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De Múgica AD, Bailey E, Loughlin A. Scleroderma: oral, maxillofacial and radiographic manifestations for dental practitioners. Br Dent J 2024; 236:881-886. [PMID: 38877249 DOI: 10.1038/s41415-024-7453-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 06/16/2024]
Abstract
Scleroderma is an autoimmune condition of unknown aetiology with a range of manifestations, which can be limited to the skin or can extend to be multisystemic. It is characterised by fibrosis, microangiopathy and dysregulation of the immune system and commonly affects the oral cavity. Frequent oral and maxillofacial features include fibrosis of the face, circumoral furrows and reduced oral aperture. Radiographic findings are often incidental, including uniform, asymptomatic periodontal ligament space widening of teeth and osteolysis of bone at muscular attachments. The oral and maxillofacial manifestations significantly contribute to its disease burden and are often overlooked and undertreated as their treatment can be limited due to their challenging rheumatological care. Given the complexity of the condition and its multisystemic impacts, better co-operation between dentists and rheumatologists may help improve this patient cohort's quality of life. This clinical article aims to better equip dentists to identify features of scleroderma and manage the day-to-day oro-facial manifestations.
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Affiliation(s)
- Alexander Davies De Múgica
- Department of Dental and Maxillofacial Radiology, Royal London Dental Hospital, Turner Street, London, E1 1FR, UK; Department of Dental and Maxillofacial Radiology, Eastman Dental Hospital, 47-49 Huntley St, London, WC1E 6DG, UK.
| | - Edmund Bailey
- Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London, Turner Street, London, E1 1FR, UK
| | - Amanda Loughlin
- Department of Dental and Maxillofacial Radiology, Royal London Dental Hospital, Turner Street, London, E1 1FR, UK
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Parodis I, Tsoi A, Gomez A, Chow JW, Girard-Guyonvarc’h C, Stamm T, Boström C. Lifestyle interventions in the management of systemic sclerosis: a systematic review of the literature. Rheumatol Adv Pract 2024; 8:rkae037. [PMID: 38590950 PMCID: PMC11001494 DOI: 10.1093/rap/rkae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/25/2024] [Indexed: 04/10/2024] Open
Abstract
Objectives We aimed to investigate the efficacy of lifestyle interventions for the management of SSc. Methods We searched the MEDLINE, Embase, Web of Science and CINAHL databases in June 2021. We included studies conducted on five or more patients with SSc published between 1 January 2000 and the search date evaluating lifestyle interventions, excluding systematic reviews without meta-analyses. Critical appraisal was conducted using critical appraisal tools from the Joanna Briggs Institute. Thirty-six studies were included for full-text evaluation. Results A total of 17 studies evaluated the effect of physical exercise alone, whereas 14 studies evaluated educational interventions for mental health management, often with physical exercise as a central component. At an aggregated level, these studies support patient education and physical exercise for the improvement of physical function, in particular hand and mouth function. Studies on diet and nutrition were few (n = 5) and pertained to gastrointestinal as well as anthropometric outcomes; these studies were insufficient to support any conclusions. Conclusion Physical exercise and patient education should be considered for improving physical function in patients with SSc. These interventions can be provided alongside pharmacotherapy, but there is no evidence supporting that they can be a substitute. Further research should aim at assessing the effects of reductions of harmful exposures, including tobacco smoking and alcohol, improving sleep and enhancing social relations, three hitherto underexplored facets of lifestyle in the context of SSc.
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Affiliation(s)
- Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Alexander Tsoi
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Alvaro Gomez
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Jun Weng Chow
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Girard-Guyonvarc’h
- Division of Rheumatology, Department of Medicine, University Hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Carina Boström
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
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Almeida TG, Ferreira AR, da Silva FS, Chaves CC, Assunção BN, Martins PS, das Dores AS, de Moura RM, Andrade JA, Santos FP, Ferreira GA, Calderaro DC. Oral health education for systemic sclerosis patients: A booklet report. PEC INNOVATION 2023; 2:100154. [PMID: 37214513 PMCID: PMC10194248 DOI: 10.1016/j.pecinn.2023.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 03/28/2023] [Accepted: 04/10/2023] [Indexed: 05/24/2023]
Abstract
Purpose/objectives Systemic sclerosis (SSc) is a rare chronic autoimmune disease characterized by vascular abnormalities and connective tissue disorders. In 2021, the multidisciplinary team of the university hospital recognized a demand for oral health information among SSc patients. This study aims to describe the development of an SSc oral health booklet and its validation by people with SSc. Methods For the development of the booklet, the project creators employed the action research methodology involving ten stages. SSc patients evaluated the material by filling out a digital form. Results One hundred and thirty-one people with SSc evaluated the booklet. It received an average score of 9.73 (SD: 0.80) in relevance, 9.82 (SD: 0.47) in explicitness, and 9.49 (SD: 0.93) in aesthetics. The final version was emailed to the participants and posted on social media. Innovation This is the first booklet that deeply addresses these issues in Portuguese and constitutes a soft technology to instruct and assist patients with SSc. Conclusion The production of high-quality educational materials on oral health for patients with SSc is necessary. The online distribution increased its reach and had great importance in the context of the COVID-19 pandemic.
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Affiliation(s)
- Thalles G. Almeida
- Universidade Federal de Minas Gerais, Medical School. Av. Prof. Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
| | - Alessandra R.H. Ferreira
- Universidade Federal de Minas Gerais, Medical School. Av. Prof. Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
| | - Felipe S. da Silva
- Universidade Federal de Minas Gerais, Medical School. Av. Prof. Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
| | - Caio C. Chaves
- Universidade Federal de Minas Gerais, Medical School. Av. Prof. Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
| | - Bárbara N. Assunção
- Faculdade Ciências Médicas de Minas Gerais, Medical School. Alameda Ezequiel Dias, 275 - Centro, Belo Horizonte 30130-110, MG, Brazil
| | - Priscila S. Martins
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
| | - Alessandra S. das Dores
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
| | - Regina M.F. de Moura
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
| | - Júnia A. Andrade
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
| | - Flávia P.S.T. Santos
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
| | - Gilda A. Ferreira
- Universidade Federal de Minas Gerais, Medical School. Av. Prof. Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
| | - Débora C. Calderaro
- Universidade Federal de Minas Gerais, Medical School. Av. Prof. Alfredo Balena, 190 - Santa Efigênia, Belo Horizonte 30130-100, MG, Brazil
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Chen YT, Kruger G, Devine A, Khanna D, Murphy SL. Experiences of Exergaming for Upper Extremity Exercises in People With Systemic Sclerosis. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023; 43:665-675. [PMID: 37162267 PMCID: PMC10527854 DOI: 10.1177/15394492231172934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Impaired upper extremity (UE) function has limited activities of daily living in people with systemic sclerosis (SSc). Exergaming, a combination of gaming and exercises, could be a novel way to improve UE exercise engagement. The objective of this study was to examine the usability of exergaming and to investigate participant experiences after exergaming among people with SSc. Both quantitative and qualitative data were collected. Participants completed questionnaires regarding the usability of exergaming. Semi-structured interviews were conducted directly after exergaming. Descriptive statistics and thematic content analysis were performed. Twenty participants with SSc participated. Exergaming was highly acceptable with a good System Usability Scale score (M = 71.6 ± 9.9). Participants described exergaming as motivating with potential physical and nonphysical benefits. Although results were generally positive, participants expressed some barriers and temporary side effects of using exergaming and needs for improvement. This work stands to inform future exergaming interventions in people with SSc.
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Parodis I, Gomez A, Tsoi A, Chow JW, Pezzella D, Girard C, Stamm TA, Boström C. Systematic literature review informing the EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis. RMD Open 2023; 9:e003297. [PMID: 37532469 PMCID: PMC10401222 DOI: 10.1136/rmdopen-2023-003297] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023] Open
Abstract
Through this systematic literature review, we assembled evidence to inform the EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). We screened articles published between January 2000 and June 2021. Studies selected for data extraction (118 for SLE and 92 for SSc) were thematically categorised by the character of their intervention. Of 208 articles included, 51 were classified as robust in critical appraisal. Physical activity was the most studied management strategy and was found to be efficacious in both diseases. Patient education and self-management also constituted widely studied topics. Many studies on SLE found psychological interventions to improve quality of life. Studies on SSc found phototherapy and laser treatment to improve cutaneous disease manifestations. In summary, non-pharmacological management of SLE and SSc encompasses a wide range of interventions, which can be combined and provided either with or without adjunct pharmacological treatment but should not aim to substitute the latter when this is deemed required. While some management strategies i.e., physical exercise and patient education, are already established in current clinical practice in several centres, others e.g., phototherapy and laser treatment, show both feasibility and efficacy, yet require testing in more rigorous trials than those hitherto conducted.
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Affiliation(s)
- Ioannis Parodis
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Department of Rheumatology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Alvaro Gomez
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Alexander Tsoi
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Jun Weng Chow
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Denise Pezzella
- Division of Rheumatology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Charlotte Girard
- Division of Rheumatology, Department of Medicine, University of Geneva, Geneva, Switzerland
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Ludwig Boltzmann Gesellschaft, Vienna, Austria
| | - Carina Boström
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Haque M, Ahmad R. Oral health alterations: Glimpse into its connection to inflammatory rheumatic diseases. ADVANCES IN HUMAN BIOLOGY 2023. [DOI: 10.4103/aihb.aihb_11_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
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Murphy SL, Poole JL, Chen YT, Lescoat A, Khanna D. Rehabilitation Interventions in Systemic Sclerosis: A Systematic Review and Future Directions. Arthritis Care Res (Hoboken) 2022; 74:59-69. [PMID: 34165263 PMCID: PMC8695630 DOI: 10.1002/acr.24737] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/13/2021] [Accepted: 06/22/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To systematically review evidence of rehabilitation interventions for improving outcomes in systemic sclerosis (SSc) and to evaluate evidence quality. METHODS Several electronic databases were searched to identify studies in which rehabilitation professionals delivered, supervised, or participated in interventions for individuals with SSc. Randomized controlled trials (RCTs) or non-randomized trials, one-arm trials, and prospective quasi-experimental studies with interventions were included if they had ≥10 participants. Quality appraisal was conducted by 2 independent raters using the Physiotherapy Evidence Database (PEDro) Scale. RESULTS A total of 16 good or excellent quality studies (15 RCTs, 1 prospective quasi-experimental study) were included. Most rehabilitation interventions focused on hands/upper extremities, followed by multicomponent, orofacial, and directed self-management. Sample sizes varied between 20-267 participants (median 38). In 50% of studies, participants in intervention groups significantly improved compared to controls. Most studies demonstrated within-group improvements in intervention groups. Interventions varied in content, delivery, length, and dose and outcome measures collected. CONCLUSION Existing evidence provides some support for rehabilitation in SSc, such as interventions that focus on hand and upper extremity outcomes or are multicomponent, although there is high study heterogeneity. The evidence base would benefit from interventions testing similar replicable components, use of common outcome measures, and incorporation of delivery modes that enable larger sample sizes. There are challenges in recruiting participants due to the rarity of SSc and high disease burden, as participants' involvement in rehabilitation studies requires active participation over time. Intervention studies designed to reduce participation barriers may facilitate translation of effective interventions into practice.
