1
|
Ahsan T, Erum U, Dahani A, Khowaja D. Clinical and immunological profile in patients with mixed connective tissue disease. J PAK MED ASSOC 2018; 68:959-962. [PMID: 30323370] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Mixed connective tissue disease (MCTD) is a rare disease and presents with varied overlapping symptoms of different connective tissue disorders. Many patients evolve into other connective tissue disorders with the passage of time. The case series included 20 patients with the diagnosis of MCTD, registered at the Rheumatology Clinic of Jinnah Postgraduate Medical Centre (JPMC), Karachi, from June 2010 to May 2015. Of these, 16 (80.0%) were female and 4 (20.0%) patients were male. The mean age was 30.5±8.9 years and the mean duration of illness was 4.5±2 years. Commonest presenting symptom was arthralgia in 17 (85%) patients. All the patients had positive ANA and anti-RNP antibodies. Over the disease course of 6 years, 2 (10%) patients evolved into Systemic lupus erythematosus (SLE); One each (5%) into Sjogren's syndrome, Scleroderma and Rheumatoid arthritis.
Collapse
Affiliation(s)
- Tasnim Ahsan
- Medical Unit-II, Jinnah Postgraduate Medical Centre, Karachi
| | - Uzma Erum
- Medical Unit-II, Jinnah Postgraduate Medical Centre, Karachi
| | | | - Danish Khowaja
- Medical Unit-II, Jinnah Postgraduate Medical Centre, Karachi
| |
Collapse
|
2
|
Abstract
The clinical cardiac manifestations most frequently reported in idiopathic inflammatory myopathies, myositis, are congestive heart failure, conduction abnormalities, that may lead to complete heart block and coronary artery disease. Although clinically overt cardiac involvement is rarely reported in myositis patients, subclinical manifestations are frequently observed and are predominated by conduction abnormalities and arrhythmias detected by ECG. Furthermore, cardiovascular manifestations constitute a major cause of death in myositis, thus cardiac involvement maybe overlooked in these patients. Also children with juvenile dermatomyositis may develop cardiac involvement although the frequency seems to be low. The underlying pathophysiologic mechanisms that may cause cardiac manifestations could involve myocarditis and coronary artery disease as well as involvement of the small vessels of the myocardium. In patients with mixed connective tissue disease (MCTD) clinically significant cardiac involvement is also rare, the most frequently reported manifestations being pericarditis and pulmonary hypertension, the latter often attributable to small vessel disease, and often a prognostic unfavourable manifestation.
Collapse
Affiliation(s)
- I E Lundberg
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
3
|
Mosca M. Mixed connective tissue diseases: new aspects of clinical picture, prognosis and pathogenesis. Isr Med Assoc J 2014; 16:725-726. [PMID: 25558705] [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: 06/04/2023]
|
4
|
Zold E, Bodolay E, Dezső B, Soos G, Nakken B, Szodoray P. Mixed connective tissue disease associated with autoimmune hepatitis and pulmonary fibrosis. Isr Med Assoc J 2014; 16:733-734. [PMID: 25558707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Eva Zold
- Department of Medicine, University of Debrecen, Hungary
| | | | | | | | | | | |
Collapse
|
5
|
Hamoir B, Giroux M, Outteryck O, Launay D, Vermersch P. Mixed connective tissue disease presenting as trigeminal neuropathy. Acta Neurol Belg 2014; 114:245-6. [PMID: 23903962 DOI: 10.1007/s13760-013-0226-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/18/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Bertrand Hamoir
- Department of Neurology, EA2686, Hôpital Roger Salengro, Université Lille Nord de France, 1 rue Emile Laine, 59037, Lille Cedex, France
| | | | | | | | | |
Collapse
|
6
|
Bergeron A, Bengoufa D, Feuillet S, Meignin V, de Latour RP, Rybojad M, Gossot D, Azoulay E, Socié G, Tazi A. The spectrum of lung involvement in collagen vascular-like diseases following allogeneic hematopoietic stem cell transplantation: report of 6 cases and review of the literature. Medicine (Baltimore) 2011; 90:146-157. [PMID: 21358437 DOI: 10.1097/md.0b013e31821160af] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Multisystem autoimmune diseases occurring after allogeneic hematopoietic stem cell transplantation are infrequent, late-onset manifestations that resemble well-defined collagen vascular disorders. Because the lung is frequently involved in the course of connective tissue disorders, we focused on lung manifestations occurring in autoimmune diseases following allogeneic stem cell transplantation. In the present series, we report 6 patients with systemic lupus erythematous, mixed connective tissue disease, Sjögren syndrome, polymyositis, and ANCA-positive vasculitis who presented with a spectrum of pulmonary manifestations affecting the airways, lung parenchyma, and probably respiratory muscles. We identified 3 different histopathologic patterns of interstitial pneumonia consistent with the underlying autoimmune disorder: lymphocytic interstitial pneumonia and non-specific interstitial pneumonia in 2 patients with Sjögren syndrome and diffuse alveolar damage in 1 patient with ANCA-positive vasculitis. These lung manifestations had poor prognoses. Further studies are needed to determine the optimal therapy for these complications.
