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Stjernbrandt A, Pettersson H, Vihlborg P, Höper AC, Aminoff A, Wahlström J, Nilsson T. Raynaud's phenomenon in the feet of Arctic open-pit miners. Int J Circumpolar Health 2024; 83:2295576. [PMID: 38109321 PMCID: PMC10732197 DOI: 10.1080/22423982.2023.2295576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023] Open
Abstract
The literature on Raynaud's phenomenon (RP) in the feet is scarce, especially in the occupational setting. The primary aim of our study was to investigate the occurrence of RP in the feet of miners. As part of the MineHealth project, written surveys and clinical examinations were completed by 260 Arctic open-pit miners working in northern Sweden and Norway (participation rate 53.6%). Data on RP were collected using standardised colour charts and questionnaire items. Clinical examination included assessing the perception of vibration and pain in both feet. There were eight women and three men who reported RP in the feet. Four also had RP in their hands but none acknowledged any first-degree relatives with the condition. Nine reported exposure to foot-transmitted vibration and one to hand-arm vibration. Seven showed signs of neurosensory injury in the feet. To conclude, the occurrence of RP in the feet of miners was 4.4%. Most cases with RP in the feet did not report the condition in the hands and were exposed to vibration transmitted directly to the feet. There were no reports of a hereditary component. Most cases with RP in the feet also had clinical findings suggestive of peripheral neuropathy in the feet.
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Affiliation(s)
- Albin Stjernbrandt
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Hans Pettersson
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Per Vihlborg
- Department of Geriatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anje Christina Höper
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anna Aminoff
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jens Wahlström
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tohr Nilsson
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Liang Y, Li J, Zhang Z, Jiang T, Yang Z. Extrahepatic conditions of primary biliary cholangitis: A systematic review and meta-analysis of prevalence and risk. Clin Res Hepatol Gastroenterol 2024; 48:102321. [PMID: 38518985 DOI: 10.1016/j.clinre.2024.102321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/16/2024] [Accepted: 03/16/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND AND AIM Many studies reported the prevalence of extrahepatic conditions (EHC) of primary biliary cholangitis (PBC), but the great heterogeneity existed across different studies. Therefore, we conducted the systematic review and meta-analyses to determine EHC prevalence and association with PBC. METHODS We searched PUBMED and included observational, cross-sectional and case-controlled studies. A random or fixed effects model was used to estimate the pooled prevalence and odd ratio (OR) as appropriate. RESULTS Of 5370 identified publications, 129 publications with 133 studies met the inclusion criteria. Sjögren's syndrome had the highest prevalence (21.4 % vs. 3 % in non-PBC individuals), followed by Raynaud's syndrome (12.3 % vs. 1 %), rheumatoid arthritis-like arthritis (5 % vs. 3 %), systemic sclerosis (3.7 % vs. 0 %) and systemic lupus erythematosus (2 % vs. 0 %). The prevalence of overall thyroid diseases (11.3 %), autoimmune thyroid diseases (9.9 %), osteoporosis (21.1 %), celiac disease (1 %) and chronic bronchitis (4.6 %) was also increased among PBC patients. CONCLUSION This is the first exhaustive study on the old theme about EHC of PBC. Given increased prevalence of many EHCs in PBC patients, promptly recognizing these EHCs are of great importance for timely and precise diagnosis of PBC.
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Affiliation(s)
- Yan Liang
- Department of Laboratory Medicine, Changzheng Hospital, Naval Medical University, Shanghai, PR China.
| | - Jie Li
- Department of Laboratory Medicine, Huangyan Hospital of Wenzhou Medical University, Taizhou First People's Hospital, Taizhou, Zhejiang, PR China
| | - Zhiyu Zhang
- Health Management Center, Changzheng Hospital, Naval Medical University, Shanghai, PR China
| | - Tingwang Jiang
- Key Laboratory, Department of Science and Technology, The Second People's Hospital of Changshu, The Affiliated Changshu Hospital of Xuzhou Medical University, Changshu, Jiangsu, PR China
| | - Zaixing Yang
- Department of Laboratory Medicine, Huangyan Hospital of Wenzhou Medical University, Taizhou First People's Hospital, Taizhou, Zhejiang, PR China.
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Chen GF, Shaw KS, Xu S, Hashemi KB, Castillo RL, Vleugels RA, Cohen JM. Depression in patients with Raynaud's phenomenon: A case-control study in the National Institutes of Health's All of Us Research Program. J Am Acad Dermatol 2024; 90:857-859. [PMID: 38128831 DOI: 10.1016/j.jaad.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/09/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Affiliation(s)
| | - Katharina S Shaw
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Suzanne Xu
- Yale School of Medicine, New Haven, Connecticut
| | - Kimberly B Hashemi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rochelle L Castillo
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ruth Ann Vleugels
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut; Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut.
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Curtiss P, Svigos K, Schwager Z, Lo Sicco K, Franks AG. Part I: Epidemiology, pathophysiology, and clinical considerations of primary and secondary Raynaud's phenomenon. J Am Acad Dermatol 2024; 90:223-234. [PMID: 35809798 DOI: 10.1016/j.jaad.2022.06.1199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/24/2022]
Abstract
Raynaud's phenomenon (RP) is a relatively common disease with both primary and secondary forms. It is well understood as a vasospastic condition affecting the acral and digital arteries, resulting in characteristic, well-demarcated color changes typically in the hands and feet in response to cold or stress. Secondary RP (SRP) has been described in association with a variety of rheumatologic and nonrheumatologic diseases, environmental exposures, and/or medications. While both primary RP and SRP may impact the quality of life, SRP may lead to permanent and potentially devastating tissue destruction when undiagnosed and untreated. It is therefore crucial for dermatologists to distinguish between primary and secondary disease forms early in clinical evaluation, investigate potential underlying causes, and risk stratify SRP patients for the development of associated autoimmune connective tissue disease. The epidemiology, pathogenesis, and clinical presentation and diagnosis of both forms of RP are described in detail in this review article.
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Affiliation(s)
- Paul Curtiss
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Katerina Svigos
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Zachary Schwager
- Department of Dermatology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Kristen Lo Sicco
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York.
| | - Andrew G Franks
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York; Department of Internal Medicine, Division of Rheumatology, New York University School of Medicine, New York, New York
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Lun X, Yang J, Liu Y, Zhao F, Wei Z, Sun Y, Zhou X. Risk factors of systemic lupus erythematosus patients with pulmonary arterial hypertension: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e36654. [PMID: 38134088 PMCID: PMC10735116 DOI: 10.1097/md.0000000000036654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND To investigate the risk factors for the development of pulmonary arterial hypertension (PAH) in patients with systemic lupus erythematosus (SLE). METHODS The literature related to risk factors for the development of PAH in SLE patients was searched by the computer on China national knowledge infrastructure (CNKI), PubMed, and Embase, and the literature search was limited to the period of library construction to October 2022. Two researchers independently performed literature screening and literature information extracting, including first author, publication time, case collection time, sample size, and study factors, and used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of the literature. The relationship between each clinical manifestation and laboratory index and the occurrence of PAH in SLE patients was evaluated based on the ratio (OR value) and its 95% CI. RESULTS A total of 24 publications were included, including 23 case-control studies and 1 cohort study with NOS ≥ 6, and the overall quality of the literature was high. The risk of PAH was higher in SLE patients who developed Raynaud phenomenon than in those who did not [OR = 2.39, 95% CI (1.91, 2.99), P < .05]; the risk of PAH was higher in SLE patients who were positive for anti-RNP antibodies than in those who were negative for anti-RNP antibodies [OR = 1.77, 95% CI (1.17, 3.2.65), P < .05]; the risk of PAH was higher in SLE patients with interstitial lung lesions than in those without combined interstitial lung lesions [OR = 3.28, 95% CI (2.37, 4.53), P < .05]; the risk of PAH was higher in SLE patients with combined serositis than in those without serositis [OR = 2.28, 95% CI (1.83, 2.84), P < .05]. The risk of PAH was higher in SLE patients with combined pericardial effusion than in those without pericardial effusion [OR = 2.97, 95% CI (2.37, 3.72), P < .05]; the risk of PAH was higher in SLE patients with combined vasculitis than in those without vasculitis [OR = 1.50, 95% CI (1.08, 2.07), P < .05]; rheumatoid factor-positive SLE patients had a higher risk of PAH than those with rheumatoid factor-negative [OR = 1.66, 95% CI (1.24, 2.24), P < .05]. CONCLUSION Raynaud phenomenon, vasculitis, anti-RNP antibodies, serositis, interstitial lung lesions, rheumatoid factor, and pericardial effusion are risk factors for the development of PAH in patients with SLE.
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Affiliation(s)
- Xueping Lun
- Ji’nan Zhangqiu District Hospital of Traditional Chinese Medicine, Jinan City, China
| | - Jianguo Yang
- First Clinical Medical College, Shandong university of traditional Chinese medicine, Jinan City, China
| | - Ying Liu
- Rheumatology and immunology Department, The affiliated hospital of Shandong university of traditional Chinese medicine, Jinan City, China
| | - Fuyu Zhao
- Guanghua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhiliang Wei
- Radiological department, Shanghe county hospital of traditional Chinese medicine, Jinan City, China
| | - Yuying Sun
- First Clinical Medical College, Shandong university of traditional Chinese medicine, Jinan City, China
| | - Xinpeng Zhou
- Rheumatology and immunology Department, The affiliated hospital of Shandong university of traditional Chinese medicine, Jinan City, China
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Barbacki A, Rached-d'Astous N, Pineau CA, Vinet E, Grenier LP, Kalache F, Fallavollita S, Lukusa L, Bernatsky S. Clinical Significance of Raynaud Phenomenon in Systemic Lupus Erythematosus. J Clin Rheumatol 2022; 28:e488-e490. [PMID: 35192594 DOI: 10.1097/rhu.0000000000001773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE There are limited reports of the clinical significance of Raynaud phenomenon (RP) in systemic lupus erythematosus (SLE), with some suggesting RP is associated with less severe lupus. Since most prior studies were small and/or focused on a specific race/ethnic demographic, it is unclear if those results are generalizable. We evaluated whether RP was associated with demographic and clinical factors in a large multiethnic SLE cohort. METHODS We studied Montreal General Hospital SLE cohort patients who are followed with standardized annual assessments. We included patients with at least 1 visit across 2011-2018 and assessed demographic and clinical variables (using the 1997 American College of Rheumatology criteria and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index) at their first visit. We present multivariate logistics regression analyses of cross-sectional associations between these variables and RP in SLE. RESULTS Of 489 SLE patients, most were female (n = 445, 91%). Mean age at SLE diagnosis was 31.5 (standard deviation, 13.5) years, and 169 (34.6%) had RP. In our fully adjusted model, female sex (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.07-6.03), White race/ethnicity (OR, 1.85; 95% CI, 1.10-3.17), neurological/neuropsychiatric manifestations (OR, 1.98; 95% CI, 1.10-3.56), and anti-RNP antibodies (OR, 3.03; 95% CI, 1.73-5.38) were positively associated with RP, whereas hemolytic anemia and cellular casts were negatively associated. CONCLUSIONS/DISCUSSION Over one third of our large multiethnic North American SLE cohort had RP. This study confirmed associations between RP and a specific SLE phenotype.