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Affiliation(s)
- Susan L. Murphy
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
- VA Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center, GRECC, Ann Arbor, MI USA
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Janet L. Poole
- Department of Occupational Therapy, University of New Mexico, Albuquerque, New Mexico, USA
| | - Yen T. Chen
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Alain Lescoat
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Dinesh Khanna
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
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Pettersson H, Alexanderson H, Poole JL, Varga J, Regardt M, Russell AM, Salam Y, Jensen K, Mansour J, Frech T, Feghali-Bostwick C, Varjú C, Baldwin N, Heenan M, Fligelstone K, Holmner M, Lammi MR, Scholand MB, Shapiro L, Volkmann ER, Saketkoo LA. Exercise as a multi-modal disease-modifying medicine in systemic sclerosis: An introduction by The Global Fellowship on Rehabilitation and Exercise in Systemic Sclerosis (G-FoRSS). Best Pract Res Clin Rheumatol 2021; 35:101695. [PMID: 34217607 PMCID: PMC8478716 DOI: 10.1016/j.berh.2021.101695] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Systemic sclerosis (SSc) is a heterogeneous multisystem autoimmune disease whereby its main pathological drivers of disability and damage are vascular injury, inflammatory cell infiltration, and fibrosis. These mechanisms result in diffuse and diverse impairments arising from ischemic circulatory dysfunction leading to painful skin ulceration and calcinosis, neurovascular aberrations hindering gastrointestinal (GI) motility, progressive painful, incapacitating or immobilizing effects of inflammatory and fibrotic effects on the lungs, skin, articular and periarticular structures, and muscle. SSc-related impairments impede routine activities of daily living (ADLs) and disrupt three critical life areas: work, family, social/leisure, and also impact on psychological well-being. Physical activity and exercise are globally recommended; however, for connective tissue diseases, this guidance carries greater impact on inflammatory disease manifestations, recovery, and cardiovascular health. Exercise, through myogenic and vascular phenomena, naturally targets key pathogenic drivers by downregulating multiple inflammatory and fibrotic pathways in serum and tissue, while increasing circulation and vascular repair. G-FoRSS, The Global Fellowship on Rehabilitation and Exercise in Systemic Sclerosis recognizes the scientific basis of and advocates for education and research of exercise as a systemic and targeted SSc disease-modifying treatment. An overview of biophysiological mechanisms of physical activity and exercise are herein imparted for patients, clinicians, and researchers, and applied to SSc disease mechanisms, manifestations, and impairment. A preliminary guidance on exercise in SSc, a research agenda, and the current state of research and outcome measures are set forth.
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Affiliation(s)
- Henrik Pettersson
- Women's Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Division of Rheumatology, Department of Medicin, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Helene Alexanderson
- Women's Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Division of Rheumatology, Department of Medicin, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Janet L Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, NM, USA
| | - Janos Varga
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Malin Regardt
- Women's Health and Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden; Department of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
| | - Anne-Marie Russell
- University of Exeter, College of Medicine and Health, Exeter, UK; National Institute of Health Research, Senior Nurse Research Leader, London, UK
| | - Yasser Salam
- Department of Physical Therapy, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Kelly Jensen
- Oregon Health and Science University, Portland, OR, USA; New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; Tulane University School of Medicine, New Orleans, USA
| | - Jennifer Mansour
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; Tulane University School of Medicine, New Orleans, USA
| | - Tracy Frech
- Vanderbilt University, Division of Rheumatology, Nashville, TN, USA
| | | | - Cecília Varjú
- Department of Rheumatology and Immunology, University of Pécs Clinical Center, Pecs, Hungary
| | | | - Matty Heenan
- Scleroderma Foundation/Pulmonary Hypertension Association, Tucson, AZ, USA
| | - Kim Fligelstone
- Scleroderma & Raynaud Society UK (SRUK), London, UK; Royal Free Hospital, London, UK
| | - Monica Holmner
- The Swedish Rheumatism Association National Association for Systemic Sclerosis, Sweden
| | - Matthew R Lammi
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, USA; Louisiana State University School of Medicine, Section of Pulmonary Medicine, New Orleans, USA
| | - Mary Beth Scholand
- University of Utah, Division of Pulmonary Medicine, Pulmonary Fibrosis Center, Salt Lake City, UT, USA
| | - Lee Shapiro
- Division of Rheumatology, Albany Medical Center, Albany, NY, USA; Steffens Scleroderma Foundation, Albany, NY, USA
| | - Elizabeth R Volkmann
- University of California, David Geffen School of Medicine, UCLA Scleroderma Program and UCLA CTD-ILD Program, Division of Rheumatology, Department of Medicine, Los Angeles, CA, USA
| | - Lesley Ann Saketkoo
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, USA; Tulane University School of Medicine, New Orleans, USA; University Medical Center - Comprehensive Pulmonary Hypertension Center and Interstitial Lung Disease Clinic Programs, New Orleans, USA; Louisiana State University School of Medicine, Section of Pulmonary Medicine, New Orleans, USA.
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Ritschl V, Ferreira RJO, Santos EJF, Fernandes R, Juutila E, Mosor E, Santos-Costa P, Fligelstone K, Schraven L, Stummvoll G, Salvador M, Poole JL, van den Ende C, Boström C, Stamm TA. Suitability for e-health of non-pharmacological interventions in connective tissue diseases: scoping review with a descriptive analysis. RMD Open 2021; 7:rmdopen-2021-001710. [PMID: 34326205 PMCID: PMC8323400 DOI: 10.1136/rmdopen-2021-001710] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/19/2021] [Indexed: 12/15/2022] Open
Abstract
Objective Non-pharmacological interventions support patients with connective tissue diseases to better cope with and self-manage their diseases. This study aimed to map existing evidence on non-pharmacological interventions in patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and mixed connective tissue diseases regarding content, feasibility and potential suitability in an e-health setting. Methods A literature search was performed in eight different databases in July 2020. The intervention’s content was extracted using the ‘Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide’. A Sankey diagram and descriptive statistics were used to analyse the data and illustrate the relationships between the interventions. Results Of 8198 identified records, 119 papers were eligible. One hundred and four of them (87.4%) were conducted between 2000 and 2020, mainly in the USA (SLE n=24 (21.2%), SSc n=16 (14.2%)), Brazil (SLE n=8 (7.1%), SSc n=5 (4.4%)) and Italy (SLE n=0 (0%), SSc n=12 (10.6%)). Fifty-two studies (SLE n=24 (21.2%), SSc n=28 (24.8%)) used multicomponent interventions. The single interventions were physical exercises (SLE n=16 (14.2%), SSc n=17 (15.0%)), coaching/counselling (SLE n=11 (18.0%), SSc n=0 (0%)) and education (SLE n=2 (1.8%), SSc n=3 (2.7%)). Primary outcomes focused on physical function (SLE n=1 (0.9%), SSc n=15 (13.3%)), mouth opening in SSc (n=4 (5.9%)) and physical capacity (SLE n=2 (1.8%), SSc n=1 (0.9%)). No interventions for mixed connective tissue disease were found. Conclusion There was a great variety in the intervention’s content due to differences in body structure, activity limitations and participation restrictions in SLE and SSc. These results highlight the need for personalised, multicomponent, non-pharmacological interventions, which could be delivered as e-health interventions.
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Affiliation(s)
- Valentin Ritschl
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Ricardo J O Ferreira
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Eduardo José Ferreira Santos
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Rúben Fernandes
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Essi Juutila
- Metropolia University of Applied Sciences, Helsinki, Finland
| | - Erika Mosor
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
| | - Paulo Santos-Costa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | | | - Linda Schraven
- Federation of European Scleroderma Associations, Amsterdam, The Netherlands
| | | | - Maria Salvador
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
| | - Janet L Poole
- Occupational Therapy Graduate Program, University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Carina Boström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria .,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
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Hachulla E, Agard C, Allanore Y, Avouac J, Bader-Meunier B, Belot A, Berezne A, Bouthors AS, Condette-Wojtasik G, Constans J, De Groote P, Diot E, Dumas F, Jego P, Joly F, Launay D, Le Guern V, Le Quintrec JS, Lescaille G, Meune C, Moulin B, Nguyen C, Omeish N, Pene F, Richard MA, Rochefort J, Roren A, Sitbon O, Sobanski V, Truchetet ME, Mouthon L. French recommendations for the management of systemic sclerosis. Orphanet J Rare Dis 2021; 16:322. [PMID: 34304732 PMCID: PMC8310704 DOI: 10.1186/s13023-021-01844-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 12/13/2022] Open
Abstract
Systemic sclerosis (SSc) is a generalized disease of the connective tissue, arterioles, and microvessels, characterized by the appearance of fibrosis and vascular obliteration. There are two main phenotypical forms of SSc: a diffuse cutaneous form that extends towards the proximal region of the limbs and/or torso, and a limited cutaneous form where the cutaneous sclerosis only affects the extremities of the limbs (without passing beyond the elbows and knees). There also exists in less than 10% of cases forms that never involve the skin. This is called SSc sine scleroderma. The prognosis depends essentially on the occurrence of visceral damage and more particularly interstitial lung disease (which is sometimes severe), pulmonary arterial hypertension, or primary cardiac damage, which represent the three commonest causes of mortality in SSc. Another type of involvement with poor prognosis, scleroderma renal crisis, is rare (less than 5% of cases). Cutaneous extension is also an important parameter, with the diffuse cutaneous forms having less favorable prognosis.