Collapse
Affiliation(s)
- Anne Bergeron
- From Service de Pneumologie (AB, SF, AT), Service d' Immunologie (DB), Service de Pathologie (VM), Service d'Hématologie-Greffe de moelle (RPdL, GS), Service de Dermatologie (MR), Service de Réanimation (EA), Hôpital Saint-Louis, Université Paris 7, UFR Denis Diderot; Assistance Publique-Hôpitaux de Paris, Paris; and Service de Chirurgie thoracique (DG), Institut Mutualiste Montsouris, Paris, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Soltesz P, Bereczki D, Szodoray P, Magyar MT, Der H, Csipo I, Hajas A, Paragh G, Szegedi G, Bodolay E. Endothelial cell markers reflecting endothelial cell dysfunction in patients with mixed connective tissue disease. Arthritis Res Ther 2010; 12:R78. [PMID: 20459625 PMCID: PMC2911856 DOI: 10.1186/ar2999] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 02/22/2010] [Accepted: 05/06/2010] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The aim of the present study was to investigate the association between cardiovascular risk factors and endothelial dysfunction in patients with mixed connective tissue disease (MCTD) and to determine which biomarkers are associated with atherosclerotic complications, such as cardiovascular disease. METHODS Fifty MCTD patients and 38 healthy age-matched and sex-matched controls were enrolled in this study. In order to describe endothelial dysfunction, we assessed flow-mediated dilation (FMD), nitrate-mediated dilation (NMD) and carotid artery intima-media thickness (IMT). We investigated FMD of the brachial artery after reactive hyperemia and NMD after sublingual nitroglycerin administration, while the IMT of the common carotid artery was determined by ultrasound. Anti-U1 ribonucleoprotein (anti-U1RNP) antibodies, anti-cardiolipin (anti-CL) antibodies, anti-endothelial cell antibody (AECA) and endothelial cell markers, such as soluble thrombomodulin (TM) and von Willebrand factor antigen (vWFAg), were assessed. RESULTS The endothelium-dependent vasodilation (FMD) was significantly impaired in patients with MCTD, as compared with controls (%FMD: 4.7+/-4.2% vs. 8.7+/-5.0%; P<0.001), while the percentage NMD did not differ (%NMD: 14.3+/-6.6% vs. 17.1+/-6.7%; P=0.073). Mean carotid IMT values were higher in patients than in controls (IMT: MCTD, 0.64+/-0.13 mm vs. controls, 0.53+/-0.14 mm; P<0.001). FMD negatively correlated with disease duration, the levels of apolipoprotein A1, the paraoxonase-1 activity, and systolic blood pressure in MCTD patients. The percentage FMD was significantly lower in MCTD patients with cardiovascular diseases (CVD), than in those without CVD (%FMD: 3.5+/-2.9 vs. 5.8+/-4.8, P<0.0002), while percentage NMD did not differ between patients with and without CVDs. Serum levels of autoantibodies (anti-U1RNP, AECA and anti-CL) were significantly higher in MCTD patients and differed between MCTD patients with and without CVD. Endothelial cell markers such as soluble TM (12.2+/-8.1 ng/ml vs. 3.2+/-1.3 ng/ml; P<0.001) and vWFAg (224.1+/-115% vs. 89.4+/-27.1%, P<0.001) were the highest in MCTD patients with CVD. CONCLUSIONS FMD is a reliable sensitive marker of endothelial cell dysfunction in MCTD. Beside the traditional risk factors, anti-U1RNP, AECA and anti-CL antibodies may be important not only in the pathogenesis of MCTD but in the induction of endothelial cell activation, and may play crucial roles in the development of early atherosclerosis in MCTD.
Collapse
Affiliation(s)
- Pal Soltesz
- 3rd Department of Medicine, Medical and Health Science Center, University of Debrecen, Moricz Zs. Str. 22, Debrecen 4032, Hungary
| | - Daniel Bereczki
- Department of Neurology, Semmelweis University of Budapest, Balassa Str. 6, Budapest 1083, Hungary
| | - Peter Szodoray
- Institute of Immunology, Rikshospitalet, University of Oslo, Sognsvannsveien Str. 20, Oslo 0027, Norway
| | - Maria T Magyar
- Department of Neurology, Medical and Health Science Center, University of Debrecen, Moricz Zs. Str. 22, Debrecen 4032, Hungary
| | - Henrietta Der
- 3rd Department of Medicine, Medical and Health Science Center, University of Debrecen, Moricz Zs. Str. 22, Debrecen 4032, Hungary
| | - Istvan Csipo
- 3rd Department of Medicine, Medical and Health Science Center, University of Debrecen, Moricz Zs. Str. 22, Debrecen 4032, Hungary
| | - Agota Hajas
- 3rd Department of Medicine, Medical and Health Science Center, University of Debrecen, Moricz Zs. Str. 22, Debrecen 4032, Hungary
| | - Gyorgy Paragh
- 1st Department of Medicine, Medical and Health Science Center, University of Debrecen, Nagyerdei Str. 98, Debrecen 4032, Hungary
| | - Gyula Szegedi
- 3rd Department of Medicine, Medical and Health Science Center, University of Debrecen, Moricz Zs. Str. 22, Debrecen 4032, Hungary
| | - Edit Bodolay
- 3rd Department of Medicine, Medical and Health Science Center, University of Debrecen, Moricz Zs. Str. 22, Debrecen 4032, Hungary
| |
Collapse
|
8
|
Perkins K, Hoffman RW, Bezruczko N. A Rasch analysis for classification of systemic lupus erythematosus and mixed connective tissue disease. J Appl Meas 2008; 9:136-150. [PMID: 18480510] [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: 05/26/2023]
Abstract
The classification of rheumatic diseases is challenging because these diseases have protean and frequently overlapping clinical and laboratory manifestations. This problem is typified by the difficulty of classification and differentiation of two prototypic multi-system autoimmune diseases, Systemic Lupus Erythematosus (SLE) and Mixed Connective Tissue Disease (MCTD). The researchers submitted medical risk factor data represented by instrument or laboratory measures and physician judgments (12 key features for SLE) from 43 patients diagnosed with SLE and 12 key features for MCTD from 51 patients diagnosed with MCTD to the WINSTEPS Rasch analysis program. Using Rasch model parameterization, and fit and residuals analyses, the researchers identified separate dimensions for MCTD and SLE, thereby lending support to the position that MCTD is its own separate disease, distinct from SLE.
Collapse
Affiliation(s)
- Kyle Perkins
- Florida International University, University Park, PC 543, 11200 S. W. 8th St., Miami, FL 33199, USA.
| | | | | |
Collapse
|
9
|
van der Giesen FJ, Nelissen RGHH, Rozing PM, Arendzen JH, de Jong Z, Wolterbeek R, Vliet Vlieland TPM. A multidisciplinary hand clinic for patients with rheumatic diseases: a pilot study. J Hand Ther 2007; 20:251-60; quiz 261. [PMID: 17658419 DOI: 10.1197/j.jht.2007.04.004] [Citation(s) in RCA: 11] [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] [Indexed: 02/03/2023]
Abstract
To describe the characteristics, management strategies and outcomes of patients with rheumatic diseases and complex hand function problems referred to a multidisciplinary hand clinic. Assessments (baseline and after three months of follow-up) included sociodemographic and disease characteristics and various hand function measures. The most frequently mentioned impairments and limitations of the 69 patients enrolled in the study pertained to grip, pain, grip strength, and shaking hands. Fifty-six patients received treatment advice, conservative therapy (n=39), surgery (n=12), or a combination of both (n=5). In 38 of 56 patients (68%) the recommended treatment was performed, and 33 completed the follow-up assessment. On average, patients improved, with an increase in grip strength and the Michigan Hand Outcomes Questionnaire scores reached statistical significance. Two-thirds of patients with rheumatic conditions visiting a multidisciplinary hand clinic reportedly followed the treatment advice (recommendations), with an overall trend toward a beneficial effect on hand function. To further determine the added value of a structured, multidisciplinary approach a controlled comparison with other treatment strategies is needed.