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Zhu GQ, Qiu HX, Ma XM, Liu MX. Clinical Study on Systemic Lupus Erythematosus Complicated with Knee Bone Infarction. Int J Clin Pract 2022; 2022:7025811. [PMID: 35936062 PMCID: PMC9314162 DOI: 10.1155/2022/7025811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The present study aims to (1) analyze the clinical characteristics and related influencing factors of knee bone infarction in systemic lupus erythematosus (SLE) and (2) improve the understanding of SLE complicated with knee bone infarction. METHODS The data of patients with SLE complicated with knee bone infarction were retrospectively analysed; patients with SLE during the same period who matched in age, gender, and disease duration were selected as control subjects, with a 1 : 1 ratio with the SLE group. The clinical data were collected to analyze the risk factors for SLE complicated with knee bone infarction. RESULTS In a total of 36 (6.4%) of 563 patients aged 19-33 (25.8 ± 4.8) years who had SLE during the same period, the disease was complicated with knee bone infarction. The diagnosis of knee bone infarction was made at an SLE duration of 7-65 (26.2 ± 15.7) months. During the SLE course, knee bone infarction occurred within 1 year in 6 cases (16.7%), within 1-5 years in 28 cases (77.8%), and in >5 years in 2 cases (5.6%). Raynaud's phenomenon incidence and anti-nRNP antibody positivity were significantly higher in the knee bone infarction group than in the control group (P < 0.01 and P < 0.05, respectively). The cumulative glucocorticoid dose at 1, 3, and 6 months was significantly higher in the knee bone infarction group than in the control group (P < 0.05). SLE complicated with knee necrosis had a statistically significant rank correlation with Raynaud's phenomenon (r = 0.445, P < 0.001), anti-nRNP antibody (r = 0.309, P=0.008), and renal injury (r = 0.252, P=0.032). The multivariate analysis of SLE complicated with knee bone infarction showed that Raynaud's phenomenon was an independent influencing factor for the complicated knee bone infarction in SLE patients (OR = 4.938, P=0.004), and the probability of SLE complicated with knee bone infarction in Raynaud's phenomenon positive patients was 4.938 times that of Raynaud's phenomenon negative patients. CONCLUSIONS The risk of knee bone infarction was relatively high in patients with SLE within a 5-year disease course and in young patients. The risk factors were Raynaud's phenomenon, anti-nRNP antibody positivity, and early high-dose glucocorticoid therapy.
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Affiliation(s)
- Gui-Qi Zhu
- Department of Rheumatology, Zaozhuang Municipal Hospital, Zaozhuang 277000, China
| | - Hong-Xia Qiu
- Department of Rheumatology, Xi'an Fifth Hospital, Xi'an 710000, China
| | - Xin-mei Ma
- Department of Rheumatology, Zaozhuang Municipal Hospital, Zaozhuang 277000, China
| | - Mei-Xia Liu
- Department of Physiotherapy, Zaozhuang Municipal Hospital, Zaozhuang 277000, China
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Pimenta da Fonseca E, Lins CF, de Sá Ribeiro DL, Santos WGD, Rosa G, Machicado V, Pedreira AL, Souza APMD, Baleeiro C, Dos Santos Ferreira LG, de Oliveira IS, da Silva JPCG, Atta AM, Santiago MB. Videocapillaroscopic Findings in Patients With Systemic Lupus Erythematosus With or Without Jaccoud Arthropathy. J Clin Rheumatol 2021; 27:S198-S203. [PMID: 33337816 DOI: 10.1097/rhu.0000000000001617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE Systemic lupus erythematosus (SLE) is an autoimmune disease that can present changes in blood vessels, which can be evaluated by periungual nailfold videocapillaroscopy (VCP). This technique is important for the diagnosis of systemic sclerosis and to identify individuals with Raynaud phenomenon at higher risk of developing systemic sclerosis. This study aims to describe the videocapillaroscopic profile of a series of SLE patients and to investigate if the VCP pattern is different among those with Jaccoud arthropathy (JA) compared with those without. METHODS Between September 2014 and March 2015, the patients in this study underwent VCP, clinical evaluation, and laboratory tests. The capillaroscopic patterns were defined as minor, major, and scleroderma (SD). The presence of capillaroscopic findings, such as elongated capillaries, tortuosity, ectasia, prominent venous plexus, neoangiogenesis, hemorrhage, and megacapillaries, were also observed. Associations were calculated using the χ2, Fisher exact, or Student t test. RESULTS In a population of 113 females with SLE (67 without JA and 46 with JA), at least 1 alteration was observed in VCP in 89.40% of them, among which "nonspecific changes" were the most prevalent. Minor changes were seen in 39 (58.2%) and 26 (56.5%), major changes in 21 (31.3%) and 11 (23.9%), and SD pattern in 2 (3.0%) and 3 (6.5%), in the patients without and with JA, respectively (p > 0.05). CONCLUSIONS The majority of patients with SLE demonstrated changes in the VCP examination, but this tool did not allow discrimination between those with or without JA.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Ajax Merces Atta
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Bahia
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Juche A, Siegert E, Mueller-Ladner U, Riemekasten G, Günther C, Kötter I, Henes J, Blank N, Voll RE, Ehrchen J, Schmalzing M, Susok L, Schmeiser T, Sunderkoetter C, Distler J, Worm M, Kreuter A, Horváth ON, Schön MP, Korsten P, Zeidler G, Pfeiffer C, Krieg T, Hunzelmann N, Moinzadeh P. [Reality of inpatient vasoactive treatment with prostacyclin derivatives in patients with acral circulation disorders due to systemic sclerosis in Germany]. Z Rheumatol 2020; 79:1057-1066. [PMID: 32040755 PMCID: PMC7708340 DOI: 10.1007/s00393-019-00743-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hintergrund Das Raynaud-Phänomen und die damit häufig einhergehenden digitalen Ulzerationen stellen für Patienten mit systemischer Sklerose (Sklerodermie [SSc]) ein frühes und sehr belastendes Symptom mit bedeutenden Einschränkungen der Arbeitsfähigkeit und Lebensqualität dar. Der Einsatz vasoaktiver Medikamente (insbesondere intravenöser Prostazyklinderivate) soll helfen, das Risiko hypoxischer Gewebeschäden bis hin zum Verlust der Finger zu reduzieren. Methoden Um Aufschluss über die aktuelle Versorgung von Patienten mit Prostazyklinderivaten im klinischen Alltag in Deutschland zu erhalten, führten wir eine Umfrage unter den im Deutschen Netzwerk für systemische Sklerodermie (DNSS) zusammengeschlossenen Kliniken durch. Zusätzlich erfolgte eine separate Patientenbefragung über die Sklerodermie Selbsthilfe e. V., die sich nur auf die Symptome „Raynaud-Phänomen“ und „Digitale Ulzera“ und den Einsatz intravenöser Prostazyklinderivate bezog. Ergebnisse Von den befragten 433 Patienten gaben 56 % an, dass sie bereits aufgrund ihrer Erkrankung und Symptome mit Prostazyklinderivaten behandelt wurden. Insgesamt 61 % erhielten die Therapie aufgrund starker Raynaud-Symptomatik und 39 % aufgrund digitaler Ulzerationen. Die meisten Befragten erfuhren durch die Therapie nicht nur eine Verbesserung des Raynaud-Phänomens und der digitalen Ulzera, sondern auch eine wesentliche Verbesserung von Einschränkungen im Alltag. Sie gaben zudem an, wesentlich weniger fremde Hilfe in Anspruch genommen sowie wesentlich weniger Fehlzeiten bei der Arbeit gehabt zu haben. Schlussfolgerung Die Patienten empfanden durchweg einen positiven Effekt der Therapie mit Prostazyklinderivaten auf das Raynaud-Phänomen, ihre digitalen Ulzerationen, Schmerzen und Alltagseinschränkung und fühlten sich durch die stationäre Therapie gut und sicher betreut. Diese positiven Effekte in der Patientenwahrnehmung sind eine eindrückliche Stütze und bestätigen nachdrücklich die auf europäischer und internationaler Ebene erarbeiteten Therapieempfehlungen. Zusatzmaterial online Die Online-Version dieses Beitrags (10.1007/s00393-019-00743-9) enthält die 2 Fragebögen, die für die Befragung verwendet wurden. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“. ![]()
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Affiliation(s)
- A Juche
- Klinik für Rheumatologie, Immanuel Krankenhaus Berlin-Buch, Berlin, Deutschland
| | - E Siegert
- Klinik für Rheumatologie u. klinischer Immunologie, Charité Berlin, Berlin, Deutschland
| | - U Mueller-Ladner
- Rheumatologie und klinische Immunologie, Kerckhoff-Klinik, Bad Nauheim, Deutschland
| | - G Riemekasten
- Klinik für Rheumatologie und Immunologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland
| | - C Günther
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Deutschland
| | - I Kötter
- Klinik für Rheumatologie, klinische Immunologie u. Nephrologie, Asklepios Kliniken Hamburg, Hamburg, Deutschland
| | - J Henes
- Zentrum für interdisziplinäre Rheumatologie, Immunologie und Autoimmunerkrankungen INDIRA und Medizinische Klinik II, Universitätsklinik Tübingen, Tübingen, Deutschland
| | - N Blank
- Medizinische Klinik f. Hämatologie, Onkologie u. Rheumatologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - R E Voll
- Klinik für Rheumatologie u. Klinische Immunologie, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
| | - J Ehrchen
- Klinik für Hautkrankheiten, allg. Dermatologie u. Venerologie, Universitätsklinikum Münster, Münster, Deutschland
| | - M Schmalzing
- Rheumatologie/Klinische Immunologie, Medizinische Klinik II, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - L Susok
- Klinik für Dermatologie, Allergologie u. Venerologie der Ruhr-Universität Bochum, Krankenhaus St. Josef-Hospital Bochum, Bochum, Deutschland
| | - T Schmeiser
- Klinik für Rheumatologie, Immunologie u. Osteologie, St. Josef Wuppertal, Wuppertal, Deutschland
| | - C Sunderkoetter
- Universitätsklinik u. Poliklinik für Dermatologie u. Venerologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - J Distler
- Medizinische Klinik für Rheumatologie u. Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - M Worm
- Klinik für Dermatologie, Venerologie u. Allergologie, Charité Berlin, Berlin, Deutschland
| | - A Kreuter
- Klinik für Dermatologie, Venerologie und Allergologie, HELIOS St. Elisabeth Klinik Oberhausen, Universität Witten/Herdecke, Oberhausen, Deutschland
| | - O N Horváth
- Klinik für Dermatologie u. Allergologie, Ludwig-Maximilians Universität München, München, Deutschland
| | - M P Schön
- Klinik für Dermatologie, Venerologie u. Allergologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
- Niedersächsisches Institut für Berufsdermatologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - P Korsten
- Klinik für Nephrologie u. Rheumatologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - G Zeidler
- Klinik für internistische Rheumatologie, Orthopädie u. Rheumachirurgie, Johanniter-Krankenhaus im Fläming, Treuenbrietzen, Deutschland
| | - C Pfeiffer
- Klinik für Dermatologie u. Allergologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - T Krieg
- Klinik und Poliklinik für Dermatologie und Venerologie, Universität zu Köln, Köln, Deutschland
| | - N Hunzelmann
- Klinik und Poliklinik für Dermatologie und Venerologie, Universität zu Köln, Köln, Deutschland
| | - P Moinzadeh
- Klinik und Poliklinik für Dermatologie und Venerologie, Universität zu Köln, Köln, Deutschland.
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Zaza P, Matthieu R, Jean‐Luc C, Charles K. Drug repurposing in Raynaud's phenomenon through adverse event signature matching in the World Health Organization pharmacovigilance database. Br J Clin Pharmacol 2020; 86:2217-2222. [PMID: 32337731 PMCID: PMC7576623 DOI: 10.1111/bcp.14322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/02/2020] [Accepted: 04/15/2020] [Indexed: 01/27/2023] Open
Abstract
AIMS Several pharmacological treatments are recommended for Raynaud's phenomenon (RP) secondary to systemic sclerosis, but they only have modest efficacy. A way to efficiently identify new drugs is drug repurposing, which can be based on signature matching. The signature could be derived from chemical structures, pharmacological affinity or adverse event profiles. We propose to use the World Health Organization (WHO) pharmacovigilance database to generate repositioning hypotheses for treatments of RP through adverse event signature matching. METHODS We first screened all drugs associated with at least 1 case of erythromelalgia, an adverse effect opposite to RP. In parallel, to define the adverse event signature of drugs recommended in secondary RP from the WHO pharmacovigilance database, we selected the 14 most representative adverse drug reactions (ADRs). Lastly, we performed a hierarchical cluster analysis to identify drugs with similar ADR signature to vasodilatory drugs used in RP. RESULTS In total, 179 drugs were associated with erythromelalgia; they were related to 860 334 adverse events representative of RP drugs in the WHO pharmacovigilance database. Hierarchical cluster analysis allowed identification of 6 clusters. The most stable cluster contained 7 drugs, among which 5 are recommended in secondary RP, or pertain to the same drug class: epoprostenol, nifedipine, nicardipine, lacidipine and israpidine. The 2 remaining drugs were alemtuzumab and fumaric acid. CONCLUSION Our ADR signature matching approach suggests that alemtuzumab and fumaric acid could be effective treatments of secondary RP. The latter is currently being investigated as a treatment of pulmonary hypertension in systemic sclerosis.
