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Zhou Y, Chen Y, Yin G, Xie Q. Calciphylaxis and its co-occurrence with connective tissue diseases. Int Wound J 2023; 20:1316-1327. [PMID: 36274216 PMCID: PMC10031236 DOI: 10.1111/iwj.13972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 03/23/2023] Open
Abstract
Calciphylaxis, also known as calcific uremic arteriopathy, is a rare calcification syndrome that presents as ischemic skin necrosis and severe pain. It has a high mortality rate and is characterised by calcification of the small and medium arteries and micro-thrombosis. Calciphylaxis mainly occurs in patients with end-stage renal disease. In recent years, there have been an increasing number of cases of calciphylaxis associated with connective tissue diseases. Given the absence of clear diagnostic criteria for calciphylaxis thus far, an early diagnosis is crucial for designing an effective multidisciplinary treatment plan. In this article, we review the research progress on calciphylaxis and describe its characteristics in the context of connective tissue diseases.
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Affiliation(s)
- Yueyuan Zhou
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuehong Chen
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Geng Yin
- Department of General Practice, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qibing Xie
- Department of Rheumatology and Immunology, West China Hospital, Sichuan University, Chengdu, China
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Vangaveti VN, Jhamb S, Hayes O, Goodall J, Bulbrook J, Robertson K, Biros E, Sangla KS, Malabu UH. Effects of vildagliptin on wound healing and markers of inflammation in patients with type 2 diabetic foot ulcer: a prospective, randomized, double-blind, placebo-controlled, single-center study. Diabetol Metab Syndr 2022; 14:183. [PMID: 36456992 PMCID: PMC9716851 DOI: 10.1186/s13098-022-00938-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/31/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Diabetic foot ulcers (DFU) are one of the leading long-term complications experienced by patients with diabetes. Dipeptidyl Peptidase 4 inhibitors (DPP4is) are a class of antihyperglycemic medications prescribed to patients with diabetes to manage glycaemic control. DPP4is may also have a beneficial effect on DFU healing. This study aimed to determine vildagliptin's effect on inflammatory markers and wound healing. TRIAL DESIGN Prospective, randomized, double-blind, placebo-controlled, single-center study. METHODS Equal number of participants were randomized into the treatment and placebo groups. The treatment was for 12 weeks, during which the participants had regular visits to the podiatrist, who monitored their DFU sizes using 3D camera, and blood samples were taken at baseline, six weeks, and 12 weeks during the study for measurement of inflammatory markers. In addition, demographic characteristics, co-morbidities, DFU risk factors, and DFU wound parameters were recorded. RESULTS 50 participants were recruited for the study, with 25 assigned to placebo and 25 to treatment group. Vildagliptin treatment resulted in a statistically significant reduction of HBA1c (p < 0.02) and hematocrit (p < 0.04), total cholesterol (p < 0.02), LDL cholesterol (p < 0.04), and total/HDL cholesterol ratio (P < 0.03) compared to the placebo group. Also, vildagliptin had a protective effect on DFU wound healing, evidenced by the odds ratio (OR) favoring the intervention of 11.2 (95% CI 1.1-113.5; p < 0.04) and the average treatment effect on the treated (ATET) for vildagliptin treatment group showed increased healing by 35% (95%CI; 10-60, p = 0.01) compared to placebo with the model adjusted for microvascular complications, smoking, amputation, dyslipidemia, peripheral vascular disease (PVD) and duration of diabetes. CONCLUSIONS Vildagliptin treatment was effective in healing DFU in addition to controlling the diabetes. Our findings support the use of DPP4is as a preferred option for treating ulcers in patients with diabetes. Further studies on a larger population are warranted to confirm our findings and understand how DPP4is could affect inflammation and DFU healing.