Collapse
Affiliation(s)
- F J van der Giesen
- Department of Rheumatology, Leiden University Medical Center, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
10
|
Nonomura Y, Miyasaka N. [Diagnosis and therapy for mixed connective tissue diseases]. Nihon Naika Gakkai Zasshi 2007; 96:2196-2200. [PMID: 18044155 DOI: 10.2169/naika.96.2196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
|
11
|
Ahmadi-Simab K, Gross WL. [Pulmonary arterial hypertension in collagenoses: clinical features, epidemiology, pathogenesis, diagnosis and treatment]. Z Rheumatol 2007; 65:297-300, 302-5. [PMID: 16804698 DOI: 10.1007/s00393-006-0069-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a severe vasculopathy, which is characterised by progressive narrowing and obliteration of the pulmonary arterioles and increased endothelin-1 levels. The increase of vascular resistance in the lung vessels leads to chronic pressure overload and to right heart failure, if untreated. PAH often occurs in association with rheumatic-inflammatory diseases (e.g., in 15% of patients with systemic sclerosis (SSc), especially in the limited form or in CREST patients) and determines their prognosis: in advanced stages, untreated patients die within a short period. Therefore all SSc patients, particularly the newly diagnosed ones, should be screened for PAH with echocardiography. If PAH is suspected, a right heart catheter should be performed, and if PAH is confirmed, adequate treatment should be initiated. While few years ago lung transplantation was the only option for patients with severe PAH, in recent years enormous progress was seen in drug treatment. Today prostanoids (Ventavis) and the endothelin receptor antagonist bosentan (Tracleer) are available for patients with PAH in WHO/NYHA stage III: they have substantially improved the prognosis of PAH in the last years. Since few months, also the phosphodiesterase inhibitor sildenafil (Revatio) is available. The combination of drugs with different mode of action will likely further improve the prognosis of PAH patients.
Collapse
MESH Headings
- Algorithms
- CREST Syndrome/diagnosis
- CREST Syndrome/epidemiology
- CREST Syndrome/physiopathology
- CREST Syndrome/therapy
- Cross-Sectional Studies
- Echocardiography
- Endothelium, Vascular
- Evidence-Based Medicine
- Humans
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/epidemiology
- Hypertension, Pulmonary/physiopathology
- Hypertension, Pulmonary/therapy
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/epidemiology
- Lupus Erythematosus, Systemic/physiopathology
- Lupus Erythematosus, Systemic/therapy
- Mixed Connective Tissue Disease/diagnosis
- Mixed Connective Tissue Disease/epidemiology
- Mixed Connective Tissue Disease/physiopathology
- Mixed Connective Tissue Disease/therapy
- Prognosis
- Scleroderma, Systemic/diagnosis
- Scleroderma, Systemic/epidemiology
- Scleroderma, Systemic/physiopathology
- Scleroderma, Systemic/therapy
- Vasoconstriction/physiology
- Vasodilator Agents/therapeutic use
Collapse
Affiliation(s)
- K Ahmadi-Simab
- Poliklinik für Rheumatologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck und Rheumaklinik Bad Bramstedt, Oskar-Alexander-Strasse 26, 24576, Bad Bramstedt.
| | | |
Collapse
|
12
|
Kondo H, Okada J. [Pathophysiology of and therapy for mixed connective tissue disease: recent progress on the study]. Nihon Naika Gakkai Zasshi 2006; 95:1881-7. [PMID: 17037331 DOI: 10.2169/naika.95.1881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
|
13
|
Cozzi F, Montisci R, Marotta H, Bobbo F, Durigon N, Ruscazio M, Sfriso P, Iliceto S, Todesco S. Bosentan therapy of pulmonary arterial hypertension in connective tissue diseases. Eur J Clin Invest 2006; 36 Suppl 3:49-53. [PMID: 16919011 DOI: 10.1111/j.1365-2362.2006.01684.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a life-threatening and debilitating complication of several connective tissue diseases. We aimed to evaluate the effects of long-term treatment with bosentan, an oral dual endothelin ET(A)/ET(B) receptor antagonist, in a cohort of patients with PAH related to connective tissue diseases. MATERIALS AND METHODS In the present prospective, noncontrolled study, 13 patients (nine with systemic sclerosis, two with systemic lupus erythematosus, one with mixed connective tissue disease and one with overlap syndrome including scleroderma and myositis), mostly nonresponders to prostanoids therapy, were treated for 1 year with bosentan. Cardiac haemodynamics and the diagnosis of PAH were performed by Doppler ultrasound examination. Exercise capacity was assessed by 6-min walking test at baseline and at 3, 6 and 12 months of therapy. RESULTS During bosentan treatment, progressive improvement of exercise capacity was observed. Walk distance increased in seven patients, remained unchanged in three and slightly decreased in three patients. A progressive significant decrease of right ventricular systolic pressure was also observed, whereas pulmonary artery mean pressure remained unchanged. Adverse effects related to bosentan (elevation of hepatic aminotransferases) were noted in two patients. CONCLUSION Long-term treatment with bosentan was effective in improving exercise capacity and pulmonary haemodynamics in patients with PAH related to connective tissue diseases.
Collapse
Affiliation(s)
- F Cozzi
- Division of Rheumatology, University of Padova, Padova, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Végh J, Hegedus I, Szegedi G, Zeher M, Bodolay E. Diastolic function of the heart in mixed connective tissue disease. Clin Rheumatol 2006; 26:176-81. [PMID: 16865311 DOI: 10.1007/s10067-006-0257-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 02/13/2006] [Accepted: 02/14/2006] [Indexed: 10/24/2022]
Abstract
The authors examined the right and left ventricle functions in patients with mixed connective tissue disease (MCTD) by Doppler echocardiography. Of 51 patients, 20 had temporary pulmonary arterial hypertension in their case history. According to our knowledge, this is the first study examining the use of Doppler echocardiography and tissue Doppler technique in MCTD patients. Of 51 MCTD patients, 20 had pulmonary arterial hypertension (PAH) in the past 2 years. Diameters of the right and left ventricle, systolic and diastolic blood pressure were measured both in the 51 MCTD patients and in the 30 control subjects (mean age 54.8+/-6.2 years in the case of patients and 54.2+/-8.8 years in the case of control subjects). To estimate the global ventricle functions, the myocardial performance index--as described by Tei et al. (J Am Soc Echocardiogr 6:838-874, 1996)--was applied, which reflects the ratio of the sum of the isovolumetric contraction and relaxation time as compared to the ejection time. The 20 MCTD patients with PAH received cyclophosphamide therapy for 1 year beside the pulse corticosteroid (CS) therapy. In the case of MCTD patients without PAH, different treatments were used: 12 out of 31 patients were treated with sulfasalazine, 5 of whom received a combination of CS and methotrexate, and 14 took nonsteroid antiinflammatory drugs. In the case of the 51 MCTD patients (20 with PAH and 31 without PAH), diastolic function disorder of the left ventricle was detected; the diastolic Ee/Aa velocity quotient of the lateral mitral anulus was lower (p<0.01), and the mean deceleration time was longer (p<0.001) than that of the control group. The Tei index demonstrated the damage of the global ventricle function. The Tei index of the right ventricle indicated global failure of the right ventricle function in the case of MCTD patients complicated with PAH (Tei index 0.36+/-0.07 in MCTD with PAH and 0.28+/-0.04 in MCTD without PAH, p<0.001). The right ventricle function of MCTD patients without PAH was no different from that of the control group. In the case of patients with MCTD, signs of the disorder of the left ventricle diastolic function were observed. Our results suggest that the global impairment of the left ventricle function is the consequence of the disease itself and not the side effect of the treatment. In the case of MCTD patients complicated with PAH, the signs of the right ventricle function impairment proved to be permanent.