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Affiliation(s)
- Putkaradze Zaza
- Inserm CIC1406, clinical pharmacology departmentGrenoble Alpes university hospitalGrenobleFrance
| | - Roustit Matthieu
- Inserm CIC1406, clinical pharmacology departmentGrenoble Alpes university hospitalGrenobleFrance
- Inserm, UMR 1042‐HP2university Grenoble AlpesGrenobleFrance
| | - Cracowski Jean‐Luc
- Inserm CIC1406, clinical pharmacology departmentGrenoble Alpes university hospitalGrenobleFrance
- Inserm, UMR 1042‐HP2university Grenoble AlpesGrenobleFrance
| | - Khouri Charles
- Inserm CIC1406, clinical pharmacology departmentGrenoble Alpes university hospitalGrenobleFrance
- Inserm, UMR 1042‐HP2university Grenoble AlpesGrenobleFrance
- Pharmacovigilance unitGrenoble Alpes university hospitalGrenobleFrance
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11
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Abstract
Background: Raynaud's phenomenon is induced by excessive vasoconstriction of the peripheral microcirculation in response to environmental factors, essentially cold, but also stress or emotions. The objective of the present study is to evaluate the impact of global warming on the worldwide prevalence and severity of Raynaud's phenomenon over the 21 st century. Method: We first estimated the correlation between average temperature and prevalence and severity of Raynaud's phenomenon. Then, we mapped the prevalence and the severity of Raynaud's phenomenon worldwide at Christmas 1999 using historical data and, using climate projections from the Inter-Sectoral Impact Model Intercomparison Project, we predicted the prevalence and severity of Raynaud's phenomenon at Christmas 2099 according to four greenhouse-gas emission scenarios. Results: The prevalence of Raynaud's phenomenon in the general population is expected to decrease by 0.5% per degree Celsius increase. Furthermore, patients are expected to suffer from one less attack per week for each increase of 2.5 degrees Celsius. Conclusions: Our study shows that global warming may have a significant impact on the prevalence and the severity of Raynaud's phenomenon over the 21 st century. However, as expected, this will greatly depend on the level of greenhouse-gas emissions.
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Affiliation(s)
- Charles Khouri
- Clinical pharmacology, Grenoble Alpes University Hospital, Grenoble, France
- Centre Regional de pharmacovigilance, Grenoble Alpes University Hospital, Grenoble, France
- HP2, U1042, University Grenoble Alpes, Grenoble, France
| | - Matthieu Roustit
- Clinical pharmacology, Grenoble Alpes University Hospital, Grenoble, France
- HP2, U1042, University Grenoble Alpes, Grenoble, France
| | - Jean-Luc Cracowski
- Clinical pharmacology, Grenoble Alpes University Hospital, Grenoble, France
- Centre Regional de pharmacovigilance, Grenoble Alpes University Hospital, Grenoble, France
- HP2, U1042, University Grenoble Alpes, Grenoble, France
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Prete M, Favoino E, Giacomelli R, Afeltra A, Cantatore FP, Bruno C, Corrado A, Emmi L, Emmi G, Grembiale RD, Navarini L, Marcoccia A, Liakouli V, Riccardi A, Valentini G, Perosa F. Evaluation of the influence of social, demographic, environmental, work-related factors and/or lifestyle habits on Raynaud's phenomenon: a case-control study. Clin Exp Med 2020; 20:31-37. [PMID: 31679095 DOI: 10.1007/s10238-019-00589-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/22/2019] [Indexed: 11/26/2022]
Abstract
Raynaud's phenomenon (RP) is a clinical disorder characterized by recurrent, reversible episodes of digital vasospasm. RP can be classified as primary (pRP) or secondary, depending on whether it occurs as a benign condition (not disease-associated) or is associated with other diseases, mainly of the connective tissues. In both cases, it can be triggered by environmental factors, as indicated by the increased incidence of pRP episodes following exposure to cold, vibration injury or chemicals. The purpose of this prospective case-control study was to assess, in an Italian cohort of 132 pRP patients, the association of the phenomenon with demographic, lifestyle habits, environmental and work-related factors. Compared to healthy controls, pRP was found to be inversely associated with the use of contact lenses (OR = 0.4; p = 0.004) and of chlorous-based disinfectants (OR = 0.3; p < 0.001) and directly associated with the presence of prosthesis implants (OR = 5.3; p = 0.001) and the use of hydrogen peroxide-based compounds (OR = 2.6; p = 0.002), suggesting that the latter should be avoided in RP affected patients. Multivariate and multivariable analysis confirmed the associations. Further investigations are needed to understand the mechanism(s) underlying these findings.
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Affiliation(s)
- M Prete
- Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Science and Human Oncology (DIMO), University of Bari Medical School, Piazza G. Cesare 11, I-70124, Bari, Italy
| | - E Favoino
- Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Science and Human Oncology (DIMO), University of Bari Medical School, Piazza G. Cesare 11, I-70124, Bari, Italy
| | - R Giacomelli
- Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - A Afeltra
- Clinical Medicine and Rheumatology Department, Campus Bio-Medico, University of Roma, Roma, Italy
| | - F P Cantatore
- Rheumatology Section, Department of Medical and Surgical Sciences, University of Foggia Medical School, Foggia, Italy
| | - C Bruno
- Rheumatology Research Unit, Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - A Corrado
- Rheumatology Section, Department of Medical and Surgical Sciences, University of Foggia Medical School, Foggia, Italy
| | - L Emmi
- Department of Neurosciences, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Firenze, Firenze, Italy
| | - G Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - R D Grembiale
- Rheumatology Research Unit, Department of Health Sciences, University of Catanzaro, Catanzaro, Italy
| | - L Navarini
- Clinical Medicine and Rheumatology Department, Campus Bio-Medico, University of Roma, Roma, Italy
| | - A Marcoccia
- UOSD of Ischemic Microangiopathy and Sclerodermic Ulcers, Sandro Pertini Hospital, Roma, Italy
| | - V Liakouli
- Rheumatology Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - A Riccardi
- Rheumatology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - G Valentini
- Rheumatology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - F Perosa
- Systemic Rheumatic and Autoimmune Diseases Unit, Department of Biomedical Science and Human Oncology (DIMO), University of Bari Medical School, Piazza G. Cesare 11, I-70124, Bari, Italy.
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13
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Ghrairi N, Aouadi S, Elhechmi YZ, Ben Saad S, Ben Ali I, Yalaoui S. Antinuclear antibodies in interstitial lung disease: Prevalence and clinical significance. Tunis Med 2019; 97:1240-1245. [PMID: 32173825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The diagnosis of interstitial lung disease (ILD) requires elimination of underlying connective tissue disease. Consequently, antinuclear antibodies (ANA) are routinely screened in patients with idiopathic interstitial pneumonia. However the clinical usefulness of this practice is not well clear. AIM In this study, we evaluated the frequency of ANA in ILD's patients and investigated the clinical significance of the ANA's presence in these patients. METHODS We conducted a retrospective study of hospitalized patients diagnosed ILD at pulmonary department and for which ANA was performed in the immunology laboratory of our institution. Demographic features, clinical symptoms, biological and radiologic findings and CTD-ILD diagnoses were compared between patients with positive ANA versus negative ANA. RESULTS We enrolled 73 patients. The ANA's prevalence was 32%. There were no significant differences in demographics, pulmonary function test values and radiologic findings between patients with and without ANA. Patients with positive ANA had more cutaneous manifestations (p꞊0.011) and Raynaud's phenomenon (p꞊0.029). The diagnosis of connective tissue disease was made in 42% of patients with positive ANA versus 8% with negative ANA (p꞊ 0.001). ANA's titer higher than 1/320 was predictive of CTD diagnosis (OR꞊14.4) (p<0.001). CONCLUSIONS The research of ANA in PID's patients is an important tool of CTD diagnosis specially in those with suggestive symptoms of autoimmune disease.
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Yalçın KS, Koşar A. The frequency of Raynaud’s phenomenon in patients with methylenetetrahydrofolate reductase gene mutation and hyperhomocysteinemia. Turk J Med Sci 2019; 49:1444-1449. [PMID: 31651110 PMCID: PMC7018243 DOI: 10.3906/sag-1903-206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/22/2019] [Indexed: 12/30/2022] Open
Abstract
Background/aim Raynaud’s phenomenon (RP) is not a rare health problem; global prevalence is about 3%–20%. Etiology and pathophysiology of this pathology has not been clarified. There are many precipitating factors resulting in RP. Hyperhomocysteinemia resulting from methylenetetrahydrofolate reductase (MTHFR) gene mutationmay have a role in its etiology. The aim of this study was to observe the frequency of RP in patients with MTFHR gene mutation and hyperhomocysteinemia. Possible relationships among vitamin B12, folic acid, complete blood count (leukocytes and platelets), and c-reactive protein levels and RP were also analyzed. Materials and methods A total of 388 patients admitted to the internal medicine, hematology, and obstetric clinics of a university hospital between January 2012 and April 2013 ranging in age from 21 to 83 (mean age 38.16 ± 13.1) were enrolled in the study. Eighty-five (21.9%) of the patients were male and 303 (78.1%) were female. MTHFR gene mutation was analyzed in 388 patients; 52 (13.4%) were homozygous, 275 (70.9%) were heterozygous, and 61 (15.7%) were found to be negative for the MTHFR gene mutation and accepted as a control group. Vitamin B12, folic acid, complete blood count (leukocytes and platelets), and c-reactive protein levels were also analyzed. Results Homocysteine levels were higher in both heterozygous and homozygous groups (P < 0.05). RP was more frequently observed in patients with elevated homocysteine levels (P < 0.05; X2 = 14.51). There was no significant relationship in other parameters studied. Conclusion RP was more frequently observed in the groups with the MTHFR mutation and hyperhomocysteinemia. Serum homocysteine levels in patients with RP may be helpful for diagnosis.
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Affiliation(s)
- Kadir Serkan Yalçın
- Department of Internal Diseases, Lokman Hekim Ankara Hospital, Ankara, Turkey
| | - Ali Koşar
- Department of Hematology, Lokman Hekim Ankara Hospital, Ankara, Turkey
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Kwakkenbos L, Sanchez TA, Turner KA, Mouthon L, Carrier ME, Hudson M, van den Ende CHM, Schouffoer AA, Welling JJKC, Sauvé M, Thombs BD. The association of sociodemographic and disease variables with hand function: a Scleroderma Patient-centered Intervention Network cohort study. Clin Exp Rheumatol 2018; 36 Suppl 113:88-94. [PMID: 30277865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/02/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Impaired hand function in systemic sclerosis (SSc) is a primary cause of disability and contributes diminished health-related quality of life. The objective of the present study was to evaluate sociodemographic, lifestyle, and disease-related factors independently associated with hand function in SSc. METHODS Patients enrolled in the Scleroderma Patient-centered Intervention Network Cohort who completed baseline study questionnaires between March 2014 and September 2017 were included. Hand function was measured using the Cochin Hand Function Scale (CHFS). Multiple linear regression analysis was used to identify independent correlates of impaired hand function. RESULTS Among 1193 participants (88% female), the mean CHFS score was 13.3 (SD=16.1). Female sex (standardised regression coefficient, beta (β)=.05), current smoking (β=.07), higher BMI (β=.06), diffuse SSc (β=0.14), more severe Raynaud's scores (β=.23), more severe finger ulcer scores (β=.23), moderate (β=0.19) or severe small joint contractures (β=.20), rheumatoid arthritis (β=0.07), and idiopathic inflammatory myositis (β=0.06) were significantly associated with higher CHFS scores (more impaired hand function). Consumption of 1-7 alcoholic drinks per week (β=-0.07) was associated with lower CHFS scores (less impaired hand function) compared to no drinking. CONCLUSIONS Multiple factors are associated with hand function in SSc. The presence of moderate or severe small joint contractures, the presence of digital ulcers, and severity of Raynaud's phenomenon had the largest associations. Effective interventions are needed to improve the management of hand function in patients with SSc.