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Affiliation(s)
- Venkat N Vangaveti
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, 100 Angus Smith Drive, Douglas, QLD, 4814, Australia
| | - Shaurya Jhamb
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, 100 Angus Smith Drive, Douglas, QLD, 4814, Australia
- Department of Endocrinology and Diabetes, Townsville University Hospital, Douglas, Townsville, QLD, 4814, Australia
| | - Oliver Hayes
- Department of Endocrinology and Diabetes, Townsville University Hospital, Douglas, Townsville, QLD, 4814, Australia
| | - Julie Goodall
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, 100 Angus Smith Drive, Douglas, QLD, 4814, Australia
- Department of Endocrinology and Diabetes, Townsville University Hospital, Douglas, Townsville, QLD, 4814, Australia
| | - Jacqueline Bulbrook
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, 100 Angus Smith Drive, Douglas, QLD, 4814, Australia
- Department of Endocrinology and Diabetes, Townsville University Hospital, Douglas, Townsville, QLD, 4814, Australia
| | - Kelvin Robertson
- Department of Pharmacy, Townsville University Hospital, Douglas, Townsville, QLD, 4814, Australia
| | - Erik Biros
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, 100 Angus Smith Drive, Douglas, QLD, 4814, Australia
| | - Kunwarjit S Sangla
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, 100 Angus Smith Drive, Douglas, QLD, 4814, Australia
- Department of Endocrinology and Diabetes, Townsville University Hospital, Douglas, Townsville, QLD, 4814, Australia
| | - Usman H Malabu
- Translational Research in Endocrinology and Diabetes, College of Medicine and Dentistry, James Cook University, 100 Angus Smith Drive, Douglas, QLD, 4814, Australia.
- Department of Endocrinology and Diabetes, Townsville University Hospital, Douglas, Townsville, QLD, 4814, Australia.
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Safavi M, Sadeghi P, Hosseinlou S. Calciphylaxis in an adolescent without renal failure. Arch Dis Child 2022; 107:1137. [PMID: 35840314 DOI: 10.1136/archdischild-2022-324345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Moeinadin Safavi
- Pathology Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Payman Sadeghi
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran.,Children's Medical Center, Pediatrics Center of Excellence, Tehran, Iran.,Pediatric Rheumatology Society of Iran, Tehran, Iran
| | - Shima Hosseinlou
- Pathology Department, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Bajaj R, Courbebaisse M, Kroshinsky D, Thadhani RI, Nigwekar SU. Calciphylaxis in Patients With Normal Renal Function: A Case Series and Systematic Review. Mayo Clin Proc 2018; 93:1202-1212. [PMID: 30060958 DOI: 10.1016/j.mayocp.2018.06.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 06/02/2018] [Accepted: 06/05/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To define concomitant risk factors, treatment, and outcomes for patients with nonnephrogenic calciphylaxis (NNC). PATIENTS AND METHODS A retrospective review of Massachusetts General Hospital (MGH) medical records (January 1, 2014, through February 29, 2016) and a systematic literature review of PubMed, Google Scholar, EMBASE, MEDLINE, and CENTRAL (August 1, 1970, through July 31, 2016) were performed. Demographic characteristics and concomitant features were summarized and compared between patients with different lesion characteristics. Outcomes (lesion improvement and mortality) and their predictors were analyzed. RESULTS Nine patients (median age, 72 years [interquartile range (IQR), 44-82 years]; 78% women; 89% white race) were identified through MGH records. The literature review identified 107 patients (median age, 60 years [IQR, 49-72 years]; 77% women; 86% white race). Vitamin K antagonism and obesity were the most common concomitant factors. In the literature review, lower age (P<.001) and higher body mass index (P=.03) were associated with the central location of lesions, whereas vitamin K antagonism was associated with the peripheral location (P=.009). In the MGH series, median survival was 24.0 months (95% CI, 7.8-36.0 months), and 33% (95% CI, 14%-60%) had lesion improvement by 6 months. In the literature review, median survival was 4.2 months (95% CI, 1.9-5.9 months), median time to lesion improvement was 5.9 months (95% CI, 3.9-8.9 months), and none of the treatments were associated with lesion improvement or survival. CONCLUSION This description of concomitant traits may augment an earlier recognition of NNC. Future research is needed to investigate NNC pathogenesis and treatments.
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Affiliation(s)
- Richa Bajaj
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, MA; Khorana Scholar 2016, Khorana Program for Scholars, INDO-US Science and Technology Forum, New Delhi, India
| | - Marie Courbebaisse
- Division of Bone and Mineral Research, Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA; Faculty of Medicine, Paris Descartes University, Paris, France
| | | | - Ravi I Thadhani
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, MA; Department of Biomedical Sciences and Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sagar U Nigwekar
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, MA.