Collapse
MESH Headings
- Adult
- Aged
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Cyclophosphamide/therapeutic use
- Diastole
- Drug Therapy, Combination
- Echocardiography, Doppler
- Female
- Glucocorticoids/therapeutic use
- Heart Ventricles/drug effects
- Heart Ventricles/pathology
- Heart Ventricles/physiopathology
- Humans
- Hypertension, Pulmonary/complications
- Hypertension, Pulmonary/drug therapy
- Hypertension, Pulmonary/physiopathology
- Immunosuppressive Agents/therapeutic use
- Male
- Methotrexate/therapeutic use
- Middle Aged
- Mixed Connective Tissue Disease/complications
- Mixed Connective Tissue Disease/drug therapy
- Mixed Connective Tissue Disease/physiopathology
- Myocardium/pathology
- Pulse Therapy, Drug
- Severity of Illness Index
- Sulfasalazine/therapeutic use
- Ventricular Dysfunction, Left/drug therapy
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/drug therapy
- Ventricular Dysfunction, Right/physiopathology
Collapse
Affiliation(s)
- Judit Végh
- 3rd Department of Internal Medicine, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary.
| | | | | | | | | |
Collapse
|
15
|
Vegh J, Szodoray P, Kappelmayer J, Csipo I, Udvardy M, Lakos G, Aleksza M, Soltesz P, Szilágyi A, Zeher M, Szegedi G, Bodolay E. Clinical and Immunoserological Characteristics of Mixed Connective Tissue Disease Associated with Pulmonary Arterial Hypertension. Scand J Immunol 2006; 64:69-76. [PMID: 16784493 DOI: 10.1111/j.1365-3083.2006.01770.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [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: 12/20/2022]
Abstract
We investigated the clinical characteristics and immunoserological alterations in patients with mixed connective tissue disease (MCTD) associated with pulmonary arterial hypertension (PAH). Anti-U1RNP autoantibodies, anti-endothelial cell antibodies (AECA) and serum thrombomodulin (TM) as well as von Willebrand factor antigen (vWFAg) concentrations were measured in 25 patients with MCTD associated with PAH and in 154 MCTD patients without PAH. The results showed that the probability of survival was lower in MCTD patients with PAH than in the 154 MCTD-non-PAH patients (5-year survival rate in MCTD with PAH: 73%, versus 96% in MCTD-non-PAH; P < 0.01). AECA were more frequently present in the sera of MCTD patients with PAH than in MCTD-non-PAH (P < 0.001). Serum TM and vWFAg levels were higher in MCTD-PAH patients than in MCTD-non-PAH patients (TM: P < 0.001; vWFAg: P < 0.001). Significant correlation was noticed between the quantity of AECA and TM level (r = 0.466) as well as the quantity of AECA and vWFAg level (r = 0.550). In conclusion, our results suggest that in MCTD the presence of AECA and endothelial cell activation may play a role in the development of PAH and in the maintenance of obliterative vascular processes.
Collapse
Affiliation(s)
- J Vegh
- 3rd Department of Internal Medicine, University of Debrecen, Medical and Health Science Centre, Debrecen, Hungary
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Affiliation(s)
- Manisha S Kumar
- Scripps Clinic, Division of Rheumatology, La Jolla, CA 92037, USA.
| | | | | |
Collapse
|
17
|
Houghton KM, Page J, Cabral DA, Petty RE, Tucker LB. Systemic lupus erythematosus in the pediatric North American Native population of British Columbia. J Rheumatol 2006; 33:161-3. [PMID: 16395763] [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: 05/06/2023]
Abstract
OBJECTIVE To compare the estimated prevalence and the phenotype of pediatric systemic lupus erythematosus (SLE) in a North American Native population with other ethnic groups. METHODS We performed a retrospective chart review of all patients with SLE currently followed at the single tertiary care pediatric rheumatology clinic in our province. Data collected included demographic characteristics, family history, classification criteria for SLE, laboratory tests at diagnosis, SLE Disease Activity Index (SLEDAI) at presentation, and Systemic Lupus International Collaborating Clinics (SLICC) damage index at 6 months. RESULTS The prevalence of SLE in our pediatric Native population is 8.8 per 100,000 (n = 6) compared to 3.3 per 100,000 in the non-NAI population (n = 34) (p = 0.037, Fisher's exact test; OR 2.6, 95% CI 1.1-6.3). Family history of rheumatic disease is more common in our Native children (5/6, 83%) compared to non-Native children (5/34, 15%) (p = 0.002 Fisher's exact test; OR 29, 95% CI 2.8-303.3). The sample size is too small for reliable interpretation of disease phenotype, autoantibodies, disease activity, and disease damage measures. CONCLUSION There is an increased prevalence of SLE and familial autoimmunity among Native children in our population. Public health measures to screen children at risk may detect early disease and may reduce disease morbidity.
Collapse
Affiliation(s)
- Kristin M Houghton
- Division of Rheumatology, Department of Pediatrics, University of British Columbia and British Columbia's Children's Hospital, Vancouver, British Columbia, Canada.