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Affiliation(s)
- Linda Kwakkenbos
- Behavioural Science Institute, Clinical Psychology, Radboud University, Nijmegen, the Netherlands; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal; Department of Psychiatry, McGill University, Montreal, Canada
| | - Tatiana A Sanchez
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Kimberly A Turner
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Luc Mouthon
- Université Paris Descartes, Assistance Publique-Hopitaux de Paris; Service de Medicine Interne, Centre de Reference Maladies Systémiques Autoimmunes Rares, vascularites nécrosantes et sclérodermie systémique, Hopital Cochin, Paris, France
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Marie Hudson
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal; Department of Medicine, McGill University, Montreal, Canada
| | | | - Anne A Schouffoer
- Leiden University Medical Center, Leiden; Haga Teaching Hospital, The Hague, the Netherlands
| | - Joep J K C Welling
- NVLE Dutch patient organisation for systemic autoimmune diseases, Utrecht, the Netherlands; and Federation of European Scleroderma Associations, Brussels, Belgium
| | - Maureen Sauvé
- Scleroderma Society of Ontario, Hamilton; and Scleroderma Society of Canada, Ottawa, Canada
| | - Brett D Thombs
- Lady Davis Inst. Med. Res., Jewish General Hosp., Montreal; Dept.of Psychiatry, Dept.of Medicine, Dept.of Epidemiology, Biostatistics and Occupational Health, Dept.of Educational & Counselling Psychology, Dept.of Psychology , McGill Univ., Montreal, Canada
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Kampolis CF, Fragkioudaki S, Mavragani CP, Zormpala A, Samakovli A, Moutsopoulos HM. Prevalence and spectrum of symptomatic pulmonary involvement in primary Sjögren's syndrome. Clin Exp Rheumatol 2018; 36 Suppl 112:94-101. [PMID: 29846161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The present cross-sectional study aimed to estimate the prevalence of chronic respiratory symptoms in primary Sjögren's syndrome (pSS) and define the clinical, functional and imaging characteristics of symptomatic pulmonary disease in pSS. METHODS Four hundred and fourteen consecutive pSS patients were interviewed for the presence of chronic respiratory complaints (cough and/or dyspnea). Symptomatic pSS patients without respiratory or other comorbidities underwent further investigation with clinical evaluation and assessment with pulmonary functional testing (PFTs) and chest high resolution CT (hrCT) on inspiratory and expiratory phase. Comparison of clinical and laboratory features between symptomatic and asymptomatic pSS patients was also performed. RESULTS Prevalence of chronic respiratory symptoms in pSS was estimated at 21.5% (89/414). Symptoms were attributed to underlying comorbidities in approximately one third of cases (30/89). Thirty nine of the remaining 59 patients were finally assessed with PFTs and hrCT. Small airway disease was diagnosed in 20 individuals with an obstructive pattern in PFTs and/or compatible radiological signs. Seven patients were diagnosed with interstitial lung disease, while in the remaining 12 pSS patients, with normal PFTs and hrCT, symptoms were attributed to xerotrachea. Raynaud's phenomenon occurred more frequently in symptomatic than asymptomatic patients (p=0.024). CONCLUSIONS Approximately one fifth of a large cohort of pSS patients presented chronic respiratory symptoms. Small airway disease was the most commonly recognized pulmonary disorder among symptomatic pSS patients, followed by xerotrachea and interstitial lung disease.
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Affiliation(s)
- Christos F Kampolis
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece.
| | - Sofia Fragkioudaki
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Clio P Mavragani
- Department of Pathophysiology, and Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | | | | | - Haralampos M Moutsopoulos
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece
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Abstract
BACKGROUND Peripheral vascular abnormalities caused by a dysregulation between peripheral vasoconstriction and vasodilatation, clinically appearing with Raynaud's phenomenon, have been described in anorexia nervosa but specific characteristics of microcirculation in anorexic patients have not yet been studied. METHODS We performed nailfold videocapillaroscopy to assess microcirculatory alteration in anorexic patients and found three different patterns: normal, aspecific and early scleroderma pattern. We also evaluated several laboratory and clinical parameters to better assess our capillaroscopic findings. RESULTS None of the clinical parameters examined correlated with specific capillaroscopic findings. An increased risk of autoimmune diseases in eating disorder patients has been described. Our results evidenced an association between early scleroderma capillaroscopic pattern and Raynaud's phenomenon that occurs in anorexia nervosa patients, whereas no significant association was found between all three capillaroscopic patterns and the presence of autoantibodies, as well as ESR and CRP values. CONCLUSIONS Our study reveals that patients with AN suffering from RP exhibit NVC findings typical of connective tissue diseases.
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Affiliation(s)
- Massimo De Martinis
- a Department of Life, Health, & Environmental Sciences , University of L'Aquila , Italy
- b Allergology and Clinical Immunology Unit, AUSL 04, Teramo , Italy
| | - Maria Maddalena Sirufo
- a Department of Life, Health, & Environmental Sciences , University of L'Aquila , Italy
- b Allergology and Clinical Immunology Unit, AUSL 04, Teramo , Italy
| | - Lia Ginaldi
- a Department of Life, Health, & Environmental Sciences , University of L'Aquila , Italy
- b Allergology and Clinical Immunology Unit, AUSL 04, Teramo , Italy
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Nilsson T, Wahlström J, Burström L. Hand-arm vibration and the risk of vascular and neurological diseases-A systematic review and meta-analysis. PLoS One 2017; 12:e0180795. [PMID: 28704466 PMCID: PMC5509149 DOI: 10.1371/journal.pone.0180795] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 06/21/2017] [Indexed: 11/19/2022] Open
Abstract
Background Increased occurrence of Raynaud’s phenomenon, neurosensory injury and carpal tunnel syndrome has been reported for more than 100 years in association with work with vibrating machines. The current risk prediction modelling (ISO-5349) for “Raynaud’s phenomenon” is based on a few studies published 70 to 40 years ago. There are no corresponding risk prediction models for neurosensory injury or carpal tunnel syndrome, nor any systematic reviews comprising a statistical synthesis (meta-analysis) of the evidence. Objectives Our aim was to provide a systematic review of the literature on the association between Raynaud’s phenomenon, neurosensory injuries and carpal tunnel syndrome and hand-arm vibration (HAV) exposure. Moreover the aim was to estimate the magnitude of such an association using meta-analysis. Methods This systematic review covers the scientific literature up to January 2016. The databases used for the literature search were PubMed and Science Direct. We found a total of 4,335 abstracts, which were read and whose validity was assessed according to pre-established criteria. 294 articles were examined in their entirety to determine whether each article met the inclusion criteria. The possible risk of bias was assessed for each article. 52 articles finally met the pre-established criteria for inclusion in the systematic review. Results The results show that workers who are exposed to HAV have an increased risk of vascular and neurological diseases compared to non-vibration exposed groups. The crude estimate of the risk increase is approximately 4–5 fold. The estimated effect size (odds ratio) is 6.9 for the studies of Raynaud’s phenomenon when including only the studies judged to have a low risk of bias. The corresponding risk of neurosensory injury is 7.4 and the equivalent of carpal tunnel syndrome is 2.9. Conclusion At equal exposures, neurosensory injury occurs with a 3-time factor shorter latency than Raynaud’s phenomenon. Which is why preventive measures should address this vibration health hazard with greater attention.
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Affiliation(s)
- Tohr Nilsson
- Occupational and Environmental Medicine, Department of Public Health & Clinical Medicine, Umeå University, Umeå, Sweden
- * E-mail:
| | - Jens Wahlström
- Occupational and Environmental Medicine, Department of Public Health & Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lage Burström
- Occupational and Environmental Medicine, Department of Public Health & Clinical Medicine, Umeå University, Umeå, Sweden
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Cavagna L, Codullo V, Ghio S, Scirè CA, Guzzafame E, Scelsi L, Rossi S, Montecucco C, Caporali R. Undiagnosed connective tissue diseases: High prevalence in pulmonary arterial hypertension patients. Medicine (Baltimore) 2016; 95:e4827. [PMID: 27684814 PMCID: PMC5265907 DOI: 10.1097/md.0000000000004827] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Among different subgroups of pulmonary arterial hypertension (PAH), those associated with connective tissue diseases (CTDs) have distinct hemodynamic and prognostic features; a correct etiologic diagnosis is thus mandatory.To estimate frequency and prognosis of previously undiagnosed CTDs in a suspect idiopathic (i) PAH cohort.Consecutive patients with PAH confirmed by right heart catheterization referred at the Cardiology Division of our Hospital without a previous rheumatological assessment or the occurrence of other conditions explaining PAH were checked for CTD by a clinical, laboratory, and instrumental evaluation. Survival in each group has also been analyzed.In our study 17 of 49 patients were classified as CTD-PAH, corresponding to a prevalence (95% CI) of 34.7% (21.7-49.6%). ANA positivity had 94% (71.3-99.9%) sensitivity and 78.1% (60-90.7%) specificity for a diagnosis of CTD-PAH; Raynaud phenomenon (RP) showed 83.3% (51.6-97.9%) sensitivity and 100% (90.5-100%) specificity for the diagnosis of Systemic Sclerosis (SSc)-PAH. At diagnosis, SSc patients were older and had a lower creatinine clearance compared with iPAH and other CTD-PAH. After a median follow-up of 44 (2-132) months, 18 of 49 (36.7%) patients died: 31.2% in the iPAH group, 20% in the CTD-, and 58.3% in the SSc-PAH group. Mortality was significantly higher in SSc-PAH (HR 3.32, 1.11-9.95, P <0.05) versus iPAH.We show a high prevalence of undiagnosed CTDs in patients with iPAH without a previous rheumatological assessment. All patients with RP were diagnosed with SSc. Our data stress the importance of a rheumatological assessment in PAH, especially because of the unfavorable prognostic impact of an associated SSc.
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Affiliation(s)
| | | | - Stefano Ghio
- Department of Cardiology, University and IRCCS Foundation Policlinico S. Matteo, Pavia
| | | | - Eleonora Guzzafame
- Department of Cardiology, University and IRCCS Foundation Policlinico S. Matteo, Pavia
| | - Laura Scelsi
- Department of Cardiology, University and IRCCS Foundation Policlinico S. Matteo, Pavia
| | | | | | - Roberto Caporali
- Division of Rheumatology
- Correspondence: Roberto Caporali, Division of Rheumatology, University and IRCCS Foundation Policlinico S. Matteo, Piazzale Golgi, 2, 27100 Pavia, Italy (e-mail: )
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Weder-Cisneros ND, Téllez-Zenteno JF, Cardiel MH, Guibert-Toledano M, Cabiedes J, Velásquez-Paz AL, García-Ramos G, Cantú C. Prevalence and Factors Associated with Headache in Patients with Systemic Lupus Erythematosus. Cephalalgia 2016; 24:1031-44. [PMID: 15566417 DOI: 10.1111/j.1468-2982.2004.00822.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Headache is common in systemic lupus erythematosus with reported prevalence as high as 70%. The aims of this study were: to estimate the prevalence and types of headache in a sample of patients with systemic lupus erythematosus comparing it with rheumatoid arthritis, to determine clinical and serological associations. Eighty-one systemic lupus erythematosus and 29 rheumatoid arthritis consecutive patients seen in our outpatient clinic were interviewed. Headache was evaluated using the diagnostic criteria proposed by the International Headache Society. Additional evaluations were carried out in the 81 systemic lupus erythematosus patients including depression, disease activity, lupus damage, function disability, quality of life, and severity degree using a validated scales. We analysed the following autoantibodies: anti-double stranded DNA, anti-nucleosomes, anti-histones, anti-ribosomal P, anti-cardiolipin antibodies, anti-β2-glycoprotein-I (GPI), and antinuclear antibodies. Forty-one per cent of systemic lupus erythematosus and 17% of rheumatoid arthritis patients suffered from headache ( P = 0.02). No significant difference for any primary headache type between the two groups was found. Frequency of headache types in systemic lupus erythematosus patients was: migraine 24%, tensional-type headache 11%, and mixed headache 5%. In systemic lupus erythematosus patients the risk factors associated with headaches were Raynaud's phenomenon (OR 3.6; 95% CI 1.3-9.5; P = 0.009) and β2GPI antibody positivity (OR 4.5; 95% CI 1.2-16.2; p = 0.016). We conclude that headache is more common in systemic lupus erythematosus than in rheumatoid arthritis patients and was independently associated with Raynaud's phenomenon and β2GP-I antibodies.