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Affiliation(s)
- Eric Hachulla
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence Des Maladies Autoimmunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000, Lille, France.
| | - Christian Agard
- Internal Medicine, Nantes University Hospital, University of Nantes, Nantes, France
| | - Yannick Allanore
- Rheumatology Department, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Jerome Avouac
- Rheumatology Department, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Brigitte Bader-Meunier
- Department of Pediatric Immunology and Rheumatology; Hospital Necker, APHP, Paris, France
| | - Alexandre Belot
- Pediatric Nephrology, Rheumatology, Dermatology, HFME, Hospices Civils de Lyon, Bron, France
| | - Alice Berezne
- Department of Internal Medicine, CHR Annecy-Genevois, Annecy, France
| | - Anne-Sophie Bouthors
- Anaesthesia Intensive Care Unit, Jeanne de Flandre Women Hospital, Academic Hospital, ULR 7365 - GRITA - Groupe de Recherche Sur Les Formes Injectables Et Les Technologies Associées, University Lille, Lille, France
| | - Geraldine Condette-Wojtasik
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence Des Maladies Autoimmunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000, Lille, France
| | - Joël Constans
- Vascular Medicine Department, Bordeaux University Hospital Centre, Saint André Hospital, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) PeripherAL Artery DIsease Network (PALADIN), Bordeaux, France
| | - Pascal De Groote
- Cardiology Department, Lung-Heart Institute, CHU de Lille, 59000, Lille, France
| | | | - Florence Dumas
- Emergency Department, Cochin Hospital, Paris University, Paris, France
| | - Patrick Jego
- Internal Medicine and Clinical Immunology Unit, CHU Rennes, Rennes, France
| | - Francisca Joly
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, INSERM UMRS-1149, Assistance Publique-Hôpitaux de Paris, University of Paris, Clichy, France
| | - David Launay
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence Des Maladies Autoimmunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000, Lille, France
| | - Veronique Le Guern
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares D'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), APHP-CUP, Hôpital Cochin, Université de Paris, 75014, Paris, France
| | | | - Geraldine Lescaille
- Centre d'Immunologie et Maladies Infectieuses (CIMI-Paris), Department of Odontology, Paris Diderot/Paris 07, Sorbonne Paris Cité, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Christophe Meune
- Cardiology Department, Hôpital Avicenne, AP-HP, Université de Paris, Paris, France
| | - Bruno Moulin
- Department of Nephrology and Kidney Transplantation, Nouvel Hôpital Civil, University Hospitals of Strasbourg, Strasbourg, France
| | - Christelle Nguyen
- Physical Medicine and Rehabilitation Department, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Nadine Omeish
- Oral and Dental Medicine, Hôpital Pitié-Salpêtrière, APHP, Université de Paris, Paris, France
| | - Frederic Pene
- Medical Intensive Care Unit, Hôpital Cochin, AP-HP. Centre & Université de Paris, Paris, France
| | - Marie-Aleth Richard
- Department of Dermatology, Timone Hospital, University Hospital of Marseille, Marseille, France
| | - Juliette Rochefort
- Oral and Dental Medicine, Hôpital Pitié-Salpêtrière, APHP, Université de Paris, Paris, France
| | - Alexandra Roren
- AP-HP Cochin Hospital, Université Paris Descartes Sorbonne Paris Cité, INSERM U1153, Paris, France
| | - Olivier Sitbon
- Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Hôpital Bicêtre, Laboratoire d'Excellence en Recherche Sur le Médicament et Innovation Thérapeutique, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Vincent Sobanski
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence Des Maladies Autoimmunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000, Lille, France
| | | | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares D'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), APHP-CUP, Hôpital Cochin, Université de Paris, 75014, Paris, France.
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11
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Cüzdan N, Türk İ, Çiftçi V, Arslan D, Doğan MC, Ünal İ. The effect of a home-based orofacial exercise program on oral aperture of patients with systemic sclerosis: A single-blind prospective randomized controlled trial. Arch Rheumatol 2021; 36:176-184. [PMID: 34527921 PMCID: PMC8418773 DOI: 10.46497/archrheumatol.2021.8295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aims to evaluate the effect of a home-based orofacial exercise program on the oral aperture (OA) of systemic sclerosis (SSc) patients. PATIENTS AND METHODS This single-blind prospective randomized controlled study performed between March 2017 and January 2019 included 56 SSc patients (3 males, 53 females; mean age 52.9±10.6 years; range, 31 to 70 years) with an OA of <40 mm. Patients were divided into two groups. Group 1 (n=28, mean age 53.8±9.6 years) was given orofacial exercise program twice a day for one month in addition to oral hygiene care advices, followed by no activity for the next month. Group 2 (n=28, mean age 50.0±11 years) received oral hygiene care advices for the first month followed by the same exercise program for the next month. Patients' OA was measured at baseline, and at first and second months. RESULTS After the first month, OA increased in Group 1 (p<0.001), whereas no change was observed in Group 2 (p=0.579). At the end of two months, there was no additional increase in Group 1 (p=0.352), while there was a significant increase in Group 2 (p<0.001). There was no difference between OAs of the groups at the end of the trial (p=0.564). CONCLUSION Our results suggest that home-based orofacial exercise program improves OA of SSc patients.
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Affiliation(s)
- Nihan Cüzdan
- Department of Physical Therapy and Rehabilitation & Rheumatology, Balıkesir Atatürk City Hospital, Balıkesir, Turkey
| | - İpek Türk
- Rheumatology, Osmaniye State Hospital, Osmaniye, Turkey
| | - Volkan Çiftçi
- Pediatric Dentistry, Çukurova University Faculty of Dentistry, Adana, Turkey
| | - Didem Arslan
- Department of Internal Medicine, Rheumatology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Muharrem Cem Doğan
- Pediatric Dentistry, Çukurova University Faculty of Dentistry, Adana, Turkey
| | - İlker Ünal
- Department of Biostatistics, Çukurova University Faculty of Medicine, Adana, Turkey
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Abstract
Systemic sclerosis (SSc) is a connective tissue disease characterized by progressive fibrosis of the skin and internal organs and has significant clinical sequelae. Management of SSc cutaneous disease remains challenging and often is driven by extracutaneous manifestations. Methotrexate is the typical first-line therapy for patients with early progressive cutaneous disease. However, in patients with diffuse progressive skin disease and inflammatory arthritis, methotrexate or rituximab monotherapy should be considered. First-line therapy for patients with concomitant myositis includes methotrexate or intravenous immunoglobulin (IVIG). For patients with both cutaneous findings and interstitial lung disease, studies have suggested the efficacy of mycophenolate mofetil or rituximab. Second-line therapies, including UVA-1 phototherapy, IVIG, or rituximab, can be considered in patients with disease refractory to first-line treatments. Clinical trials investigating the utility of emerging therapies such as abatacept and tocilizumab in the treatment of SSc are under way, and preliminary results are promising. Nonetheless, all patients with SSc benefit from a gentle skin-care regimen to alleviate pruritis, which is a commonly reported symptom. Additional cutaneous manifestations of SSc include telangiectasias, calcinosis cutis, microstomia, and Raynaud’s phenomenon. Telangiectasia may be managed with camouflage techniques, pulse dye laser, and intense pulse light. Calcinosis cutis therapy is guided by the size of the calcium deposits, although treatment options are limited. Mouth augmentation and oral stretching exercises are recommended for patients with reduced oral aperture. Raynaud’s phenomenon is treated with a combination of lifestyle modification and calcium channel blockers, such as amlodipine. Overall, SSc is a clinically heterogenous disease that affects multiple organ systems. Providers should assess extracutaneous involvement and use evidence-based recommendations to select the most appropriate therapy for patients with SSc.
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Affiliation(s)
- Jane L Zhu
- Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - Samantha M Black
- Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - Henry W Chen
- Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
| | - Heidi T Jacobe
- Department of Dermatology, University of Texas at Southwestern Medical Center, Dallas, TX, USA
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13
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Sydow E, Van der Elst K, Verschueren P, Lenaerts J, Westhovens R, De Langhe E. A mixed method study exploring patient satisfaction and feasibility of two exercise programmes in systemic sclerosis-associated microstomia. Rheumatol Adv Pract 2021; 5:rkab017. [PMID: 34013159 PMCID: PMC8117948 DOI: 10.1093/rap/rkab017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/03/2021] [Indexed: 11/15/2022] Open
Abstract
Objective SSc often leads to fibrotic cutaneous involvement of the face and reduced oral aperture, with impaired food intake and oral hygiene. Oral exercises can increase oral aperture but are often hampered by low adherence rates. The aim of this mixed method study was to explore the feasibility, patient satisfaction and effectiveness of two exercise programmes in SSc-associated microstomia. Methods Adult patients suffering from SSc and microstomia (maximal oral aperture <40 mm) were randomized to two groups. Group A exercised with a jaw motion device (Therabite), whereas group B performed mouth-stretching exercises. Patients were expected to exercise for 10 min, three times per day for 3 months. Patients were evaluated at baseline, 3 months (period without intervention), 6 months (after 3 months of intervention) and 9 months (post-intervention). At month 6, semi-structured one-to-one interviews were conducted. Results We included six women and three men, median age 60 years and median disease duration 8 years. At 6 months, all patients in group A (n = 4) and four in group B (n = 5) improved, with a median of 9 and 7 mm, respectively. The adherence ranged between 63.7 and 98.9% in group A and between 48.5 and 97.4% in group B. The interview revealed three themes: drivers, challenges and perceived improvement. Conclusion Both interventions improved maximal oral aperture. The adherence to therapy was high, but none of the patients considered it feasible to continue practising three times per day. Future studies are needed in order to define feasible long-term exercise programmes.