| | | | | | | | | |
Collapse
|
18
|
Végh J, Szilasi M, Soós G, Dévényi K, Dezso B, Soltész P, Zeher M, Szegedi G, Bodolay E. [Interstitial lung disease in mixed connective tissue disease]. Orv Hetil 2005; 146:2435-43. [PMID: 16408383] [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: 05/06/2023]
Abstract
INTRODUCTION The authors analyzed the incidence of interstitial lung disease in mixed connective tissue disease. They were seeking an answer to the following problems: the nature of the pathological course of mixed connective tissue disease complicated by and the therapy to be used in interstitial lung disease. PATIENTS AND METHODS 179 patients were followed up during a period of 15.9 +/- 6.1 years. Interstitial lung disease was diagnosed using high resolution computed tomography. The diagnosis of interstitial lung disease was not obvious in 5 patients thus open lung biopsy was performed, which confirmed common interstitial pneumonitis. The patients were followed-up, and the data of computed tomography and respiratory function tests were detected 6 months, and then 4 years after the acute lung disease complicated by mixed connective tissue disease. RESULTS Out of the 179 mixed connective tissue disease patients 96 (53.6%) had interstitial lung disease. The onset of interstitial lung disease was the most frequent in the 2-4 years of the disease. Four years after the first appearance of interstitial lung disease severe fibrosis was diagnosed in 24 patients (25%). A honey comb formation in the lung developed only in one patient. For the treatment of interstitial lung disease, corticosteroid treatment had to be combined with cyclophosphamide in 51 cases. In 4 patients (24%), pulmonary arterial hypertension evolved 2-4 years following interstitial lung disease. The high pulmonary arterial pressure decreased using pulsed corticosteroid treatment, cyclophosphamide, prostacyclin analogue, anticoagulants therapy and the 4 patients stay alive. The pulmonary arterial hypertension was caused by obliterative vasculopathy. CONCLUSION Pulmonary involvement is found in more than half of the patients with mixed connective tissue disease. Early diagnosis of interstitial lung disease is possible by computed tomography. Interstitial lung disease can be treated by the combination of corticosteroids and cyclophosphamide. The authors were the first to detect the coexistence of interstitial lung disease and pulmonary arterial hypertension in mixed connective tissue disease. Subsequent respiratory alterations in these patient necessitate regular patient follow up.
Collapse
Affiliation(s)
- Judit Végh
- Debreceni Egyetem, Orvos- es Egészségtudományi Centrum, Altalános Orvosi Kar, III. Belgyógyászati Klinika, Immunológiai Tanszék
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Helenius LMJ, Meurman JH, Helenius I, Kari K, Hietanen J, Suuronen R, Hallikainen D, Kautiainen H, Leirisalo-Repo M, Lindqvist C. Oral and salivary parameters in patients with rheumatic diseases. Acta Odontol Scand 2005; 63:284-93. [PMID: 16419434 DOI: 10.1080/00016350510020043] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [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: 10/25/2022]
Abstract
We studied the presence of secondary Sjögren's syndrome (SS) and the composition of saliva, prevalence of oral pathogens, periodontitis, mouth mucosa, and teeth in patients with various rheumatic diseases and in healthy controls. The hypothesis was that different rheumatic diseases might cause differences in oral health characteristics because of the liability of secondary SS in the patients. The study involved 77 patients and 77 age-matched and sex-matched controls. Twenty patients were suffering from spondylarthropathy (SPA), 18 from ankylosing spondylitis (AS), 24 from rheumatoid arthritis (RA), and 15 from mixed connective tissue disease (MCTD). Clinical and radiographic oral health status was recorded and salivary flow rates were measured. Selected salivary proteins and immunoglobulins were analysed by routine methods. Minor salivary gland biopsy samples were taken from the patients for assessment of inflammatory focus scores. Differences between patients and controls and in between the different rheumatic diseases were analysed statistically. Secondary SS was diagnosed in 39% (30/77) of the patients. A severe periodontal condition (community periodontal index of treatment needs score 3 or 4) occurred in 58% (45/77) of the rheumatic patients compared with only 26% (20/77) of the controls (p < 0.0001). The severity of focal sialadenitis (focus score) correlated significant with salivary IgA, IgG, and IgM concentrations. Salivary albumin, total protein, IgG, and IgM concentrations were higher in all patient groups than in the controls. The number of patients with low salivary flow rates was higher in all patient groups compared to controls. Oral yeast counts were significantly higher in the patients than in the controls (p < 0.001). In a subgroup analysis, patients with SS had higher values for salivary IgA and IgM than patients without SS. Dental caries and oral lactobacilli were more frequent in patients with SS, but SS was not associated with periodontitis. No major differences were noted in other salivary biochemical parameters between these two groups. Patients with rheumatic diseases, irrespective of specific diagnosis, thus had various alterations in salivary flow and composition and oral health. The findings may reflect the autoimmune inflammation of the salivary glands frequently observed in these patients.
Collapse
Affiliation(s)
- L Miia J Helenius
- Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Finland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Abstract
Mixed connective tissue disease (MCTD) refers to a disease process with combined clinical features characteristic of systemic lupus erythematous, scleroderma, and polymyositis-dermatomyositis. This article focuses on the pulmonary vasculature manifestations of MCTD. We briefly discuss associations between MCTD and interstitial lung disease, pleural disease, and alveolar hemorrhage.
Collapse
Affiliation(s)
- Todd M Bull
- Division of Pulmonary Sciences and Critical Care Medicine, Pulmonary Hypertension Center, University of Colorado School of Medicine, 4200 East Ninth Avenue, Box C-272, Denver, CO 80262, USA.
| | | | | |
Collapse
|
21
|
Abstract
This article describes other manifestations of mixed connective tissue disease (MCTD). We focus on inflammatory arthritis, the gastrointestinal tract (the esophagus in particular), the kidney, skin, and hematologic changes such as thrombocytopenia. Due to the complexity of potential organ involvements in MCTD, vigilance with appropriate diagnosis and treatment is warranted.
Collapse
Affiliation(s)
- Janet E Pope
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, University of Western Ontario, 1151 Richmond Street, London, ON N6A 5B8, Canada.
| |
Collapse
|
22
|
Khamaganova IV, Dvornikov AS. [Endocrine disturbances in circumscribed scleroderma]. TERAPEVT ARKH 2005; 77:39-44. [PMID: 16320683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
AIM To evaluate prevalence of endocrine pathology in patients with circumscribed scleroderma (CS), baseline immunopathological alterations in CS patients. MATERIAL AND METHODS Circulating immune complexes were studied by the Digeon method in a total of 70 CS patients (female 52, 74.3%; male 18, 25.7%; age 16 to 70 years). RESULTS Circulating immune complexes assay by Digeon detected evident immune imbalance characteristic for metabolic disturbances of the connective tissue and affection of the endocrine system. CONCLUSION CS patients need a combined examination including endocrinological and immunological tests.