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Affiliation(s)
- N D Weder-Cisneros
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Immunology and Rheumatology, INCMNSZ
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Hottenga JJ, Vanmolkot KRJ, Kors EE, Kheradmand Kia S, de Jong PTVM, Haan J, Terwindt GM, Frants RR, Ferrari MD, van den Maagdenberg AMJM. The 3p21.1-p21.3 Hereditary Vascular Retinopathy Locus Increases the Risk for Raynaud's Phenomenon and Migraine. Cephalalgia 2016; 25:1168-72. [PMID: 16305605 DOI: 10.1111/j.1468-2982.2005.00994.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Previously, we described a large Dutch family with hereditary vascular retinopathy (HVR), Raynaud's phenomenon and migraine. A locus for HVR was mapped on chromosome 3p21.1-p21.3, but the gene has not yet been identified. The fact that all three disorders share a vascular aetiology prompted us to study whether the HVR haplotype also contributed to Raynaud's phenomenon and migraine in this family. Whereas the parent-child transmission disequilibrium test (TDT) did not reach significance, the sibling TDT revealed that the HVR haplotype harbours a susceptibility factor for Raynaud's phenomenon and migraine. Identification of the HVR gene will improve the understanding of the pathophysiology of HVR, Raynaud's phenomenon and migraine.
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Affiliation(s)
- J J Hottenga
- Department of Human Genetics, Leiden University Medical Centre, Leiden, and Department of Neurology, Rijnland Hospital, Leiderdorp, The Netherlands
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Farrington S. Last word with ... SUE FARRINGTON. Community Pract 2016; 89:48. [PMID: 27443032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Plissonneau Duquene P, Pistorius MA, Pottier P, Aymard B, Planchon B. Cold climate could be an etiologic factor involved in Raynaud's phenomenon physiopathology. Epidemiological investigation from 954 consultations in general practic. INT ANGIOL 2015; 34:467-474. [PMID: 25394956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM The physiopathology of Raynaud's phenomenon (RP) is not currently fully resolved. The cold seems to be not only an important factor triggering attacks, but also inducing RP. The aims of this study were to assess the prevalence of RP in Nantes urban district, and study the relationship between RP prevalence and cold climate. METHODS Patients aged between 10 and 80 years old, consulting in five Nantes General Practices, from June 2011 and March 2012, were included. Patients presenting RP underwent a full clinical examination. Subjects not meeting Allen and Brown criteria benefited from at least a dosage of Anti-Nuclear Antibodies and a naifold Capillaroscopy. Climate data provided by French national weather agency allowed establishing an average of observed temperatures during the past five years and correlating them to the observed prevalence. RESULTS Of 954 patients included, 78 had a RP, for an overall prevalence estimated at 8.2%. The prevalence among women (8.9%) was slightly higher than men (7.3%). Secondary form represented 5.1% of RP. In the RP group, 13 patients were active smokers, mean BMI was 22.3±3.2 kg/m², and only 4 patients were treated by vasoconstrictor therapy. According to French national weather agency, between 2007 and 2011, mean temperature of January in Nantes area was 5.8 °C. CONCLUSION We confirmed that the lower winter temperatures a region experiences, the higher the prevalence of RP, thus raising the question of the physiopathological role of the cold in the induction or in the revelation of RP.
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Deshayes S, Auboire L, Jaussaud R, Lidove O, Parienti JJ, Triclin N, Imbert B, Bienvenu B, Aouba A. Prevalence of Raynaud phenomenon and nailfold capillaroscopic abnormalities in Fabry disease: a cross-sectional study. Medicine (Baltimore) 2015; 94:e780. [PMID: 25997047 PMCID: PMC4602884 DOI: 10.1097/md.0000000000000780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Fabry disease (FD) is a lysosomal disorder leading to progressive systemic involvement, including microvascular damage that leads to neurological and cardiovascular disorders. We hypothesize that the latter could be documented at an early stage by performing a microcirculation study with nailfold capillaroscopy and evaluation of Raynaud phenomenon.The objective was to measure the prevalence of Raynaud phenomenon and nailfold capillaroscopic abnormalities in FD.This cross-sectional study included a standardized questionnaire and a nailfold capillaroscopy that assessed previously reported patterns in FD (dystrophic and giant capillaries, avascular fields, irregular architecture, dilatation and density of capillaries, hemorrhage), and was conducted on 32 Fabry patients and 39 controls. Capillaroscopic photographs were reviewed by 2 independent blinded investigators.Twelve Fabry patients (38%) suffered from Raynaud phenomenon, 5 were males (ie, 50% of male Fabry patients), compared with 2 controls (13%) (P < 0.001), of whom none were males (P < 0.001). Raynaud phenomenon was concomitant or before the occurrence of pain in the extremities in 42% of Fabry patients.More ramified capillaries were significantly observed in Fabry patients (12/32, 38%) than in controls (5/39, 13%, P = 0.016).Secondary Raynaud phenomenon should lead to screening for FD, especially in men. By extension, in high-risk populations for FD, the presence of Raynaud phenomenon and ramified capillaries should be assessed.
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Affiliation(s)
- Samuel Deshayes
- From the Departments of Internal Medicine (SD, BB) and Biostatistics (JJP), C.H.U. Côte de Nacre, Caen; University of Tours, Inserm Imagerie et Cerveau UMR U930, Tours (LA); Department of Internal Medicine and Infectious Diseases, C.H.U. Robert Debré, Reims, France (RJ); Department of Internal Medicine, Hôpital de la Croix Saint-Simon, Paris (OL); APMF, Vendresse (NT); Department of Internal Medicine, C.H.U. Michallon, Grenoble, France (BI)
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Abstract
OBJECTIVE To systematically review the literature with regard to the prevalence, incidence, risk factors and associations of primary Raynaud's phenomenon (PRP). METHOD A systematic review of the literature of observational studies for PRP was undertaken using five electronic databases. Any studies reporting prevalence, incidence and risk factors of PRP were collected. Relative risk or OR and 95% CI were extracted or calculated to present the association between risk factors and PRP. Random effects model was used to pool the results. RESULTS 33 articles assessing a total of 33,733 participants were included in this analysis (2 cohort, 17 cross-sectional and 14 case-control studies). The pooled prevalence of PRP was 4.85% (95% CI 2.08% to 8.71%) in the general population. The pooled annual incidence of PRP was 0.25% (95% CI 0.19% to 0.32%). Risk factors and associations for PRP included female gender (OR=1.65, 95% CI 1.42 to 1.91), family history (OR=16.6, 95% CI 7.44 to 36.8), smoking (OR=1.27, 95% CI 1.06 to 1.53), manual occupation (OR=2.66 95% CI 1.73 to 4.08), migraine (OR=4.02, 95% CI 2.62 to 6.17), cardiovascular disease (OR=1.69, 95% CI 1.22 to 2.34) and marital status (married, OR=0.60, 95% CI 0.43 to 0.83). The definition of PRP varied considerably between studies. CONCLUSIONS This is the first systematic review of the prevalence, incidence, risk factors and associations of PRP. Further study using uniform strict criteria for the condition is required to confirm these findings, particularly the possible association with cardiovascular disease.
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Affiliation(s)
- Rozeena Garner
- Department of Rheumatology, Queens Medical Centre, Nottingham, UK
| | - Rakesh Kumari
- Department of Rheumatology, Queens Medical Centre, Nottingham, UK
| | - Peter Lanyon
- Department of Rheumatology, Queens Medical Centre, Nottingham, UK
| | - Michael Doherty
- Department of Rheumatology, Queens Medical Centre, Nottingham, UK
- Department of Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Weiya Zhang
- Department of Academic Rheumatology, University of Nottingham, Nottingham, UK
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Min HK, Lee JH, Jung SM, Lee J, Kang KY, Kwok SK, Ju JH, Park KS, Park SH. Pulmonary hypertension in systemic lupus erythematosus: an independent predictor of patient survival. Korean J Intern Med 2015; 30:232-41. [PMID: 25750566 PMCID: PMC4351331 DOI: 10.3904/kjim.2015.30.2.232] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 03/26/2014] [Accepted: 04/01/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS We investigated whether transthoracic echocardiography-suspected pulmonary hypertension (PH) affects survival in systemic lupus erythematosus (SLE) patients and examined factors associated with PH occurrence and survival. METHODS This retrospective single-center study included 154 Korean SLE patients fulfilling the American College of Rheumatology criteria (January 1995 to June 2013). Student t test, Mann-Whitney U test, Kaplan-Meier curves, and log-rank tests were used for comparisons. RESULTS A total of 35 SLE patients with PH (SLE/PH+) and 119 without PH (SLE/PH-) were analyzed. Higher percentages of interstitial lung disease, Raynaud's phenomenon (RP), World Health Organization functional classification III/IV, and cardiomegaly were found in SLE/PH+ compared to SLE/PH-. Furthermore, the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index was significantly higher in SLE/PH+ (2.46 ± 1.245 vs. 1.00 ± 1.235), whereas survival rates were significantly higher in SLE/PH- in log-rank tests (p = 0.001). In multivariate analysis, the adjusted mortality hazard ratio (HR) for SLE/PH+ patients was 3.10. Subgroup analysis demonstrated a higher percentage of lupus nephritis in the SLE/PH+ patients who died (p = 0.039) and low complement-3 levels (p = 0.007). In univariate analysis, the mortality HR for SLE/PH+ patients with lupus nephritis was 4.62, whereas the presence of RP decreased the mortality risk in multivariate analysis; adjusted HR, 0.10. CONCLUSIONS PH is an independent factor predicting survival in SLE patients. The presence of lupus nephritis resulted in an increased trend for mortality, whereas coexistence of RP was associated with a better survival prognosis in SLE/PH+ patients.
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Affiliation(s)
- Hong Ki Min
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Ho Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Min Jung
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jennifer Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwi Young Kang
- Division of Rheumatology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Su Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Tovoli F, Granito A, Giampaolo L, Frisoni M, Volta U, Fusconi M, Masi C, Lenzi M. Nailfold capillaroscopy in primary biliary cirrhosis: a useful tool for the early diagnosis of scleroderma. J Gastrointestin Liver Dis 2014; 23:39-43. [PMID: 24689095 DOI: pmid/24689095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIM Primary biliary cirrhosis (PBC) is frequently associated with other autoimmune diseases, including systemic sclerosis (SSc). In the last years many efforts have been dedicated to the research of widely accepted criteria for the early diagnosis of SSc. Since studies on the prevalence of early SSc in PBC patients are lacking, our aim was to investigate its hitherto unknown prevalence in a large cohort of PBC patients. METHODS We studied 80 PBC patients and 72 patients with other chronic liver diseases. Diagnostic workup included research into signs of connective tissue disease, determination of autoantibody profile, and examination of capillary abnormalities through nailfold videocapillaroscopy. RESULTS Ten PBC patients (12.5%) satisfied diagnostic criteria for early SSc and 5 (6.3%) had definite SSc. None of the patients in the control group were diagnosed either with early or definite SSc. No differences were observed in terms of aminotransferases, alkaline phosphatase, and liver function tests between PBC patients with and without associated SSc. CONCLUSIONS Early SSc is significantly frequent in PBC patients. The detection of early SSc in PBC patients may lead to a prompt treatment of its complications, preventing inabilities and preserving the chance of liver transplantation.