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Lorriaux A, Chaby G, Dhaille F, Dadban A, Arnault JP, Dhillies AS, Lombart F, Chatelain D, Lok C. Nonuraemic calciphylaxis: response to treatment with pamidronate and negative pressure therapy. Clin Exp Dermatol 2014; 40:52-5. [DOI: 10.1111/ced.12505] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2014] [Indexed: 01/02/2023]
Affiliation(s)
- A. Lorriaux
- Department of Dermatology; Université de Picardie Jules Verne; Amiens University Medical Center; North Hospital; Amiens France
| | - G. Chaby
- Department of Dermatology; Université de Picardie Jules Verne; Amiens University Medical Center; North Hospital; Amiens France
| | - F. Dhaille
- Department of Dermatology; Université de Picardie Jules Verne; Amiens University Medical Center; North Hospital; Amiens France
| | - A. Dadban
- Department of Dermatology; Université de Picardie Jules Verne; Amiens University Medical Center; North Hospital; Amiens France
| | - J. P. Arnault
- Department of Dermatology; Université de Picardie Jules Verne; Amiens University Medical Center; North Hospital; Amiens France
| | - A. S. Dhillies
- Department of Dermatology; Université de Picardie Jules Verne; Amiens University Medical Center; North Hospital; Amiens France
| | - F. Lombart
- Department of Dermatology; Université de Picardie Jules Verne; Amiens University Medical Center; North Hospital; Amiens France
| | - D. Chatelain
- Department of Pathology; Université de Picardie Jules Verne; Amiens University Medical Center; North Hospital; Amiens France
| | - C. Lok
- Department of Dermatology; Université de Picardie Jules Verne; Amiens University Medical Center; North Hospital; Amiens France
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Abstract
Calciphylaxis is a devastating disorder with a mortality rate of 80% due to sepsis and organ failure. Hallmarks of this rare disease are arteriolar media calcification, thrombotic cutaneous ischemia, and necrotic ulcerations. Different mechanisms of vascular calcification can lead to calciphylaxis. Early diagnosis by deep cutaneous ulcer biopsy is most important for prognosis. Here, dermatologists play a significant role although treatment usually needs an interdisciplinary approach. Surgical procedures had been the cornerstone of treatment in the past including parathyroidectomy, but recently new medical treatments emerged aiming to normalize disturbances of minerals to reduce the serum concentration of sodium phosphate and to prevent precipitation and calcification. Multimodal therapy is warranted but only aggressive surgical debridement of cutaneous ulcers has shown significant outcome improvement.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, 01067 Dresden, Germany
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Calcific uremic arteriolopathy on multimodal combination therapy: still unmet goal. Int J Nephrol 2012; 2012:390768. [PMID: 22518312 PMCID: PMC3299321 DOI: 10.1155/2012/390768] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 11/18/2011] [Accepted: 12/03/2011] [Indexed: 11/18/2022] Open
Abstract
Background. Calcific uremic arteriolopathy (CUA) or calciphylaxis though generally noted for its high mortality, recent case reports have shown promising results using single agent therapies. However, it is not clear whether combination therapeutic agents will improve course of the disease. Objective. To determine clinical outcome in subjects with CUA on multimodal treatment. Methods. All patients with end-stage renal failure (ESRF) at The Townsville Hospital, Australia, from April 1, 2006, to March 31, 2011, with diagnosis of CUA were retrospectively studied. Results. Six subjects with CUA (4 females and 2 males) were on various combination therapeutic agents comprising sodium thiosulphate, hyperbaric oxygen, prednisolone, cinacalcet, and parathyroidectomy in addition to intensified haemodialysis, specialist local wound care, and antibiotics. The wounds failed to heal in 3 patients while 5 of the 6 subjects died; cause of death being sepsis in 3 and myocardial infarction in 2. Conclusion. Prognosis of CUA remains poor in spite of multimodal combination therapy. Further prospective studies on a larger population are needed to verify our findings.
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