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Affiliation(s)
- Ellinor Sydow
- Division of Rheumatology, University Hospitals Leuven
| | | | | | - Jan Lenaerts
- Division of Rheumatology, University Hospitals Leuven
| | | | - Ellen De Langhe
- Division of Rheumatology, University Hospitals Leuven.,Laboratory of Tissue Homeostasis and Disease, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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14
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Molés-Poveda P, Comis LE, Joe GO, Mitchell SA, Pichard DC, Rosenstein RK, Solomon B, Pavletic SZ, Cowen EW. Rehabilitation Interventions in the Multidisciplinary Management of Patients With Sclerotic Graft-Versus-Host Disease of the Skin and Fascia. Arch Phys Med Rehabil 2020; 102:776-788. [PMID: 33347890 DOI: 10.1016/j.apmr.2020.10.141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/02/2020] [Accepted: 10/29/2020] [Indexed: 11/27/2022]
Abstract
Graft-versus-host disease (GVHD) is a multisystemic disorder that affects 30%-80% of patients who undergo allogeneic hematopoietic stem cell transplantation 10%-15% of GVHD patients develop sclerotic features affecting the skin or deeper tissues, leading to functional limitations and poor quality of life. There is limited literature regarding the indications and efficacy of specific rehabilitative interventions in sclerotic GVHD (sclGVHD). In this article, we summarize the current evidence supporting rehabilitation intervention in sclGVHD and offer our approach to the multidisciplinary management of this disease. In addition, we review techniques that have been employed in other sclerotic skin diseases (eg, iontophoresis, extracorporeal shock waves, botulinum toxin A, adipose derived stromal vascular fraction), but that require further validation in the sclGVHD setting. Ultimately, optimal care for this complex disease requires a multidisciplinary approach that includes a rehabilitation and adaptive program tailored to each patient's needs.
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Affiliation(s)
- Paula Molés-Poveda
- Instituto de Investigación Sanitaria la Fe, Valencia, Spain; Dermatology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Hospital Universitario de la Plana, Catellón, Spain.
| | - Leora E Comis
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Galen O Joe
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Sandra A Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Dominique C Pichard
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Rachel K Rosenstein
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
| | - Beth Solomon
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Steven Z Pavletic
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Edward W Cowen
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
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Jeon FHK, Griffin M, Varghese J, Butler PEM. Oro-facial fibrosis in systemic sclerosis: a reconstructive journey. BMJ Case Rep 2020; 13:13/10/e236663. [PMID: 33040038 DOI: 10.1136/bcr-2020-236663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Oro-facial fibrosis presents a significant disease burden in patients with systemic sclerosis, but there remains no established treatment modality. Autologous fat grafting is a minimally invasive surgical procedure that is now increasingly recognised for its regenerative capacity, propagating an expansion of heterogeneous indications beyond volume restoration, including fibrotic diseases such as systemic sclerosis. We present a 42-year-old woman with oro-facial involvement of systemic sclerosis leading to severe limitation in mouth opening and closure, with marked retraction of the lower lip and gingival display. We describe the reconstructive journey over a 12-year period, where the antifibrotic effect of autologous fat grafting served as the basis on which a series of surgical procedures were performed to achieve functional and aesthetic improvement. Autologous fat grafting provides a novel treatment modality for oro-facial skin fibrosis, previously considered a non-treatable disease manifestation of systemic sclerosis.
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Affiliation(s)
- Faith Hyun Kyung Jeon
- Division of Surgery & Interventional Science, University College London, London, UK .,Charles Wolfson Centre for Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Michelle Griffin
- Division of Surgery & Interventional Science, University College London, London, UK.,Charles Wolfson Centre for Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, UK.,Plastic & Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Jajini Varghese
- Division of Surgery & Interventional Science, University College London, London, UK.,Plastic & Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Peter Edward Michael Butler
- Division of Surgery & Interventional Science, University College London, London, UK.,Charles Wolfson Centre for Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, UK.,Plastic & Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, UK
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16
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Feasibility study of stem-cell enriched autologous lipotransfer to treat oro-facial fibrosis in systemic sclerosis (Sys-Stem): Protocol for open-label randomised controlled trial. Int J Surg Protoc 2020; 23:6-10. [PMID: 32803023 PMCID: PMC7419663 DOI: 10.1016/j.isjp.2020.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 12/04/2022] Open
Abstract
Oro-facial fibrosis presents a significant disease burden in systemic sclerosis. There is currently no treatment available for oro-facial fibrosis. Autologous fat grafting is a novel therapeutic method for oro-facial fibrosis.
Introduction Oro-facial fibrosis is a common and disabling manifestation of systemic sclerosis (SSc), causing a plethora of functional, aesthetic and social compromise, yet is without effective treatment. Autologous lipotransfer is an established minimally invasive surgical procedure that is postulated to exert anti-fibrotic effects by adipose-derived stem cells, and presents a novel method in the treatment of fibrotic conditions. This study aims to assess the safety and efficacy of autologous lipotransfer for facial involvement in SSc. Methods and analysis This is the first randomised controlled study with an open label design to assess autologous lipotransfer for oro-facial involvement in systemic sclerosis. The goals of this study are to assess the feasibility of using a range of quantitative and qualitative outcome measures to effectively measure disease severity and treatment outcome, and to assess patient acceptability for future multi-centre trials. A total of 50 participants will be randomised to a treatment or control group. The treatment group will receive autologous fat transfer to the peri-oral region by a single surgeon. Dermal fibroblasts and adipose-derived stem cells will be isolated from tissue samples. All outcome measures will be taken at baseline, then at 6 weeks, 3 months and 6 months from the time of intervention in the treatment arm, or from baseline in the control arm. Ethics and dissemination The study has ethical approval (REC reference 19/LO/0718). Results will be available to patients, patient user groups, clinicians and the public through presentations at national and international rheumatology conferences and published in peer reviewed journals. Trial registration Registered on ISRCTN registry (ISRCTN17793055).
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Liem SIE, Vliet Vlieland TPM, Schoones JW, de Vries-Bouwstra JK. The effect and safety of exercise therapy in patients with systemic sclerosis: a systematic review. Rheumatol Adv Pract 2019; 3:rkz044. [PMID: 31858074 PMCID: PMC6913710 DOI: 10.1093/rap/rkz044] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/21/2019] [Indexed: 01/08/2023] Open
Abstract
Given the shortcomings of previous literature reviews evaluating the effect and safety of exercise therapy in SSc, we aimed to carry out a systematic review of the literature specifically on this topic. A structured search strategy was performed in Medline (via PubMed) and other electronic databases from 1990 to 3 September 2019. Randomized controlled trials, observational designs, conference abstracts and trial registrations were included if they concerned SSc patients ≥18 years of age, exercise therapy and reported outcomes related to physical functioning. Nine articles were included. Four randomized controlled trials compared (a) hand exercises, (b) orofacial exercises, (c) aerobic exercises or (d) aerobic exercises plus resistance training with no exercise, demonstrating effects on hand function (a), maximum mouth opening (b), peak oxygen uptake (c + d) and quality of life. All five observational studies concerning hand, orofacial, aerobic and/or strengthening exercises reported improvements of hand function, mouth opening, aerobic capacity and/or muscle strength. In conclusion, the evidence on the effect and safety of exercise therapy in SSc is scanty.
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Affiliation(s)
| | | | - Jan W Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands
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18
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Vitali C, Baldanzi C, Crispiatico V, Polini F, Ammenti P, Montesano A, Cattaneo D. Effect of Impairment-Oriented and Function-Oriented Exercises on Mouth Function in Subjects with Systemic Sclerosis. Folia Phoniatr Logop 2019; 72:389-401. [PMID: 31550704 DOI: 10.1159/000502643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 08/09/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aim of this study was to develop an exercise protocol to improve maximal mouth opening (MMO), tongue protrusion (Tprot), tongue strength (Tstren), and lip strength (Lstren), and to assess its effects on subjects with scleroderma. METHODS We performed four replicated single-system studies in a consecutive sample of subjects with scleroderma. An instrumented assessment measured MMO, Tprot, Tstren, and Lstren. Each day, subjects were assessed and performed orofacial exercises conducted by speech therapists. Treatments were first aimed at improving mouth physical characteristics by impairment-oriented exercises and then to improve skills with function-oriented exercises. RESULTS The mean phase differences between assessment and treatment phases across subjects were from 0.88 to 9.56 mm in MMO, from 2.03 to 12.3 mm in Tprot, from -0.12 to 5.35 N in Tstren, and from -0.84 to 5.19 N in Lstren. After treatment, 3 subjects crossed the 5th percentile discriminating normal from abnormal performances for both Tstren and Tprot, while this occurred in 2 subjects for MMO and Lstren. CONCLUSIONS The results of this study suggest that rehabilitation appears to be useful in reducing tongue and lip impairments and in improving oral functions in subjects with scleroderma.
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Uras C, Mastroeni S, Tabolli S, Masini C, Pallotta S, Teofoli P, Rocco G, Mazzanti C, Abeni D. A comparison between two educational methods in the rehabilitation of the microstomia in systemic sclerosis: a randomized controlled trial. Clin Rehabil 2019; 33:1747-1756. [PMID: 31216880 DOI: 10.1177/0269215519858395] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To test the effectiveness of an educational intervention including "face to face" training, compared to a standard information program, to reduce microstomia in women with systemic sclerosis. DESIGN Single-blind, two-arm, randomized controlled study with a 12-month follow-up period. SETTING Hospital wards of a large Italian dermatological reference center. SUBJECTS Female inpatients with diagnosis of systemic sclerosis. INTERVENTIONS For both groups an information brochure and an audio-visual DVD were developed specifically for the study. The control group was assigned to educational materials alone (i.e. brochures and DVD), while the experimental group, in addition to the same educational materials, received specific "face-to-face" interventions, repeated at each follow-up visit. MAIN MEASURES Primary outcome was measurement of the opening of the mouth. Secondary outcomes was the self-reported mouth disability. RESULTS The intention-to-treat analysis included 63 patients. Compared to the baseline measurement, we observed an increase of the mouth opening of 0.31 cm (95% confidence interval: 0.13-0.49), P = 0.003; in the control group, the increase was 0.13 cm (95% confidence interval: 0.01-0.25), P = 0.06. The difference in improvement between the two groups was not statistically significant (P = 0.10); however, it reached statistical significance in the per-protocol analysis (39 patients, P = 0.02). CONCLUSION Face-to-face nursing rehabilitation training seems to improve microstomia to a greater extent, when compared to a standard intervention based only on written and audio-visual materials.