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Affiliation(s)
- Francesco Tovoli
- Department of Medical and Surgical Sciences, University of Bologna, Italy.
| | - Alessandro Granito
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Luca Giampaolo
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Magda Frisoni
- Department of Internal Medicine and Digestive Diseases, Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Bologna, Italy
| | - Umberto Volta
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Marco Fusconi
- Department of Internal Medicine and Digestive Diseases, Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Bologna, Italy
| | - Chiara Masi
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Marco Lenzi
- Department of Medical and Surgical Sciences, University of Bologna, Italy
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Berrevoets MAH, Markhorst J, Meek IL, van Ede AE, Vonk MC. [Systemic sclerosis: a multisystem disease]. Ned Tijdschr Geneeskd 2014; 158:A7703. [PMID: 25052356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Systemic sclerosis is a rare, systemic autoimmune disease, characterized by inflammation, vasculopathy and fibrosis of the skin and internal organs. The disease is associated with a significantly increased morbidity and mortality, and can be rapidly progressive. Interstitial lung disease, renal hypertensive crisis, cardiac involvement and pulmonary arterial hypertension are life-threatening complications. Early treatment with immunosuppressive drugs can prevent progression and decrease morbidity and mortality.
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Scantlebury DC, Prasad A, Rabinstein AA, Best PJM. Prevalence of migraine and Raynaud phenomenon in women with apical ballooning syndrome (Takotsubo or stress cardiomyopathy). Am J Cardiol 2013; 111:1284-8. [PMID: 23415512 DOI: 10.1016/j.amjcard.2013.01.269] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 01/10/2013] [Accepted: 01/10/2013] [Indexed: 11/16/2022]
Abstract
Apical ballooning syndrome (ABS), migraine, and Raynaud phenomenon are characterized by female predominance, identifiable triggers, and, likely, vascular dysfunction. Estrogen deficiency, such as in menopause, is considered to be a predisposing factor for ABS. We investigated the association of ABS with migraine, Raynaud phenomenon, and hormonal factors. We compared 25 consecutive residents (all women) of Olmsted County, Minnesota, presenting with ABS, to 2 age-matched control groups from the same community: 25 women presenting with ST-segment elevation myocardial infarction (STEMI), matched for the index ABS event date, and 50 women with neither diagnosis. The patients with ABS were more likely to have a migraine history (11 [44%] vs 4 [16%] STEMI controls, p = 0.031, and vs 6 [12%] population controls, p = 0.003), and "possible migraine" (including other headache syndromes suggestive of migraine; 15 [60%] vs 6 [24%] STEMI controls, p = 0.012; and vs 12 [24%] population controls, p = 0.003). Of the patients with ABS, 4 (16%) had Raynaud phenomenon compared to no STEMI controls and 1 (2%) population control (p = 0.038). No differences were present in parity, menopausal status, years since the onset of menopause, and frequency of oophorectomy. Current hormonal replacement therapy use was greater in those with ABS than in the population controls: 4 (16%) versus none (p = 0.002). In conclusion, the association of ABS with migraine and Raynaud phenomenon supports a role of vasomotor dysfunction in the pathogenesis of ABS. The absence of an association with reproductive characteristics and the finding that ABS occurred despite exogenous hormonal use in some patients suggests that estrogen deficiency per se is not the primary factor in the pathophysiology.
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Affiliation(s)
- Dawn C Scantlebury
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Xu D, Li MT, Hou Y, Wang Q, Hu CJ, Song N, Zhao JL, Zeng XF, Zhang FC. Clinical characteristics of systemic sclerosis patients with digital ulcers in China. Clin Exp Rheumatol 2013; 31:46-49. [PMID: 23910609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 03/15/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To investigate the clinical characteristics of SSc patients with DUs in China. METHODS The data of 267 consecutive SSc patients based on the EUSTAR DATABASE from Peking Union Medical College Hospital from February 2009 to March 2012 were prospectively collected. The patients with DUs were compared to those without DUs. RESULTS Seventy-nine patients (29.6%) had DUs out of 267 SSc patients analysed. There were significant differences between patients with and without DU based on sex (female/male: 65/14 vs. 174/14), age of onset of SSc (32.3±11.7 vs. 40.4±12.6 y), age of onset of Raynaud's phenomenon (31.8±12.3 vs. 38.7±12.2) (p<0.05). In addition, there was a higher rate of diffuse SSc, gastrointestinal involvement, (especially esophageal involvement), and pericardial effusion, higher mRodnan score, and more anti-scl70 antibody positivity in patients with DU (p<0.05). A multivariate analysis identified anti-Scl70 antibody positivity, gastrointestinal involvement and a younger age at disease onset as three risk factors for developing DUs in SSc patients. CONCLUSIONS The occurrence of DUs in Chinese SSc patients is frequent. It is possible that SSc patients with DUs were influenced by the disease earlier in life, which should be detected early for effective intervention.
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Affiliation(s)
- Dong Xu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
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Cavazzana I, Fredi M, Taraborelli M, Quinzanini M, Tincani A, Franceschini F. A subset of systemic sclerosis but not of systemic lupus erythematosus is defined by isolated anti-Ku autoantibodies. Clin Exp Rheumatol 2013; 31:118-121. [PMID: 23910615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/21/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES We aimed to analyse the annual incidence of anti-Ku antibodies and to study their clinical associations in patients mainly affected by systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) overlap diseases. METHODS Anti-Ku were detected by counterimmunoelectrophoresis in a total of 203 sera during 14 years of anti-ENA detection. Anti-Ku+ sera belong to 46 patients, mostly affected by UCTD (12 cases), SSc spectrum diseases (13 cases), including SSc/PM, SSc/DM and SSc; and SLE spectrum diseases (9 cases), including SLE, SLE/APS, SLE/SS, SLE/PM. RESULTS Anti-Ku antibodies represent 2% of all anti-ENA positive sera, and are found in 1.3-3% of anti-ENA positive sera per year. Anti-Ku+ SSc represents 2% of all SSc patients. All anti-Ku+ SSc spectrum diseases showed a limited cutaneous disease; myositis, dysphagia and isolated anti-Ku in more than 70% of cases. Interstitial lung disease (ILD) was found in 54% of SSc patients, frequently with mild functional impairment. When compared with other limited SSc cases, anti-Ku+ SSc showed a higher rate of male patients, arthritis, myositis and ILD. A lower rate of digital ulcers was found, although both groups showed the same rate of SSc pattern at nailfold capillaroscopy. Anti-Ku+ SLE patients (representing 1.5% of all SLE) showed cutaneous features, Raynaud's phenomenon, multiple autoantibodies, without major organ manifestations. Isolated anti-Ku+ patients significantly show a diagnosis within SSc spectrum diseases, with arthralgias, Raynaud's phenomenon, dysphagia, ILD, myositis and sclerodactyly. CONCLUSIONS In SLE spectrum diseases, anti-Ku are found associated with other autoantibodies, without a peculiar clinical profile, except for Raynaud's phenomenon and severe alterations of capillary bed. In SSc anti-Ku are frequently associated with myositis and ILD, mostly found as isolated autoantibodies.
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Affiliation(s)
- Ilaria Cavazzana
- Rheumatology and Clinical Immunology Unit, Spedali Civili, piazzale Spedali Civili 1, 25100 Brescia, Italy.
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Dönmez S, Pamuk ÖN, Ümit EG, Top MŞ. Autoimmune rheumatic disease associated symptoms in fibromyalgia patients and their influence on anxiety, depression and somatisation: a comparative study. Clin Exp Rheumatol 2012; 30:65-69. [PMID: 23137613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 09/26/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES In this study we evaluated the frequency of autoimmune rheumatic disease associated major symptoms in fibromyalgia (FM) patients, and the association between their presence and anxiety, depression and somatisation. METHODS Two hundred and thirty-two FM, 78 systemic lupus erythematosus (SLE) patients and 70 healthy controls were included. All subjects were questioned face-to-face for the presence of autoimmune rheumatic disease-associated symptoms and antinuclear antibody (ANA) was determined. All FM patients were questioned for the severity of pain and symptoms of FM by using a visual analogue scale. In addition, all subjects were interrogated for anxiety, depression, somatic symptoms and neuropathic pain by using different validated questionnaires. RESULTS FM patients had significantly higher frequency of photosensitivity (27.6% vs. 11.4%) and Raynaud phenomenon (22% vs. 10%) when compared to controls (p-values, 0.005 and 0.026). FM patients had significantly lower frequencies of photosensitivity, oral ulcers, xerostomia, and xerophthalmia than SLE patients (all p-values <0.001). ANA positivity was 11.8% in FM patients and 7.1% in healthy controls. ANA-positive and negative FM patients had similar frequencies of autoimmune rheumatic disease symptoms. FM patients with photosensitivity had higher anxiety (p=0.002), somatic symptoms (p=0.015) and neuropathic pain (p=0.03) scores than others. FM patients with Raynaud had higher anxiety (p=0.004), depression (p=0.001), somatic symptom (p<0.001) and neuropathic pain scores than others. CONCLUSIONS The presence of which findings in FM seems to be associated with anxiety, depression, and somatization rather than ANA positivity and disease severity.
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Affiliation(s)
- Salim Dönmez
- Division of Rheumatology, Trakya University Medical Faculty, Edirne, Turkey.
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Mohokum M, Hartmann P, Schlattmann P. The association of Raynaud's syndrome with cisplatin-based chemotherapy - a meta-analysis. Eur J Intern Med 2012; 23:594-8. [PMID: 22939802 DOI: 10.1016/j.ejim.2012.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 02/11/2012] [Accepted: 03/26/2012] [Indexed: 01/23/2023]
Abstract
BACKGROUND Vasospastic disorders of the digital circulation such as the Raynaud's syndrome (RS) are known side-effects of treatment of cisplatin-based chemotherapy. The prevalence of RS in patients during treatment with cisplatin-based chemotherapy is not well-defined. OBJECTIVE The objective of this paper was to assess the prevalence of RS in patients receiving cisplatin-based chemotherapy - a meta-analysis of published data was performed. MATERIAL AND METHODS The PubMed database of the National Library of Medicine and ISI Web of Knowledge was used for studies dealing with RS and patients receiving cisplatin-based chemotherapy. The studies provided sufficient data to estimate the prevalence of RS in patients receiving cisplatin-based chemotherapy. A forest plot was determined by the revealed prevalences. Statistical analysis was based on methods for a random effects meta-analysis and a finite mixture model for proportions. Publication bias was investigated with the linear regression test (Egger's method). A meta-regression was conducted by the year of publication and latitude. RESULTS 24 eligible studies, contributing data on 2749 subjects, were included in this meta-analysis. For RS in patients receiving cisplatin-based chemotherapy a pooled prevalence of 24% and 95% CI (0.175, 0.313) was obtained. A mixture model analysis found four latent classes. Statistically, publication bias was not present (p-value 0.74). The meta-regression indicated that the odds ratio increased when the latitude increased, too (p-value 0.011). CONCLUSION Despite some heterogeneity there is a possible indication of an association between RS and patients receiving cisplatin-based chemotherapy.
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Affiliation(s)
- Melvin Mohokum
- Department of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany.
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Mohokum M, Hartmann P, Schlattmann P. Association of Raynaud's syndrome with interferons. A meta-analysis. INT ANGIOL 2012; 31:408-413. [PMID: 22990501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM Vasospastic disorders of the digital circulation such as the Raynaud's syndrome (RS) are known side-effects of treatment of interferons. The prevalence of RS in patients during treatment with interferons agents is not well-defined. The objective of this paper was to assess the prevalence of RS in patients receiving interferons - a meta-analysis of published data was performed. METHODS The PubMed database of the National Library of Medicine and ISI Web of Knowledge was used for studies dealing with RS and patients receiving interferons. The studies provided sufficient data to estimate the prevalence of RS in patients receiving interferons. A forest plot was determined by the revealed prevalences. Statistical analysis was based on methods for a random effects meta-analysis and a finite mixture model for proportions. Publication bias was investigated with the linear regression test (Egger's method). A meta-regression was conducted by the year of publication. RESULTS Six eligible studies, contributing data on 183 subjects, were included in this meta-analysis. For RS in patients receiving interferons a pooled prevalence of 13.6% and 95% CI (95% CI 0.026, 0.313) was obtained. A mixture model analysis found three latent classes. Statistically, publication bias was not present (p-value 0.335). CONCLUSION Despite some heterogeneity there is a possible indication of an association between RS and patients receiving interferons.
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Affiliation(s)
- M Mohokum
- Department of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany.