Collapse
|
23
|
Bodolay E, Csipo I, Gál I, Sipka S, Gyimesi E, Szekanecz Z, Szegedi G. Anti-endothelial cell antibodies in mixed connective tissue disease: frequency and association with clinical symptoms. Clin Exp Rheumatol 2004; 22:409-15. [PMID: 15301236] [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: 04/30/2023]
Abstract
OBJECTIVE Anti-endothelial cell antibodies (AECA) have been described in a number of systemic autoimmune-inflammatory diseases. However, little is known about the relationship of AECA with mixed connective tissue disease (MCTD). METHODS Using an ELISA, the presence of AECA was evaluated in the sera of 33 patients with MCTD and of 30 healthy subjects as controls. Serum levels of AECA were correlated with clinical activity, as well as the existence of various organ manifestations. RESULTS Significantly increased AECA production was observed in MCTD patients (OD = 0.337+/-0.193) compared to controls (OD = 0.136+/-0.065). In addition, patients with active MCTD exerted significantly elevated serum AECA levels (OD = 0.487+/-0.090) than did patients with inactive MCTD (OD = 0.135+/-0.040) or controls. MCTD patients with pulmonary hypertension had a tendency of increased serum AECA levels (OD = 0.452+/-0.080) compared to patients without this manifestation (OD = 0.307+/-0.039). Sera of MCTD patients with AECA concentrations higher or lower than the mean serum AECA level in controls+2SD (OD = 0.266) were considered as AECAhigh (n = 19/33) and AECAlow (n = 14/33), respectively. Interestingly, all patients with active disease had AECAhigh, while all inactive MCTD patients had AECAlow sera. IgG purified from ten MCTD sera (OD = 0.415+/-0.290) showed a tendency to up-regulate E-selectin expression on cultured human umbilical vein endothelial cells (HUVEC) compared to IgG from control sera. In addition, AECAhigh MCTD sera exerted significantly increased stimulatory effect on endothelial E-selectin expression (OD = 0.651+/-0.190) compared to AECAlow (OD = 0.178+/-0.110) or control sera (OD = 0. 131+/-0.080). CONCLUSION AECA may activate endothelial cells by the up-regulation of E-selectin expression and thus may be implicated in the pathogenesis of MCTD. Furthermore, serum AECA may be a useful marker of endothelial activation and clinical activity in this disease.
Collapse
Affiliation(s)
- E Bodolay
- Division of Clinical Immunology Laboratory, Department of Internal Medicine, University Debrecen, Medical and Health Science Center, Debrecen, Hungary.
| | | | | | | | | | | | | |
Collapse
|
24
|
Abstract
Abnormalities of CD40 ligand have been demonstrated in various kinds of diseases. Our objective was to determine serum soluble CD40 ligand (sCD40L) levels in patients with mixed connective tissue disease (MCTD). Serum sCD40L levels of 23 patients with MCTD and 21 healthy individuals were measured with specific enzyme-linked immunosorbent assays. Serum levels of sCD40L were significantly higher in patients with MCTD than in healthy individuals (median 0.179 ng/ml vs 0.99 ng/ml, 25th-75th percentile; 0.117-0.296 ng/ml vs 0.82-1.70 ng/ml, P<0.005), whereas there were no significant correlation between elevated serum sCD40L levels and clinical or serological features in patients with MCTD. These results suggest that sCD40L plays a role in the pathogenesis of MCTD. Further studies are needed to clarify this.
Collapse
Affiliation(s)
- M Jinnin
- Department of Dermatology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo 113-8655, Japan
| | | | | | | | | | | |
Collapse
|
25
|
Jinnin M, Ihn H, Yamane K, Asano Y, Yazawa N, Tamaki K. Serum levels of tissue inhibitor of metalloproteinases in patients with mixed connective tissue disease. Clin Exp Rheumatol 2002; 20:539-42. [PMID: 12175110] [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: 02/26/2023]
Abstract
OBJECTIVE To determine serum tissue inhibitor of metalloproteinase (TIMP)-1 and TIMP-2 levels in patients with mixed connective tissue disease (MCTD) and investigate whether these levels were correlated with the clinical or serological features of this disease. METHODS Serum TIMP-1 and TIMP-2 levels were measured with specific enzyme-linked immunosorbent assays. Serum samples from 26 patients with MCTD and 18 healthy individuals were examined. RESULTS; Serum levels of TIMP-1 were significantly higher in patients with MCTD than those in healthy individuals (mean +/- SD: 218.9 +/- 50.8 ng/ml versus 160.0 +/- 38.7 ng/ml, P < 0.0001). MCTD patients with elevated TIMP-1 had esophageal involvement at a significantly higher incidence than those without (77.8% versus 35.3%, p < 0.05). There was no difference in serum TIMP-2 levels between patients with MCTD and healthy controls (75.6 - 11.9 ng/ml versus 77.3 +/- 10.7 ng/ml). CONCLUSION These results suggest that TIMP-1 is involved in the pathogenesis of MCTD, and that TIMP-1 may be a serological marker for the presence of esophageal involvement in these patients.
Collapse
Affiliation(s)
- M Jinnin
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Japan
| | | | | | | | | | | |
Collapse
|
26
|
Bloom BJ, Miller LC, Blier PR. Soluble adhesion molecules in pediatric rheumatic diseases. J Rheumatol 2002; 29:832-6. [PMID: 11950029] [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: 02/24/2023]
Abstract
OBJECTIVE To determine serum levels of adhesion molecules ICAM-1, ICAM-3, VCAM-1, L-selectin, and E-selectin in children with a variety of pediatric rheumatic diseases and investigate their relationship to clinical disease activity. METHODS Retrospective review of records of 18 children with rheumatic diseases who had banked sera available for study. Eight children had systemic lupus erythematosus (SLE), 2 mixed connective tissue disease, 4 dermatomyositis (DM), and 4 various forms of vasculitis. Levels of the soluble adhesion molecules were determined by sandwich ELISA. Levels were compared among patients with the various diagnoses and between patients with active vs inactive disease. Levels were also correlated with erythrocyte sedimentation rate in all patients; C3, C4, and total hemolytic complements and anti-dsDNA antibodies in SLE; and creatine phosphokinase, aldolase, and von Willebrand factor (vWF) antigen levels in DM. Levels also correlated with disease activity scores, which varied by diagnosis. RESULTS A trend toward higher levels of sE-selectin was found in vasculitis vs other diagnoses (p = 0.08). sICAM-1 was higher in patients with active vs inactive disease (p = 0.05) across all diagnoses. L-selectin levels correlated with C4 complement levels in SLE patients (r = 0.76, p = 0.03), and there was a trend toward an inverse correlation between levels of sE-selectin and vWF (r = -0.93, p = 0.08). There was no direct correlation of the adhesion molecule levels with any of the disease activity scores. CONCLUSION The small number of patients and retrospective design of this study mean that any results must be interpreted with caution. We conclude: (1) Elevated E-selectin levels in vasculitis likely reflect the high degree of endothelial activation and possibly overt vascular damage in those conditions. (2) The correlation of sL-selectin with C4 in SLE may indicate that downregulation of shedding of cell surface L-selectin is involved in continued adherence of leukocytes to endothelium, possibly causing further damage and immune complex deposition in this condition. (3) The trend toward inverse correlation between sE-selectin and vWF:Ag in DM is curious, but may show that the role of endothelium in the pathophysiology of this disease is different from those such as vasculitis. (4) Levels of sICAM- I may be a useful marker of active vs quiescent disease in general in the pediatric rheumatic diseases, although lack of correlation with disease activity indices may indicate that it is too insensitive to smaller differences in disease activity to be recommended for routine clinical use.