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Affiliation(s)
- Claudia Uras
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata-Istituto di Ricovero e Cura a Carattere Scientifico (IDI-IRCCS), Rome, Italy
| | - Simona Mastroeni
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata-Istituto di Ricovero e Cura a Carattere Scientifico (IDI-IRCCS), Rome, Italy
| | - Stefano Tabolli
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata-Istituto di Ricovero e Cura a Carattere Scientifico (IDI-IRCCS), Rome, Italy
| | - Cinzia Masini
- 5th Dermatological Clinic, Istituto Dermopatico dell'Immacolata-Istituto di Ricovero e Cura a Carattere Scientifico (IDI-IRCCS), Rome, Italy
| | - Sabatino Pallotta
- 5th Dermatological Clinic, Istituto Dermopatico dell'Immacolata-Istituto di Ricovero e Cura a Carattere Scientifico (IDI-IRCCS), Rome, Italy
| | - Patrizia Teofoli
- 5th Dermatological Clinic, Istituto Dermopatico dell'Immacolata-Istituto di Ricovero e Cura a Carattere Scientifico (IDI-IRCCS), Rome, Italy
| | - Gennaro Rocco
- Università degli Studi di Roma Tor Vergata, Rome, Italy
| | - Cinzia Mazzanti
- 1st Dermatological Clinic, Istituto Dermopatico dell'Immacolata-Istituto di Ricovero e Cura a Carattere Scientifico (IDI-IRCCS), Rome, Italy
| | - Damiano Abeni
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata-Istituto di Ricovero e Cura a Carattere Scientifico (IDI-IRCCS), Rome, Italy
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Yalcin ED, Avcu N, Uysal S, Arslan U. Evaluation of radiomorphometric indices and bone findings on panoramic images in patients with scleroderma. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 127:e23-e30. [DOI: 10.1016/j.oooo.2018.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 06/08/2018] [Accepted: 08/14/2018] [Indexed: 11/26/2022]
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Gualtierotti R, Marzano AV, Spadari F, Cugno M. Main Oral Manifestations in Immune-Mediated and Inflammatory Rheumatic Diseases. J Clin Med 2018; 8:jcm8010021. [PMID: 30585183 PMCID: PMC6351952 DOI: 10.3390/jcm8010021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 12/18/2022] Open
Abstract
Oral manifestations are frequent in patients with rheumatic diseases. The aim of this review is to offer readers practical advice concerning the onset, diagnosis and treatment of the main oral manifestations encountered in rheumatological and dental clinics. Signs and symptoms such as oral hyposalivation, xerostomia, temporomandibular joint disorders, periodontal disease, and dysphagia may be the first expression of a number of rheumatic diseases. Some of these manifestations are aspecific and very frequent, such as oral aphthosis, which can be the first manifestation in patients with systemic lupus erythematosus; some are potentially dangerous, such as jaw claudication during the course of giant cell arteritis; and some are very rare but peculiar, such as strawberry-like gingivitis in patients with granulomatosis with polyangiitis. Other oral manifestations are due to adverse reactions to disease-modifying anti-rheumatic drugs. Oral alterations in rheumatic diseases are frequently overlooked in clinical practice, but their prompt recognition not only allows the local lesions to be appropriately treated, but also makes it possible to identify an underlying systemic disease.
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Affiliation(s)
- Roberta Gualtierotti
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milano, Italy.
| | - Angelo Valerio Marzano
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Dermatology Unit, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy.
| | - Francesco Spadari
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milano, Italy.
| | - Massimo Cugno
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Internal Medicine, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy.
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Abstract
Although classification criteria for systemic sclerosis (SSc) do not incorporate gastrointestinal tract (GIT) manifestations often present in this disease, the GIT is the most common internal organ involved. Pathophysiology of GIT involvement is thought to be similar to other organs in SSc with fibroproliferative vascular lesions of small arteries and arterioles, increased production of profibrotic growth factors, and alterations of innate, humoral, and cellular immunity. These processes result in neuropathy progressing to myopathy with eventual fibrosis. Proper diagnostics and therapeutics for SSc-GIT involvement require the treating physician to have an understanding of an integrated approach and potential medication adverse effects.
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Affiliation(s)
- Tracy M Frech
- Department of Internal Medicine, Division of Rheumatology, University of Utah, Salt Lake Veterans Affair Medical Center, Salt Lake City, UT, USA.
| | - Diane Mar
- Department of Internal Medicine, University of Colorado, Denver, 12631 East 17th Avenue, Aurora, CO 80045, USA
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Asano Y, Jinnin M, Kawaguchi Y, Kuwana M, Goto D, Sato S, Takehara K, Hatano M, Fujimoto M, Mugii N, Ihn H. Diagnostic criteria, severity classification and guidelines of systemic sclerosis. J Dermatol 2018; 45:633-691. [PMID: 29687465 DOI: 10.1111/1346-8138.14162] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/06/2017] [Indexed: 01/17/2023]
Abstract
Several effective drugs have been identified for the treatment of systemic sclerosis (SSc). However, in advanced cases, not only their effectiveness is reduced but they may be also harmful due to their side-effects. Therefore, early diagnosis and early treatment is most important for the treatment of SSc. We established diagnostic criteria for SSc in 2003 and early diagnostic criteria for SSc in 2011, for the purpose of developing evaluation of each organ in SSc. Moreover, in November 2013, the American College of Rheumatology and the European Rheumatology Association jointly developed new diagnostic criteria for increasing their sensitivity and specificity, so we revised our diagnostic criteria and severity classification of SSc. Furthermore, we have revised the clinical guideline based on the newest evidence. In particular, the clinical guideline was established by clinical questions based on evidence-based medicine according to the New Minds Clinical Practice Guideline Creation Manual (version 1.0). We aimed to make the guideline easy to use and reliable based on the newest evidence, and to present guidance as specific as possible for various clinical problems in treatment of SSc.
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Affiliation(s)
- Yoshihide Asano
- Department of Dermatology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasushi Kawaguchi
- Institute of Rheumatology, Tokyo Woman's Medical University, Tokyo, Japan
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Daisuke Goto
- Department of Rheumatology, Faculty of Medicine, Univertity of Tsukuba, Ibaraki, Japan
| | - Shinichi Sato
- Department of Dermatology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Takehara
- Department of Molecular Pathology of Skin, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Masaru Hatano
- Graduate School of Medicine Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Naoki Mugii
- Section of Rehabilitation, Kanazawa University Hospital, Ishikawa, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Restoring masticatory function in a patient with severe microstomia using rapid prototyped mesh and a custom-made hinge and swing-lock prosthesis. J Prosthet Dent 2018; 119:887-892. [DOI: 10.1016/j.prosdent.2017.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 11/20/2022]
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25
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Pearson DR, Werth VP, Pappas-Taffer L. Systemic sclerosis: Current concepts of skin and systemic manifestations. Clin Dermatol 2018; 36:459-474. [PMID: 30047430 DOI: 10.1016/j.clindermatol.2018.04.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Systemic sclerosis is an uncommon autoimmune connective tissue disease with multiorgan system involvement and significant associated morbidity and mortality. Cutaneous signs and clinical manifestations are of particular importance, as they may be recognized before systemic manifestations, allowing earlier risk stratification into the limited and diffuse cutaneous subtypes, as well as earlier initiation of treatment. Important cutaneous manifestations include Raynaud's phenomenon, digital ulcers, cutaneous sclerosis, calcinosis cutis, telangiectasias, pruritus, and dyspigmentation. Despite investigation of a wide variety of treatments, no FDA-approved pharmacologic therapies exist for systemic sclerosis, and data from high-quality studies are limited. In the following review, we will discuss skin-directed therapies. Although there is evidence to support specific treatments for Raynaud's phenomenon, digital ulcers, and cutaneous sclerosis, there are limited rigorous studies evaluating the treatment of other cutaneous signs and clinical manifestations. Additional randomized-controlled trials and large observational studies are necessary to develop future evidence-based treatment options.
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Affiliation(s)
- David R Pearson
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA; Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Victoria P Werth
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA; Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa Pappas-Taffer
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA; Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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26
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Abstract
Systemic sclerosis (SSc) is a multisystem disease of unknown aetiology characterised by microangiopathy, dysregulated immune function and tissue remodelling, which commonly involves the oral cavity. Orofacial manifestations of SSc contribute greatly to overall disease burden and yet are regularly overlooked and under-treated. This may reflect a pre-occupation amongst rheumatology clinicians on potentially life-threatening internal organ involvement, but is also a consequence of insufficient engagement between rheumatologists and dental professionals. A high proportion of SSc patients report difficulty accessing a dentist with knowledge of the disease and there is recognition amongst dentists that this could impact negatively on patient care. This review shall describe the clinical features and burden of orofacial manifestations of SSc and the management of such problems. The case is made for greater collaborative working between rheumatologists and dental professionals with an interest in SSc in both the research and clinical setting.