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Tzilalis V, Panagiotopoulos N, Papatheodorou G, Rallis E, Kassimos D. Prevalence of Raynaud's phenomenon in young Greek males. Clin Rheumatol 2010; 30:57-9. [PMID: 21120563 DOI: 10.1007/s10067-010-1621-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 10/30/2010] [Accepted: 11/03/2010] [Indexed: 11/26/2022]
Abstract
The aim of this paper is to study the prevalence of Raynaud's phenomenon in young males. Young males were examined prospectively in a district hospital, and laboratory tests were performed on the basis of the clinical history. Young males (3.912), age 18-28 years old, were examined. Raynaud's phenomenon was present in seven men (1,79 per 1.000, 95% CI 0.72-3.68). Three of them had at least one member in their family diagnosed with Raynaud's phenomenon. Three were smokers. All had negative immunological test. Five patients reported having severe attacks and two had only mild ischemic attacks. The treatment was conservative for all patients, two of them necessitated vasodilators. Very low prevalence of Raynaud's phenomenon was observed in this young male group compared with the previous studies.
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Affiliation(s)
- Vassilios Tzilalis
- Department of Vascular Surgery, 401 General Military Hospital of Athens, Athens, Greece
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Frech T, Khanna D, Markewitz B, Mineau G, Pimentel R, Sawitzke A. Heritability of vasculopathy, autoimmune disease, and fibrosis in systemic sclerosis: a population-based study. ACTA ACUST UNITED AC 2010; 62:2109-16. [PMID: 20506251 DOI: 10.1002/art.27469] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To investigate the familiality of systemic sclerosis (SSc) in relation to Raynaud's phenomenon (RP) (a marker of vasculopathy), other autoimmune inflammatory disease, and fibrotic interstitial lung disease (ILD). METHODS A genealogic resource, the Utah Population Database (UPDB), was used to test heritability of RP, other autoimmune disease, and ILD. Diseases were defined by International Classification of Diseases, Ninth Revision codes and identified from statewide discharge data, the University of Utah Health Science Center Enterprise Data Warehouse, and death certificates and were linked to the UPDB for analysis. Familial standardized incidence ratio (FSIR), relative risks (RRs) to first-, second-, third-, and fourth-degree relatives for SSc, RP, other autoimmune disease, and ILD (with 95% confidence intervals [95% CIs]), and population attributable risk (PAR) were calculated. RESULTS A software kinship analysis tool was used to analyze 1,037 unique SSc patients. Fifty SSc families had significant FSIRs, ranging from 2.07 to 17.60. The adjusted PAR was approximately 8%. The RRs were significant for other autoimmune disease in the first-degree relatives (2.49 [95% CI 1.99-3.41], P = 2.42 x 10(-15)) and second-degree relatives (1.48 [95% CI 1.34-2.39], P = 0.002), for RP in first-degree relatives (6.38 [95% CI 3.44-11.83], P = 4.04 x 10(-9)) and second-degree relatives (2.39 [95% CI 1.21-4.74], P = 0.012), and for ILD in first-degree relatives (1.53 [95% CI 1.04-2.26], P = 0.03), third-degree relatives (1.47 [95% CI 1.18-1.82], P = 0.0004), and fourth-degree relatives (1.2 [95% CI 1.06-1.35], P = 0.004). CONCLUSION These data suggest that SSc pedigrees include more RP, autoimmune inflammatory disease, and ILD than would be expected by chance. In SSc pedigrees, genetic predisposition to vasculopathy is the most frequent risk among first-degree relatives.
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Affiliation(s)
- Tracy Frech
- University of Utah, Division of Rheumatology, Department of Medicine, Salt Lake City, UT 84132, USA.
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Burström L, Järvholm B, Nilsson T, Wahlström J. White fingers, cold environment, and vibration – exposure among Swedish construction workers. Scand J Work Environ Health 2010; 36:509-13. [PMID: 20567796 DOI: 10.5271/sjweh.3072] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Lage Burström
- Department of Public Health & Clinical Medicine, Occupational and Environmental Medicine, Umeå University,Umeå, Sweden.
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Mikulska D. [Raynaud's phenomenon: pathogenesis and prevalence]. Ann Acad Med Stetin 2010; 56:11-14. [PMID: 21427808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Raynaud's phenomenon is defined as occasional ischemia of the distal parts of the extremities. Ischemia may be idiopathic as in primary Raynaud's disease or instigated by a comorbidity as in Raynaud's syndrome. Opinions on the etiopathogenesis of Raynaud's phenomenon have changed during recent years. Research has shown that enhanced vascular reactivity is attributable more to local factors and less to abnormalities in the central nervous system. Local factors are classified as vascular, nervous, and intravascular. Changes in our understanding of the etiopathogenesis of Raynaud's phenomenon have resulted in modified therapeutic guidelines. The present work reviews current opinions on the etiopathogenesis of Raynaud's phenomenon.
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Affiliation(s)
- Danuta Mikulska
- Katedra i Klinika Chorób Skórnych i Wenerycznych Pomorskiej Akademii Medycznej w Szczecinie, al. Powstańców Wlkp. 72, 70-111 Szczecin
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Purdie G, Harrison A, Purdie D. Prevalence of Raynaud's phenomenon in the adult New Zealand population. N Z Med J 2009; 122:55-62. [PMID: 20145687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIMS To estimate the prevalence of Raynaud's phenomenon (RP) in the New Zealand adult population. METHODS 350 adults 18 years and over, random selected from the electoral roll, were sent a postal survey based on the UK Scleroderma Study Group questionnaire. Participants were classified as having RP if they had biphasic colour changes. RESULTS There was a 67% response rate. The prevalence of RP was estimated to be 18.8% (95% Confidence Interval (CI) 13.0%-27.1%) in females and 4.9% (95%CI 1.9%-13.0%) in males. The prevalence decreased with age. There was a higher prevalence in the warmer north of the country. People of Maori descent and in more manual occupations had more serve symptoms. Among those reporting symptoms 11% (95%CI 7%-17%) had consulted a doctor. CONCLUSION New Zealand has high rates of RP. Few people with RP consult medical practitioners about their symptoms.
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Affiliation(s)
- Gordon Purdie
- Department of Public Health, University of Otago, Wellington, PO Box 7343, Wellington South, New Zealand.
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Ziegler S, Brunner M, Eigenbauer E, Minar E. Long‐term outcome of primary Raynaud's phenomenon and its conversion to connective tissue disease: a 12‐year retrospective patient analysis. Scand J Rheumatol 2009; 32:343-7. [PMID: 15080265 DOI: 10.1080/03009740410005007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine the frequency of development of connective tissue disease (CTD) in patients considered to have idiopathic Raynaud's phenomenon (RP) > 10 years. PATIENTS AND METHODS Based on initial evaluation, 113 women and 29 men were divided into either 'primary RP' (n=109) or 'possible secondary RP' (n=33) groups and were re-evaluated after a median follow-up period of 12.4 years. RESULTS Overall 20 patients (14.1%) progressed to a definite CTD; 10 from 'primary RP' (9.2%) and 10 from possible secondary RP' (30.3%). Initial presence of antinuclear antibodies, thickening of fingers, higher age at onset of RP, and female sex seemed to be important determinants for a possible transition to a CTD. CONCLUSION In RP-patients, who are at risk of development of a CTD, serial clinical and laboratory controls are warranted for the decision to initiate therapy early.
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Affiliation(s)
- S Ziegler
- Division of Angiology, Clinic for Internal Medicine II, University Hospital School of Medicine, Vienna, Austria.
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Choi WS, Choi CJ, Kim KS, Lee JH, Song CH, Chung JH, Ock SM, Lee JB, Kim CM. To compare the efficacy and safety of nifedipine sustained release with Ginkgo biloba extract to treat patients with primary Raynaud's phenomenon in South Korea; Korean Raynaud study (KOARA study). Clin Rheumatol 2009; 28:553-9. [PMID: 19159999 DOI: 10.1007/s10067-008-1084-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Revised: 12/24/2008] [Accepted: 12/27/2008] [Indexed: 11/25/2022]
Abstract
This study examined the efficacy and safety of nifedipine sustained release (nifedipine SR) compared with Ginkgo biloba extract as treatment for primary Raynaud's phenomenon (RP) in Korea. Primary RP were screened and assigned to either the nifedipine SR group (Group N) or the Ginkgo biloba extract group (Group G) in the ratio of 2:1. After a run-in period of 2 weeks, patients received treatment for 8 weeks. We observed the percent improvement of the RP attack rate between before and after the 8-week treatment. Ninety-three subjects were randomly assigned. The percent improvement in Group N was 50.1% at 8 weeks after treatment, while it was 31.0% in Group G (p = 0.03). No serious adverse events occurred, and almost adverse events were mild and improved without specific treatment. nifedipine SR was more effective than Ginkgo biloba extract for treatment of primary RP in Korean patients. Both drugs were tolerable with primary RP patients.
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Affiliation(s)
- Whan-Seok Choi
- Department of Family Medicine, Catholic University, Seoul, Korea
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Teslariu E, Constantin B, Mihalache C. [New trends for the occupational health in accordance with the European program]. Rev Med Chir Soc Med Nat Iasi 2008; 112:769-774. [PMID: 20201267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The development of the European schedule of the occupational diseases has the aim to harmonize the data from all Member States. For this purpose European Agency for Safety and Health at work recommends for all the Member States to progressively make their statistics concerning occupational diseases, compatible with European schedule, in order to evaluate the incidence of the recognised occupational diseases and to define quantified criteria for the recognising each occupational disease. The presented data allude to the incidence of the recognised occupational diseases for the first time in 2001, supposed reference year, and to the deaths due to occupational diseases. The used indicators were the number and incidence rate of occupational diseases by sex, age, economic activity, occupation and causative agents, workplaces, exposed professions.
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Affiliation(s)
- Elena Teslariu
- Facultatea de Medicină Disciplina Medicina Muncii, Universitatea de Medicină si Farmacie "Gr. T. Popa" Iaşi
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Colaci M, Sebastiani M, Giuggioli D, Manfredi A, Rossi R, Modena MG, Ferri C. Cardiovascular risk and prostanoids in systemic sclerosis. Clin Exp Rheumatol 2008; 26:333-336. [PMID: 18565257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is characterized by Raynaud's phenomenon and frequent cutaneous ulcers. In patients resistant to oral treatments, i.v. prostanoids are usefully employed. Some anecdotal reports underlined the potential risk to develop cardiovascular ischemic complications in prostanoid-treated SSc patients. METHODS Fifty SSc patients (group 1: 44 female and 6 male, mean age 60.4 +/- 13.8SD) undergoing long-term prostanoid therapy (iloprost or alprostadil) and 42 control patients (group 2), treated with only oral drugs, were retrospectively evaluated for the cardiovascular risk and incidence of ischemic events. RESULTS Ischemic cardiovascular complications, i.e., myocardial infarction or stroke, were recorded in a significantly higher number of patients undergoing prostanoid treatment compared to controls (group 1: 7/50, 14% vs. group 2: 1/42, 2.4%; p=0.041). Interestingly, these events were significantly more frequent in the subgroup of patients with high cardiovascular risk (group 1: 6/10, 60% vs. group 2: 1/19, 5.2%; p=0.0026). CONCLUSION The present study suggests a possible role of prostanoid treatment in the pathogenesis of ischemic cardiovascular complications in SSc patients non-responders to oral vasodilators and high cardiovascular risk. Since prostanoids represent the first choice treatment of the most severe scleroderma ischemic cutaneous lesions, cardiovascular risk should be carefully evaluated in all patients before therapy.