Collapse
Affiliation(s)
- Bradley J Bloom
- Division of Pediatric Ambulatory Medicine, Hasbro Children's Hospital and Brown University Medical School, Providence, Rhode Island 02903, USA
| | | | | |
Collapse
|
27
|
Wanchu A, Sud A, Bambery P. Linear scleroderma and autoimmune hemolytic anaemia. J Assoc Physicians India 2002; 50:441-2. [PMID: 11922240] [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: 02/24/2023]
Abstract
Coexistence of localized scleroderma with other autoimmune disorders is not seen frequently. It has been reported to occur with myasthenia gravis, hemiatrophy and systemic lupus erythematosus. In this report we describe an association wherein linear scleroderma coexisted with autoimmune haemolytic anaemia.
Collapse
Affiliation(s)
- A Wanchu
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | | |
Collapse
|
28
|
Matsubara S. [Overlap syndrome]. Ryoikibetsu Shokogun Shirizu 2002:300-4. [PMID: 11555935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- S Matsubara
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
| |
Collapse
|
29
|
Cavazzana I, Franceschini F, Belfiore N, Quinzanini M, Caporali R, Calzavara-Pinton P, Bettoni L, Brucato A, Cattaneo R, Montecucco C. Undifferentiated connective tissue disease with antibodies to Ro/SSa: clinical features and follow-up of 148 patients. Clin Exp Rheumatol 2001; 19:403-9. [PMID: 11491495] [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: 02/21/2023]
Abstract
OBJECTIVE To evaluate the clinical and serologic profile, the rate of progression to well defined CTD and the possible predictors of disease evolution in patients affected by UCTD with antibodies anti-RoISSA. METHODS 148 patients diagnosed as UCTD were retrospectively evaluated. Antibodies to SSA/Ro were determined by counter-immunoelectrophoresis and ELISA. RESULTS Thirty-six patients (24.3%) developed a well-defined CTD after a mean follow-up of 4.5 years. Most patients developed primary Sjögren's syndrome (SS) (50%) or systemic lupus erythematosus (SLE) (30.5%). Leukopenia and xerophthalmia developed more frequently in the group of patients evolving to defined CTDs (p < 0.0032 and p < 0.0063). Leukopenia independently predicted the evolution in CTD by multivariate regression analysis (p < 0.019). Anti-dsDNA predicted the evolution in SLE (p < 0.0207), while the presence of additional anti-ENA specificity to anti-Ro/SSA was not associated with the outcome. CONCLUSION 24.3% of patients with UCTD and antibodies to Ro/SSA can progress in a relatively short period of time to well-defined CTDs. The development of primary SS could be predicted by xerophthalmia and SLE by the appearance of anti-dsDNA antibodies.
Collapse
Affiliation(s)
- I Cavazzana
- Servizio di Allergologia e Immunologia Clinica, Cattedra di Immunologia Clinica, Spedali Civili, Università degli Studi di Brescia, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Yokota S, Kobayashi Y. [Mixed connective tissue disease in childhood]. Ryoikibetsu Shokogun Shirizu 2001:471-4. [PMID: 11269139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- S Yokota
- Department of Pediatrics, Yokohama City University School of Medicine
| | | |
Collapse
|
31
|
Miyata M, Nishimaki T. [Neural disorders in mixed connective tissue disease(MCTD) and overlap syndrome]. Ryoikibetsu Shokogun Shirizu 2001:279-81. [PMID: 11031947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- M Miyata
- Department of Internal Medicine II, Fukushima Medical University School of Medicine
| | | |
Collapse
|
32
|
Myllykangas-Luosujärvi R, Jantunen E, Kaipiainen-Seppänen O, Mahlamäki E, Nousiainen T. Autologous peripheral blood stem cell transplantation in a patient with severe mixed connective tissue disease. Scand J Rheumatol 2001; 29:326-7. [PMID: 11093601 DOI: 10.1080/030097400447732] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
A 65-year old man with mixed connective tissue disease (MCTD) and severe therapy resistant polymyositis was considered for high-dose cyclophosphamide (200 mg/kg) supported by autologous stem cell transplantation (ASCT). During a 21 months follow-up there has been a significant subjective, but objectively only a slight improvement in muscle strength. Initially the levels of serum creatine kinase and serum aldolase normalised, but are at 21 months at about the same level as before ASCT. Based on histopathological examination there is still active myositis. Our case would suggests that this treatment may have some efficacy in MCTD with severe polymyositis although longer follow-up is needed.
Collapse
|
33
|
Tanaka K, Tanaka M. [Mixed connective tissue disease]. Ryoikibetsu Shokogun Shirizu 2001:343-6. [PMID: 11555949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- K Tanaka
- Department of Neurology, Brain Research Institute, Niigata University
| | | |
Collapse
|
34
|
Jun O, Keiko K, Hirobumi K. [MCTD and pulmonary hypertension]. Nihon Rinsho Meneki Gakkai Kaishi 2000; 23:643-6. [PMID: 11210761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- O Jun
- Department of Internal Medicine, Kitasato University School of Medicine
| | | | | |
Collapse
|
35
|
Cantatore FP, Corrado A, Covelli M, Lapadula G. [Morphologic study of the microcirculation in connective tissue diseases]. Ann Ital Med Int 2000; 15:273-81. [PMID: 11202629] [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: 02/19/2023]
Abstract
Capillaroscopy is a non-invasive diagnostic test used to study microvascular abnormalities which are present in many disorders, particularly some rheumatic pathologies, such as connective tissue diseases. In systemic sclerosis, capillaroscopy allows detection of pathognomonic microvascular alterations. In other connective tissue diseases, including systemic lupus erythematosus, dermatopolymyositis, undifferentiated connective tissue diseases, and mixed connective tissue disease, the capillaroscopic patterns, although non-specific, can provide a valid support for the diagnosis. In Raynaud's phenomenon, capillaroscopy enables detection of early microvascular abnormalities that are useful for preclinical diagnosis of secondary Raynaud's phenomenon.