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Mugii N, Hamaguchi Y, Maddali-Bongi S. Clinical significance and usefulness of rehabilitation for systemic sclerosis. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2018; 3:71-80. [PMID: 35382125 PMCID: PMC8892873 DOI: 10.1177/2397198317750043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2017] [Indexed: 07/30/2023]
Abstract
Systemic sclerosis is a multisystem connective tissue disorder characterized by excessive fibrosis of the skin and internal organs. Impairments in skin, the musculoskeletal system, and respiratory system require rehabilitation therapy because they may lead to disabilities and reduce the quality of life in daily activities. Rehabilitation for systemic sclerosis mainly comprises two distinct approaches that include local and global rehabilitation. Local rehabilitation is applied to maintain and/or improve hand and face functions, while global rehabilitation includes aerobic and resistance exercises. Although few high-quality randomized clinical trials have been conducted to date, previous studies indicated the effectiveness of rehabilitation therapy for decreasing local and systemic disabilities, resulting in improved quality of life. Rehabilitation for systemic sclerosis needs to be regularly and constantly performed at home as well as in hospitals. Physicians involved in the treatment of systemic sclerosis need to consider rehabilitation, and skilled physiotherapists and occupational therapists also play a crucial role in evaluating and treating systemic sclerosis patients.
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Affiliation(s)
- Naoki Mugii
- Department of Rehabilitation, Kanazawa
University Hospital, Kanazawa - Japan
| | - Yasuhito Hamaguchi
- Department of Dermatology, School of
Medicine, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa
University, Kanazawa - Japan
| | - Susanna Maddali-Bongi
- Rheumatological Rehabilitation Unit,
Division of General Rehabilitation, Department of Experimental and Clinical
Medicine, University of Florence, Florence - Italy
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Rannou F, Boutron I, Mouthon L, Sanchez K, Tiffreau V, Hachulla E, Thoumie P, Cabane J, Chatelus E, Sibilia J, Roren A, Berezne A, Baron G, Porcher R, Guillevin L, Ravaud P, Poiraudeau S. Personalized Physical Therapy Versus Usual Care for Patients With Systemic Sclerosis: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2017; 69:1050-1059. [DOI: 10.1002/acr.23098] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 09/08/2016] [Accepted: 09/20/2016] [Indexed: 11/11/2022]
Affiliation(s)
- François Rannou
- AP-HP Cochin Hospital, Université Paris Descartes Sorbonne Paris Cité, and INSERM U1153; Paris France
| | - Isabelle Boutron
- AP-HP Hôtel Dieu Hospital, Université Paris Descartes Sorbonne Paris Cité, and INSERM U1153; Paris France
| | - Luc Mouthon
- Reference Center for Rare Diseases, AP-HP Cochin Hospital, and Université Paris Descartes Sorbonne Paris Cité; Paris France
| | - Katherine Sanchez
- AP-HP Cochin Hospital, Université Paris Descartes Sorbonne Paris Cité, and INSERM U1153; Paris France
| | - Vincent Tiffreau
- Reference Center for Rare Diseases, Lille University Medical Center, University of Lille 2; Lille France
| | - Eric Hachulla
- Reference Center for Rare Diseases, Lille University Medical Center, University of Lille 2; Lille France
| | - Philipe Thoumie
- AP-HP Rothschild Hospital and Pierre and Marie Curie University; Paris France
| | - Jean Cabane
- AP-HP Saint-Antoine Hospital and Pierre and Marie Curie University; Paris France
| | - Emmanuel Chatelus
- Hôpital Hautepierre, Fédération de Médecine Translationnelle de Strasbourg, UMR INSERM 1109, Université de Strasbourg-Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Jean Sibilia
- Hôpital Hautepierre, Fédération de Médecine Translationnelle de Strasbourg, UMR INSERM 1109, Université de Strasbourg-Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Alexandra Roren
- AP-HP Cochin Hospital, Université Paris Descartes Sorbonne Paris Cité, and INSERM U1153; Paris France
| | - Alice Berezne
- Reference Center for Rare Diseases, AP-HP Cochin Hospital, and Université Paris Descartes Sorbonne Paris Cité; Paris France
| | - Gabriel Baron
- AP-HP Hôtel Dieu Hospital, Université Paris Descartes Sorbonne Paris Cité, and INSERM U1153; Paris France
| | - Raphael Porcher
- AP-HP Hôtel Dieu Hospital, Université Paris Descartes Sorbonne Paris Cité, and INSERM U1153; Paris France
| | - Loic Guillevin
- Reference Center for Rare Diseases, AP-HP Cochin Hospital, and Université Paris Descartes Sorbonne Paris Cité; Paris France
| | - Philippe Ravaud
- AP-HP Hôtel Dieu Hospital, Université Paris Descartes Sorbonne Paris Cité, and INSERM U1153; Paris France
| | - Serge Poiraudeau
- AP-HP Cochin Hospital, Université Paris Descartes Sorbonne Paris Cité, and INSERM U1153; Paris France
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Frost R, Levati S, McClurg D, Brady M, Williams B. What Adherence Measures Should Be Used in Trials of Home-Based Rehabilitation Interventions? A Systematic Review of the Validity, Reliability, and Acceptability of Measures. Arch Phys Med Rehabil 2017; 98:1241-1256.e45. [PMID: 27702555 DOI: 10.1016/j.apmr.2016.08.482] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/26/2016] [Accepted: 08/31/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To systematically review methods for measuring adherence used in home-based rehabilitation trials and to evaluate their validity, reliability, and acceptability. DATA SOURCES In phase 1 we searched the CENTRAL database, NHS Economic Evaluation Database, and Health Technology Assessment Database (January 2000 to April 2013) to identify adherence measures used in randomized controlled trials of allied health professional home-based rehabilitation interventions. In phase 2 we searched the databases of MEDLINE, Embase, CINAHL, Allied and Complementary Medicine Database, PsycINFO, CENTRAL, ProQuest Nursing and Allied Health, and Web of Science (inception to April 2015) for measurement property assessments for each measure. STUDY SELECTION Studies assessing the validity, reliability, or acceptability of adherence measures. DATA EXTRACTION Two reviewers independently extracted data on participant and measure characteristics, measurement properties evaluated, evaluation methods, and outcome statistics and assessed study quality using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. DATA SYNTHESIS In phase 1 we included 8 adherence measures (56 trials). In phase 2, from the 222 measurement property assessments identified in 109 studies, 22 high-quality measurement property assessments were narratively synthesized. Low-quality studies were used as supporting data. StepWatch Activity Monitor validly and acceptably measured short-term step count adherence. The Problematic Experiences of Therapy Scale validly and reliably assessed adherence to vestibular rehabilitation exercises. Adherence diaries had moderately high validity and acceptability across limited populations. The Borg 6 to 20 scale, Bassett and Prapavessis scale, and Yamax CW series had insufficient validity. Low-quality evidence supported use of the Joint Protection Behaviour Assessment. Polar A1 series heart monitors were considered acceptable by 1 study. CONCLUSIONS Current rehabilitation adherence measures are limited. Some possess promising validity and acceptability for certain parameters of adherence, situations, and populations and should be used in these situations. Rigorous evaluation of adherence measures in a broader range of populations is needed.
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Affiliation(s)
- Rachael Frost
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, Scotland.
| | - Sara Levati
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, Scotland
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, Scotland
| | - Marian Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, Scotland
| | - Brian Williams
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, Scotland
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30
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Xiong Y, Berrueta L, Urso K, Olenich S, Muskaj I, Badger GJ, Aliprantis A, Lafyatis R, Langevin HM. Stretching Reduces Skin Thickness and Improves Subcutaneous Tissue Mobility in a Murine Model of Systemic Sclerosis. Front Immunol 2017; 8:124. [PMID: 28261202 PMCID: PMC5311037 DOI: 10.3389/fimmu.2017.00124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 01/25/2017] [Indexed: 12/18/2022] Open
Abstract
Objective Although physical therapy can help preserve mobility in patients with systemic sclerosis (SSc), stretching has not been used systematically as a treatment to prevent or reverse the disease process. We previously showed in rodent models that stretching promotes the resolution of connective tissue inflammation and reduces new collagen formation after injury. Here, we tested the hypothesis that stretching would impact scleroderma development using a mouse sclerodermatous graft-versus-host disease (sclGvHD) model. Methods The model consists in the adoptive transfer (allogeneic) of splenocytes from B10.D2 mice (graft) into Rag2−/− BALB/c hosts (sclGvHD), resulting in skin inflammation followed by fibrosis over 4 weeks. SclGvHD mice and controls were randomized to stretching in vivo for 10 min daily versus no stretching. Results Weekly ultrasound measurements of skin thickness and subcutaneous tissue mobility in the back (relative tissue displacement during passive trunk motion) successfully captured the different phases of the sclGvHD model. Stretching reduced skin thickness and increased subcutaneous tissue mobility compared to no stretching at week 3. Stretching also reduced the expression of CCL2 and ADAM8 in the skin at week 4, which are two genes known to be upregulated in both murine sclGvHD and the inflammatory subset of human SSc. However, there was no evidence that stretching attenuated inflammation at week 2. Conclusion Daily stretching for 10 min can improve skin thickness and mobility in the absence of any other treatment in the sclGvHD murine model. These pre-clinical results suggest that a systematic investigation of stretching as a therapeutic modality is warranted in patients with SSc.
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Affiliation(s)
- Ying Xiong
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Lisbeth Berrueta
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Katia Urso
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Sara Olenich
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Igla Muskaj
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Gary J Badger
- Department of Medical Biostatistics, University of Vermont , Burlington, VT , USA
| | - Antonios Aliprantis
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School , Boston, MA , USA
| | - Robert Lafyatis
- University of Pittsburgh, School of Medicine , Pittsburgh, PA , USA
| | - Helene M Langevin
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurological Sciences, University of Vermont, Burlington, VT, USA
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31
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Rosholm Comstedt L, Svensson Å, Hesselstrand R, Lehti L, Troilius Rubin A. Effects of intense pulsed light in microstomia in patients with systemic sclerosis: A pilot study. J COSMET LASER THER 2017; 19:143-148. [DOI: 10.1080/14764172.2016.1262961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Åke Svensson
- Department of Dermatology and Venerology, Skåne University Hospital, Malmö, Sweden
| | - Roger Hesselstrand
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Leena Lehti
- Vascular Center, Skåne University Hospital, Malmö, Sweden
| | - Agneta Troilius Rubin
- Department of Dermatology and Venerology, Section of Laser & Vascular Anomaly, Skåne University Hospital, Malmö, Sweden
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Abrão ALP, Santana CM, Bezerra ACB, Amorim RFBD, Silva MBD, Mota LMHD, Falcão DP. What rheumatologists should know about orofacial manifestations of autoimmune rheumatic diseases. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 56:441-450. [PMID: 27692394 DOI: 10.1016/j.rbre.2016.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 08/28/2015] [Indexed: 12/18/2022] Open
Abstract
Orofacial manifestations occur frequently in rheumatic diseases and usually represent early signs of disease or of its activity that are still neglected in clinical practice. Among the autoimmune rheumatic diseases with potential for oral manifestations, rheumatoid arthritis (RA), inflammatory myopathies (IM), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), relapsing polychondritis (RP) and Sjögren's syndrome (SS) can be cited. Signs and symptoms such as oral hyposalivation, xerostomia, temporomandibular joint disorders, lesions of the oral mucosa, periodontal disease, dysphagia, and dysphonia may be the first expression of these rheumatic diseases. This article reviews the main orofacial manifestations of rheumatic diseases that may be of interest to the rheumatologist for diagnosis and monitoring of autoimmune rheumatic diseases.
