secondary RP based on causality. RP has been reported in some cases diagnosed with coronavirus disease 2019 (COVID-19) infection. We report the case of a 14-year-old Caucasian female who presented during the pandemic with chief complaints of suicidal ideations and attempted suicide and had a history of attention-deficit hyperactivity disorder (ADHD) and persistent RP after a stimulant trial. After an initial failure of treatment with lisdexamfetamine, she was switched to methylphenidate hydrochloride (MPH). Within two months of starting MPH, the patient noticed skin discoloration of the lower legs and feet along with numbness. The discoloration of skin was mainly limited to her feet and gradually moved up her legs. She was advised to discontinue the MPH, but her symptoms persisted for four more months until her admission. Other etiologies were ruled out by multi-specialties and during her hospitalization. She was started on atomoxetine and buspirone with appropriate dose titration. Post-discharge from the hospital, no improvement was observed in the patient's RP at an outpatient follow-up performed within a month. The development of RP following MPH treatment and its persistence after stopping MPH is a fascinating event. Clinicians should be aware of the potential rare side effects of stimulants and stimulant-like medications, including vascular, hematological, and dermatological effects. Adolescents with ADHD may be particularly distressed by the COVID-19 pandemic and display increased behavioral issues. Stress can be a trigger for RP; therefore, minimizing stress in at-risk patients is essential.
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