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Affiliation(s)
- M Colaci
- Chair and Rheumatology Unit, University of Modena e Reggio Emilia, Medical School; Policlinico di Modena, Modena, Italy
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Namura O, Saitoh M, Moro H, Watanabe H, Sogawa M, Nishikura K, Hayashi JI. A case of biatrial multiple myxomas with glandular structure. Ann Thorac Cardiovasc Surg 2007; 13:423-427. [PMID: 18292730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Accepted: 02/05/2007] [Indexed: 05/25/2023] Open
Abstract
A 45-year-old male, who had been indicated by brain magnetic resonance imaging to have cerebral infarctions, was found by echocardiography to have a tumor in the left atrium. He had experienced several of the constitutional disturbances associated with myxoma. At the ages of 19 and 35 he had had two episodes associated with embolisms, and at the later one he was diagnosed as having multiple cerebral aneurysms. He received an urgent operation in which three left atrial tumors and one right atrial tumor were resected. Histologically, the tumors were myxomas, and the left atrial main tumor had glandular structure. In view of his clinical history, this patient seems to have had cardiac myxomas for a long period. The multiple growths that occurred in this case may be a good argument for allowing this condition to last for so long. To our knowledge, the present case was the first report of cardiac myxoma with glandular structure in Japan.
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Affiliation(s)
- Osamu Namura
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Abstract
Hypothenar hammer syndrome (HHS) is an uncommon form of secondary Raynaud phenomenon, occurring mainly in subjects who use the hypothenar part of the hand as a hammer; the hook of the hamate strikes the superficial palmar branch of the ulnar artery in the Guyon space, leading to occlusion and/or aneurysm of the ulnar artery. In patients with HHS, such injuries of the palmar ulnar artery may lead to severe vascular insufficiency in the hand with occlusion of digital artery. To date, only a few series have analyzed the long-term outcome of patients with HHS. This prompted us to conduct the current retrospective study to 1) evaluate the prevalence of HHS in patients with Raynaud phenomenon and 2) assess the short-term and long-term outcome in patients with HHS. From 1990 to 2006, 4148 consecutive patients were referred to the Department of Internal Medicine at the University of Rouen medical center for evaluation of Raynaud phenomenon using nailfold capillaroscopy. HHS was diagnosed in 47 of these 4148 patients (1.13% of cases).Forty-three patients (91.5%) had occupational exposure to repetitive palmar trauma. The more common occupations were factory worker (21.3%), mason (12.8%), carpenter (10.6%), and metal worker (10.6%); the mean duration of occupational exposure to repetitive palmar trauma at HHS diagnosis was 21 years. One patient (2.1%) had recreational exposure (aikido training) to repetitive trauma of the palmar ulnar artery, and 3 other patients (6.4%) developed HHS related to a single direct injury to the hypothenar area. Clinical manifestations were more often unilateral (87.2%) involving the dominant hand (93%). HHS complications included digital ischemic symptoms (ischemia: n = 21, necrosis: n = 20) and irritation of the sensory branch of the ulnar nerve (n = 11). In HHS patients, angiography demonstrated occlusion of the ulnar artery in the area of the Guyon space (59.6%), aneurysm of the ulnar artery in the area of the Guyon space (40.4%), and embolic multiple occlusions of the digital arteries (57.4%). All patients were advised to change their occupational exposure. They were given vasodilators, including calcium channel blocker (n = 37) and buflomedil (n = 12); 36 patients (76.6%) also received oral platelet aggregation inhibitors. Twenty-one patients with digital ischemia/necrosis were further given hemodilution therapy to reduce the hematocrit level to 35%. In 3 patients with HHS-related digital necrosis who exhibited partial improvement with vasodilators, prostacyclin analog therapy (a 5-day regimen of intravenous prostacyclin analog) was instituted, resulting in complete healing of digital ulcer in these 3 patients. Other conservative treatment options included controlling risk factors (smoking cessation, low-lipid diet, therapy for arterial hypertension) and careful local wound care of fingers in the 20 patients with digital necrosis. Only 2 patients, exhibiting digital necrosis and multiple digital artery occlusions, with nonthrombotic ulnar artery aneurysm underwent reconstructive surgery, that is, resection of the aneurysm with end-to-end anastomosis of the ulnar artery. The median length of follow-up in patients with HHS was 15.9 months. Thirteen patients (27.7%) exhibited clinical recurrences of HHS; the median time of HHS recurrence onset was 11 months. Outcome of HHS relapse was favorable with conservative measures in all cases. Awareness of HHS is required to increase suspicion of the disorder so that further exposure to risk factors like repetitive hypothenar trauma can be avoided for these patients; this is of great importance for their overall prognosis. We found favorable outcomes in most patients after conservative measures were initiated; therefore we suggest that surgery may be undertaken in the subgroup of patients who exhibit partial improvement while receiving conservative therapy. Finally, because we observed recurrence of HHS in 27.7% of patients, we note that HHS patients require close follow-up, including both regular and systematic physical vascular examination.
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Affiliation(s)
- Isabelle Marie
- From Department of Internal Medicine (IM, FH, NC, HL) and Department of Radiology (EP), Rouen University Hospital, Rouen, France
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Salvat-Melis M, Carpentier PH, Moreau-Gaudry A, Boignard A, Paris A, Cracowski JL. Analyse spectrale par transformée de Fourier du flux sanguin cutané dans la sclérodermie systémique. ACTA ACUST UNITED AC 2007; 32:83-9. [PMID: 17329053 DOI: 10.1016/j.jmv.2006.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Accepted: 12/13/2006] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Endothelial dysfunction is an early event and a critical step in the pathogenesis of systemic sclerosis. Accurate and sensitive tests are needed to correctly assess the degree of microvascular endothelial dysfunction. Spectral analysis of skin blood flow contains a characteristic low frequency reported to be associated with endothelial function in healthy subjects. We hypothesized that the relative amplitude of the oscillation recorded for this low frequency spectrum (0.008 to 0.021 Hz) would be less pronounced in patients with systemic sclerosis than in healthy subjects and in patients with primary Raynaud's phenomenon. PATIENTS AND METHOD Twenty-one patients with systemic sclerosis, twenty patients with primary Raynaud phenomenon and eleven healthy subjects were enrolled. Skin perfusion was recorded at rest for 30 minutes using laser Doppler flowmetry on the pad of the left third left. Fourier transform spectral analysis was applied to obtain the mean amplitude of the cutaneous blood perfusion signal of the total spectrum from 0.008 to 1.6 Hz and the mean amplitude of each characteristic frequency in the laser Doppler flowmeter blood flow oscillations. RESULTS The relative amplitudes of each characteristic frequency in the laser Doppler flowmeter blood flow oscillations were not statistically different in the three groups, particularly for frequency spectrum from 0.008 Hz to 0.021 Hz. CONCLUSION Fourier transform spectral analysis of baseline cutaneous blood flow does not provide significant information. Further studies are required, perhaps using wavelet spectral analysis or stimulated conditions.
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Affiliation(s)
- M Salvat-Melis
- Laboratoire HP2 EA 3745, Inserm ERI 017, université de Grenoble 1 EA 3745, CHU de Grenoble, 38043 Grenoble cedex 09, France
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Suter LG, Murabito JM, Felson DT, Fraenkel L. Smoking, alcohol consumption, and Raynaud's phenomenon in middle age. Am J Med 2007; 120:264-71. [PMID: 17349450 DOI: 10.1016/j.amjmed.2006.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Revised: 05/24/2006] [Accepted: 06/01/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Data suggest Raynaud's phenomenon shares risk factors with cardiovascular disease. Studies of smoking, alcohol consumption, and Raynaud's have produced conflicting results and were limited by small sample size and failure to adjust for confounders. Our objective was to determine whether smoking and alcohol are independently associated with Raynaud's in a large, community-based cohort. METHODS By using a validated survey to classify Raynaud's in the Framingham Heart Study Offspring Cohort, we performed sex-specific analyses of Raynaud's status by smoking and alcohol consumption in 1840 women and 1602 men. Multivariable logistic regression analyses were used to examine the relationship of Raynaud's to smoking and alcohol consumption. RESULTS Current smoking was not associated with Raynaud's in women but was associated with increased risk in men (adjusted odds ratio [OR] 2.59, 95% confidence interval [CI], 1.11-6.04). Heavy alcohol consumption in women was associated with increased risk of Raynaud's (adjusted OR 1.69, 95% CI, 1.02-2.82), whereas moderate alcohol consumption in men was associated with reduced risk (adjusted OR 0.51, 95% CI, 0.29-0.89). In both genders, red wine consumption was associated with a reduced risk of Raynaud's (adjusted OR 0.59, 95% CI, 0.36-0.96 in women and adjusted OR 0.30, 95% CI, 0.15-0.62 in men). CONCLUSIONS Our data suggest that middle-aged women and men may have distinct physiologic mechanisms underlying their Raynaud's, and thus sex-specific therapeutic approaches may be appropriate. Our data also support the possibility that moderate red wine consumption may protect against Raynaud's.
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Affiliation(s)
- Lisa G Suter
- VA Connecticut Healthcare System, West Haven, Conn, USA.
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Weigel I, Klein-Weigel P, Kinzl J, Biebl W, Fraedrich G, Heidrich H. [Psychometric investigation of Tyrolean patients with primary Raynaud's phenomenon]. Wien Med Wochenschr 2007; 156:574-82. [PMID: 17160374 DOI: 10.1007/s10354-006-0338-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Accepted: 04/07/2006] [Indexed: 11/24/2022]
Abstract
Primary Raynaud's phenomenon (PRP) is provoked by digital vasospasm induced by cold and emotional strain. By use of established psychometric test instruments (Freiburger Aggressionsfragebogen (FAF), Fragebogen zur Abschätzung psychosomatischen Krankheitserlebens (FAPK), Stressverarbeitungsfragebogen (SVF 120)) we examined the patients' ways of dealing with aggression and distress as well as their experience of psychosomatic illness. In all psychometric tests performed there were no statistically significant differences between the patients and the controls, indicating that patients with PRP depict no specific ways of dealing with aggression and distress, and do not experience psychosomatic illness. The subgroup of patients with affective disorders and the subgroup of patients with impaired psychological well-being, displayed a 'depressive style' of dealing with life events. Patients with major physical complaints of symptoms of Raynaud's phenomenon showed either an inability or a propensity to deny aggression. Patients with impaired psychological well-being tended to complain more often about severe physical symptoms associated with Raynaud's phenomenon. Psychometric testing in patients with primary Raynaud's phenomenon cannot be recommended without additional psychiatric diagnostic. In patients with primary Raynaud's phenomenon and psychiatric comorbidity psychometric testing can additionally provide useful clinical information.
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Affiliation(s)
- Iris Weigel
- Landesamt für Gesundheit und Soziales, Berlin, Germany.
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Abstract
There are potential concerns regarding serotonin receptor agonists in SLE patients with migraine, particularly patients with concomitant Raynaud's syndrome. We estimated the prevalence of lupus-related headache and Raynaud's syndrome in the Montreal General Hospital SLE clinic cohort and evaluated the relationship between these two variables in multivariable logistic regression models, controlling for age, sex, race, SLE duration and the presence of lupus anticoagulant and antibodies to cardiolipin and beta2 glycoprotein I. We also assessed, through chart review in those individuals with both Raynaud's syndrome and migraine, a history of serotonin receptor agonist use, and any associated worsening vasospasm. Based on Systemic Lupus Activity Measure (SLAM) scores, the cumulative incidence of lupus-related headache in our sample (n = 391) was 46.1%; the prevalence of Raynaud's syndrome was 49.4%. The adjusted odds ratio (OR) for lupus-related headache and Raynaud's syndrome was 1.7 (95% CI 1.1, 2.5). In addition, there was a strong independent relationship between headache and anti-beta2 glycoprotein I antibodies (adjusted OR 5.6 [95% CI 1.8, 17.0]). The data from our chart review suggest that careful use of serotonin receptor agonists in patients with both Raynaud's syndrome and migraines may be undertaken, although caution would necessitate that these agents not be used in individuals with very severe Raynaud's (eg, digital ulcerations, and so on).
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Affiliation(s)
- S Bernatsky
- Division of Clinical Epidemiology, Montreal General Hospital, Montreal, PQ, Canada
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Cherkas LF, Williams FMK, Carter L, Howell K, Black CM, Spector TD, MacGregor AJ. Heritability of Raynaud's phenomenon and vascular responsiveness to cold: A study of adult female twins. ACTA ACUST UNITED AC 2007; 57:524-8. [PMID: 17394182 DOI: 10.1002/art.22626] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- L F Cherkas
- Twin Research and Genetic Epidemiology Unit, St. Thomas' Hospital, Kings College, London, UK.
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