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Affiliation(s)
- Aline Lauria Pires Abrão
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília (UnB), Brasília, DF, Brazil.
| | - Caroline Menezes Santana
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, DF, Brazil
| | - Ana Cristina Barreto Bezerra
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília (UnB), Brasília, DF, Brazil
| | | | | | | | - Denise Pinheiro Falcão
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, DF, Brazil
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Orofacial Manifestations and Temporomandibular Disorders of Systemic Scleroderma: An Observational Study. Int J Mol Sci 2016; 17:ijms17071189. [PMID: 27455250 PMCID: PMC4964558 DOI: 10.3390/ijms17071189] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/08/2016] [Accepted: 07/19/2016] [Indexed: 12/22/2022] Open
Abstract
Scleroderma is a disorder involving oral and facial tissues, with skin hardening, thin lips, deep wrinkles, xerostomia, tongue rigidity, and microstomia. The aim of this study was to investigate the prevalence of oral manifestations and temporomandibular disorders (TMD) in Systemic Sclerosis (SSc) patients compared with healthy people. Eighty patients (6 men, 74 women) fulfilling ACR/EULAR SSc Criteria were enrolled. A randomly selected group of 80 patients, matched by sex and age served as control group. The examination for TMD signs and symptoms was based on the standardized Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) through a questionnaire and clinical examination. SSc patients complained more frequently (78.8%) of oral symptoms (Xerostomia, dysgeusia, dysphagia and stomatodynia) than controls (28.7%) (χ2 = 40.23 p = 0.001). TMD symptoms (muscle pain on chewing, difficulty in mouth opening, headaches) were complained by 92.5% of SSc patients and by 76.2% of controls (χ2 = 8.012 p = 0.005). At the clinical examination, 85% of SSc patients showed restricted opening versus 20.0% of controls (χ2 = 67.77 p = 0.001), 81.2% of SSc showed reduced right lateral excursion versus 50% of controls (χ2 = 17.316 p = 0.001); 73.8% of SSc showed limited left lateral excursion versus 53.8% of controls (χ2 = 6.924 p = 0.009); and 73.8% of SSc had narrow protrusion versus 56.2% of controls (χ2 = 5.385 p = 0.02).
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34
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Bennani I, Lopez R, Bonnet D, Prevot G, Constantin A, Chauveau D, Paul C, Bulai Livideanu C. Improvement of Microstomia in Scleroderma after Carbon Dioxide Laser Treatment. Case Rep Dermatol 2016; 8:142-50. [PMID: 27403126 PMCID: PMC4924459 DOI: 10.1159/000445821] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Limited mouth opening (LMO) is a frequent complication of systemic sclerosis (SS). Its management is complex and there are limited treatment options. We report four patients with SS and severe LMO [interincisal distance (IID) <30 mm] treated with pulsed carbon dioxide (CO2) laser. Pulsed CO2 laser treatment of the white lips was performed after all patients had signed a written informed consent in the absence of alternative treatment. Treatment was carried out under locoregional anaesthesia using a Sharplan 30C CO2 laser in the Silk Touch® resurfacing mode. One to three laser sessions were performed at intervals of 8-12 months between sessions. Assessments were performed at 3 and 12 months with measurement of the IID using a ruler, calculation of the Mouth Handicap in Systemic Sclerosis (MHISS) scale and global evaluation by the patients. Adverse events were also reported. In all four patients, an improvement in IID occurred 3 months after the first session with a mean gain of +5 mm (range: 2-7). At 12 months, a mean gain of +8.5 mm (range: 7-10) in IID was observed. The MHISS score decreased by a mean of •14 (range: 11-17). All patients showed improvement of lip flexibility or mouth opening, allowing better phonation and mastication and easier dental care. Adverse effects were transient erythema and/or dyschromia. CO2 laser appears to be effective and well tolerated in the improvement of LMO in SS.
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Affiliation(s)
- Imane Bennani
- Department of Dermatology, Paul Sabatier University, Toulouse, France
| | - Raphael Lopez
- Departments of Oral and Maxillofacial Surgery, Toulouse University Hospital, Toulouse, France
| | - Delphine Bonnet
- Departments of Internal Medicine, Toulouse University Hospital, Toulouse, France
| | - Gregoire Prevot
- Departments of Pulmonology, Toulouse University Hospital, Toulouse, France
| | - Arnaud Constantin
- Departments of Rheumatology, Toulouse University Hospital, Toulouse, France
| | - Dominique Chauveau
- Departments of Nephrology, Toulouse University Hospital, Toulouse, France
| | - Carle Paul
- Department of Dermatology, Paul Sabatier University, Toulouse, France
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Abrão ALP, Santana CM, Bezerra ACB, Amorim RFBD, Silva MBD, Mota LMHD, Falcão DP. What rheumatologists should know about orofacial manifestations of autoimmune rheumatic diseases. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 56:S0482-5004(16)00021-8. [PMID: 26947177 DOI: 10.1016/j.rbr.2015.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 07/10/2015] [Accepted: 08/28/2015] [Indexed: 12/30/2022] Open
Abstract
Orofacial manifestations occur frequently in rheumatic diseases and usually represent early signs of disease or of its activity that are still neglected in clinical practice. Among the autoimmune rheumatic diseases with potential for oral manifestations, rheumatoid arthritis (RA), inflammatory myopathies (IM), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), relapsing polychondritis (RP) and Sjögren's syndrome (SS) can be cited. Signs and symptoms such as oral hyposalivation, xerostomia, temporomandibular joint disorders, lesions of the oral mucosa, periodontal disease, dysphagia, and dysphonia may be the first expression of these rheumatic diseases. This article reviews the main orofacial manifestations of rheumatic diseases that may be of interest to the rheumatologist for diagnosis and monitoring of autoimmune rheumatic diseases.
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Affiliation(s)
- Aline Lauria Pires Abrão
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília (UnB), Brasília, DF, Brasil.
| | - Caroline Menezes Santana
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, DF, Brasil
| | - Ana Cristina Barreto Bezerra
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade de Brasília (UnB), Brasília, DF, Brasil
| | | | | | | | - Denise Pinheiro Falcão
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília (UnB), Brasília, DF, Brasil
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Almeida LF, Lima MCD, Macieira JC, César CPHAR, Baldrighi SEZDM. Intervenção fonoaudiológica na esclerose sistêmica: relato de casos. REVISTA CEFAC 2016. [DOI: 10.1590/1982-0216201618117715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A Esclerose Sistêmica é uma doença reumática autoimune do tecido conjuntivo, progressiva, pouco frequente, de etiologia desconhecida e com evolução variável. Atinge órgãos nobres e tecidos periorais, causando limitação na abertura da boca, hipertonia dos órgãos fonoarticulatórios, face com "aparência de máscara", dificuldades na mastigação e deglutição. Com o objetivo de comparar os resultados pré e pós-intervenção fonoaudiológica miofuncional orofacial em sujeitos com esclerose sistêmica, realizou-se estudo clínico exploratório qualiquantitativo no setor de Reumatologia do Hospital Universitário e na Clínica escola de Fonoaudiologia da Universidade Federal de Sergipe, no período de julho/2012 a dezembro/2013. A amostra foi composta por cinco indivíduos, de ambos os gêneros, com faixa etária entre 24 e 60 anos e diagnóstico médico confirmado da referida afecção. Os indivíduos passaram por avaliação por meio do protocolo MBGR e 36 sessões de terapia fonoaudiológica (miofuncional e mioterápica). Ao término, os resultados iniciais e finais foram comparados a partir dos indicadores clínicos trabalhados. Diante da análise dos resultados obtidos, foram observadas melhoras em todos os aspectos trabalhados. A avaliação anterior à fonoterapia revelou restrição na abertura da boca em todos os indivíduos e os resultados finais apresentaram ganhos entre 5.3 e 14.2 mm de abertura (média: 9,26 mm). Com relação à tonicidade, mobilidade dos órgãos fonoarticulatórios e dormência orofacial, observaram-se melhoras e evidências de adequação das funções orais. Pode-se concluir que, apesar de alguns pacientes ainda apresentarem alterações, a reabilitação fonoaudiológica promoveu melhoras significativas no quadro clínico e qualidade de vida dos indivíduos do grupo de estudo.
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Willems LM, Vriezekolk JE, Schouffoer AA, Poole JL, Stamm TA, Boström C, Kwakkenbos L, Vliet Vlieland TPM, van den Ende CHM. Effectiveness of Nonpharmacologic Interventions in Systemic Sclerosis: A Systematic Review. Arthritis Care Res (Hoboken) 2015; 67:1426-39. [PMID: 25832447 DOI: 10.1002/acr.22595] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 02/24/2015] [Accepted: 03/24/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To systematically and comprehensively document the effectiveness of nonpharmacologic interventions on physical functioning and psychological well-being in patients with systemic sclerosis (SSc). METHODS Multiple electronic databases were searched for studies on the effectiveness of nonpharmacologic interventions in SSc. Randomized clinical trials (RCTs), controlled clinical trials (CCTs), and observational designs (ODs) with ≥10 participants were included. Two reviewers independently assessed methodologic quality using the Downs and Black checklist. RESULTS Twenty-three studies (9 RCTs, 4 CCTs, and 10 ODs) were included. Studies assessing comparable interventions were grouped, resulting in data for 16 different interventions. The total number of patients included per study ranged from 10 to 53. Seventeen different outcome domains were assessed, with hand function, limitations in activities, and quality of life being assessed most frequently. Three studies, all RCTs, were rated as high quality. These RCTs reported that 1) a multifaceted oral health intervention improves mouth hygiene, and additional orofacial exercises did not improve mouth opening, 2) a multidisciplinary team-care program improves limitations in activities, mouth opening, and hand grip strength, and 3) manual lymph drainage improves hand function, limitations in activities, and quality of life. CONCLUSION The body of knowledge regarding nonpharmacologic care in SSc is very limited due to the wide variety in studied interventions and outcomes in the relatively uncommon but highly disabling disease. To structure and focus future research, an international consensus should be established to prioritize primary targets for nonpharmacologic treatment and the content of interventions and to agree on a core set of outcome measures.
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Affiliation(s)
| | | | - Anne A Schouffoer
- Leiden University Medical Center, Leiden, and Haga Teaching Hospital, The Hague, The Netherlands
| | | | | | | | - Linda Kwakkenbos
- Jewish General Hospital and McGill University, Montreal, Quebec, Canada
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Abstract
PURPOSE OF REVIEW To review pharmacologic and nonpharmacologic therapies in the treatment of systemic sclerosis (SSc) from 2011 to 2014 through a systematic review. RECENT FINDINGS Our systematic review identifies randomized controlled trials, meta-analyses, systematic reviews, case series, and observational studies which support organ-based therapy with known immunosuppressive agents, novel agents, and hematopoietic stem cell transplantation, and also includes nonpharmacologic therapies improving visceral and physical function. SUMMARY SSc is an orphan autoimmune disorder with significant morbidity and mortality. Although there has been significant progress over the years in therapeutic options for SSc, the mainstays of treatment are organ-based and primarily symptom management. Our systematic review of the last 4 years of treatment emphasizes known treatment strategies already in practice, but also identifies new therapeutic approaches with additional biologic agents and hematopoietic stem cell transplantation.
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Abstract
Systemic sclerosis (SSc) is a chronic multi-system autoimmune disease associated with disability and reduced quality of life. There is no effective treatment or cure to SSc, so it is important improve global health of these patients and reduce morbidity and mortality associated with SSc. It was made a literature review about quality of life in patients with SSc, regarding the several factors that should be considered and evaluated when attending to SSc patients. It was also considered the validated scales and questionnaires used to measure outcomes in patients with SSc. We concluded that it is important to have an interdisciplinary approach to SSc patients considering the patient's cognitive representations of the disease and what they value most like mobility and hand function, pain, fatigue, sleep, depression and body image.
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Affiliation(s)
- Cristiana Almeida
- Department of Medicine, Centro Hospitalar Vila Nova Gaia/Espinho (CHVNG/E), Gaia, Portugal.
| | - Isabel Almeida
- Clinical Immunology Unit, Department of Medicine, Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), Porto, Portugal; Multidisciplinary Unit for Biomedical Investigation (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Portugal.
| | - Carlos Vasconcelos
- Clinical Immunology Unit, Department of Medicine, Hospital de Santo António (HSA), Centro Hospitalar do Porto (CHP), Porto, Portugal; Multidisciplinary Unit for Biomedical Investigation (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Portugal.
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Baron M, Hudson M, Tatibouet S, Steele R, Lo E, Gravel S, Gyger G, El Sayegh T, Pope J, Fontaine A, Masetto A, Matthews D, Sutton E, Thie N, Jones N, Copete M, Kolbinson D, Markland J, Nogueira-Filho G, Robinson D, Gornitsky M. The Canadian systemic sclerosis oral health study II: the relationship between oral and global health-related quality of life in systemic sclerosis. Rheumatology (Oxford) 2014; 54:692-6. [PMID: 25288781 DOI: 10.1093/rheumatology/keu396] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Both oral and global health-related quality of life (HRQoL) are markedly impaired in SSc. In this study we aimed to determine the degree of association between oral HRQoL and global HRQoL in SSc. METHODS Subjects were recruited from the Canadian Scleroderma Research Group registry. Global HRQoL was measured using the Medical Outcomes Trust 36-item Short Form Health Survey (SF-36) and oral HRQoL with the Oral Health Impact Profile (OHIP). The Medsger Disease Severity Score was used to determine organ involvement. Multivariate regression models determined the independent association of the OHIP with the SF-36 after adjusting for confounders. RESULTS This study included 156 SSc subjects. The majority (90%) were women, with a mean age of 56 years, mean disease duration 13.8 years (s.d. 8.5) and 29% of the subjects had dcSSc. Mean total OHIP score was 40.8 (s.d. 32.4). Mean SF-36 mental component summary (MCS) score was 49.7 (s.d. 11.1) and physical component summary (PCS) score was 37.0 (s.d. 10.7). In adjusted analyses, the total OHIP score was significantly associated with the SF-36 MCS and PCS, accounting for 9.7% and 5.6% of their respective variances. Measures of disease severity were not related to OHIP score. CONCLUSION Oral HRQoL in SSc is independently associated with global HRQoL. Oral HRQoL, however, is not related to physician-assessed disease severity. This suggests that physicians may be disregarding issues related to oral health. HRQoL is an additional dimension of HRQoL not captured by generic instruments such as the SF-36.
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Affiliation(s)
- Murray Baron
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada. Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Period
| | - Marie Hudson
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada. Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Period
| | - Solène Tatibouet
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Russell Steele
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada. Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Period
| | - Ernest Lo
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Sabrina Gravel
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Geneviève Gyger
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada. Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Period
| | - Tarek El Sayegh
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Janet Pope
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Audrey Fontaine
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Ariel Masetto
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Debora Matthews
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Evelyn Sutton
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Norman Thie
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Niall Jones
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Maria Copete
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Dean Kolbinson
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Janet Markland
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Getulio Nogueira-Filho
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - David Robinson
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Mervyn Gornitsky
- Division of Rheumatology, Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, McGill University, Montreal, QC, Epidemiology, Lady Davis Institute, SMBD Jewish General Hospital, Montreal, Department of Mathematics and Statistics, Dentistry, Division of Rheumatology, Department of Medicine, University of Western Ontario, London, ON, Dentistry, Clinique Dentaire Ayotte et associées, Department of Rheumatology, Université de Sherbrooke, Sherbrooke, Division of Periodontics and Oro-facial Pain, Faculty of Dentistry, Dalhousie University, Division of Rheumatology, Faculty of Medicine, Dalhousie University, Halifax, TMD/Orofacial Pain Graduate Program, School of Dentistry, Department of Medicine, University of Alberta, Edmonton, AB, College of Dentistry, Division of Rheumatology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Department of Periodontology, Faculty of Dentistry, Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, MB and Department of Dentistry, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada
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Yuen HK, Nelson SL. Test--retest reliability of Oral Health Impact Profile (OHIP-49) in adults with systemic sclerosis. SPECIAL CARE IN DENTISTRY 2013; 34:27-33. [PMID: 24382368 DOI: 10.1111/scd.12036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To assess the test-retest reliability of the Oral Health Impact Profile (OHIP) in 3-month intervals among people with systemic sclerosis (SSc). METHODS Thirty-nine adults with SSc completed the OHIP-49 at baseline, 3 and 6 months. Intraclass correlation (ICC), standard error of measurement (SEM), SEM%, coefficient of repeatability (CoR), and 95% limits of agreement (LoA) were used to assess test-retest reliability and measurement variability. RESULTS The ICC of the OHIP for the first time point (baseline to 3-month) was excellent (>.80), and the second time point (3-month to 6-month) demonstrated good reproducibility (>.60). However, the large SEM, SEM%, CoR, and 95% LoA indicated that the OHIP was neither a precise measurement nor sensitive to change in response to interventions. CONCLUSION The values of the ICC indicated that the OHIP scores demonstrated acceptable stability across each of the two 3 months' retest duration, supporting the reliability of the OHIP for group-level comparisons. However, using the OHIP as a measure of an individual's oral health-related quality of life in adults with SSc is not recommended.
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Affiliation(s)
- Hon K Yuen
- Professor and and Director of Research, Department of Occupational Therapy, School of Health Professions, University of Alabama, Birmingham, Alabama
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Yuen HK, Weng Y, Reed SG, Summerlin LM, Silver RM. Factors associated with gingival inflammation among adults with systemic sclerosis. Int J Dent Hyg 2013; 12:55-61. [PMID: 23611650 DOI: 10.1111/idh.12024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify factors associated with increased gingival inflammation in adults with systemic sclerosis (SSc, scleroderma). METHODS In this cross-sectional study, forty-eight adults with SSc received assessment of gingival inflammation using Löe and Silness gingival index (LSGI), measurement of oral aperture and evaluation of manual dexterity to perform oral hygiene using the Toothbrushing Ability Test, as well as completion of an oral health-related questionnaire. RESULTS Three explanatory variables in the final multiple predictor models for the LSGI outcome were statistically significant--manual dexterity to perform oral hygiene, flossing in the evening and SSc subtype, with higher (i.e., worse) LSGI score among those with impaired manual dexterity, not flossing in the evening and diffuse form of SSc. In addition, posterior teeth had higher LSGI scores compared with that of the anterior teeth after adjusting for other variables. CONCLUSIONS Results suggest that dental health professionals take manual dexterity into consideration when educating patients with SSc to improve their oral hygiene and educate them on paying more attention on cleaning their posterior teeth and the importance of flossing in the evening--especially those who only floss once a day or less often.
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Affiliation(s)
- H K Yuen
- Department of Occupational Therapy, School of Health Professions, University of Alabama, Birmingham, AL, USA
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