Collapse
Affiliation(s)
- F P Cantatore
- Cattedra di Reumatologia, Università degli Studi di Foggia
| | | | | | | |
Collapse
|
36
|
Galuska L, Garai I, Csiki Z, Varga J, Bodolay E, Bajnok L. The clinical usefulness of the fingers-to-palm ratio in different hand microcirculatory abnormalities. Nucl Med Commun 2000; 21:659-63. [PMID: 10994670 DOI: 10.1097/00006231-200007000-00010] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A non-invasive nuclear medicine technique was developed to screen patients with painful hands so as to separate patients with a normal from those with an abnormal microcirculation of the hands in different clinical conditions. Such a technique is important, as the other methods available are either subjective or rather complicated. The study population consisted of 10 healthy individuals, 23 patients with Raynaud's syndrome and 15 patients with mixed connective tissue disease (MCTD). Sixty gamma-camera images of the hands (1 s each) were recorded after a bolus injection of 99Tcm-DTPA via a dorsal foot vein. Regions of interest were drawn on the summed images around the fingers and the palmar region. The fingers-to-palm ratio was then calculated from the total counts inside these regions of interest separately for each hand. The mean fingers-to-palm ratio was 0.94+/-0.18 (0.71-1.25) for the healthy group, 0.57+/-0.22 (0.21+/-1.11) for the MCTD group and 0.40+/-0.14 (0.18-0.77) for the Raynaud's patients. Analysis of variance showed these differences to be highly significant (P < 0.001). There were also significant differences between 6 MCTD patients in an active (mean 0.48) and nine patients in an inactive (mean 0.66) clinical state (two-sample t-test: P < 0.05). There were no significant differences between the fingers-to-palm ratios of the left and right hands of the same patients (one-sample t-test). Of the 23 primary Raynaud's patients, capillary microscopic data were pathological in only eight (34%). We conclude that our method is able to differentiate between patients with normal and those with abnormal microcirculation of the hands. Although measurement of the fingers-to-palm ratio is not a specific method, it is useful both for staging and in the follow-up of patients.
Collapse
Affiliation(s)
- L Galuska
- Nuclear Medicine Centre, University Medical School of Debrecen, Hungary.
| | | | | | | | | | | |
Collapse
|
37
|
Abstract
Since the original description of mixed connective tissue disease (MCTD) as an apparently unique syndrome by Sharp and co-workers, the concept of MCTD has been highly controversial. In this chapter, a quarter of a decade later, we examine the evidence that MCTD is a distinctive entity rather than a haphazard association of clinical and serological features and that the presence of high titres of autoantibodies to UIRNP influences the expression of connective tissue disease in ways that are relevant to prognosis and treatment. Results of longterm clinical studies are presented, which show that the clinical phenotype of MCTD is robust and can be defined by classification criteria that show reasonable sensitivity and specificity. In addition, the chapter addresses the results of immunogenetic and serological studies that demonstrate that MCTD is quite distinctive from systemic lupus erythematosus and systemic sclerosis. Indeed, there is good evidence that the clinical and serological features of MCTD are not just a haphazard association but that these patients represent a distinctive subset of connective tissue disease in which the specific autoimmune response is relevant to clinical expression and to understanding the underlying pathogenesis.
Collapse
Affiliation(s)
- P J Maddison
- Gwynedd Rheumatology Service, North West Wales NHS Trust, Ysbyty Gwynedd, Wales, UK
| |
Collapse
|
38
|
Stacher G, Merio R, Budka C, Schneider C, Smolen J, Tappeiner G. Cardiovascular autonomic function, autoantibodies, and esophageal motor activity in patients with systemic sclerosis and mixed connective tissue disease. J Rheumatol 2000; 27:692-7. [PMID: 10743810] [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: 02/16/2023]
Abstract
OBJECTIVE To study cardiovascular autonomic nerve function and presence of autoantibodies in relation to esophageal motor activity in patients with systemic sclerosis (SSc) and mixed connective tissue disease (MCTD). METHODS Twenty-five patients with SSc (13 limited, 12 diffuse cutaneous disease; disease duration 1-19 yrs) and 6 patients with MCTD (disease duration 1-10 yrs) were studied. Cardiovascular autonomic function was assessed using 5 standard tests and autoantibody status determined. Esophageal motor activity and lower and upper esophageal sphincter pressures were recorded manometrically. RESULTS Five patients with SSc had definite, 7 borderline, and 13 no autonomic dysfunction; 23 had antinuclear. 9 anti-Sc170, 4 anticentromere, and 1 U1snRNP antibodies. Contraction amplitudes in the smooth muscle as well as the striated muscle esophagus and lower esophageal sphincter pressures were significantly lower and autonomic dysfunction more frequent in patients with than in those without anti-Sc170 (6 of 9 vs 6 of 16 patients); upper esophageal sphincter pressures did not differ. All patients with MCTD had antinuclear antibodies, 5 had definite autonomic dysfunction; their lower esophageal sphincter pressures were significantly lower than in SSc patients without anti-Sc170 and anti-U1snRNP. CONCLUSION Esophageal motor dysfunction may be associated with the presence of anti-Sc170 and anti-U1snRNP autoantibodies and prevail in patients with cardiovascular autonomic neuropathy.
Collapse
Affiliation(s)
- G Stacher
- Department of Surgery, University of Vienna, Austria.
| | | | | | | | | | | |
Collapse
|
39
|
Abstract
The most common scleroderma overlap syndromes are mixed connective tissue disease (MCTD), scleromyositis and synthetase syndrome. There is controversy concerning MCTD as a separate entity due to heterogeneous clinical manifestations, not infrequent transformation into definite CTD and various classification criteria. Our study of 94 adult patients and 20 children, classified according to the criteria of Alarcon-Segovia, and especially a 5, 9-year follow-up showed transformation into SLE or SSc in over 20% of patients, less frequently than reported by others, whereas over half of the cases remained undifferentiated CTD. In several cases ARA criteria for both SSc and SLE were fulfilled, and there is no consensus whether such cases should be recognized as coexistence of both definite diseases or as MCTD. High titers of U1 RNP antibodies to 70 kD epitope were invariably present, whereas, by transformation into distinctive CTD there appeared, in addition, antibodies characteristic of these CTD. Of 108 cases positive for PM-Scl antibody, 83% were associated with scleromyositis. This scleroderma overlap syndrome differed from MCTD by coexistent features of dermatomyositis (myalgia, myositis, Gottron sign, heliotrope rash, calcinosis) with no component of SLE, characteristic of MCTD. The course was also chronic and rather benign, as in MCTD, and all cases responded to low or moderate doses of corticosteroids. A not infrequent complication was deforming arthritis of the hands. Our immunogenetic study showed an association of cases positive for PM-Scl antibody with HLA-DQA1x0501 alleles in 100% and with HLA-DRB1x0301 in 94% of cases. Synthetase syndrome, associated with anti-histidyl-tRNA synthetase antibodies, studied in 29 patients with myositis and interstitial lung disease (ILD), only in single cases had scleroderma-like features. These cases differed from SSc by acute onset with fever, and by response to moderate doses of corticosteroids. We also studied overlap of localized scleroderma with other CTD: 21 cases of progressive facial hemiatrophy and linear scleroderma, and 55 (39.5%) of atrophoderma Pasini-Pierini (APP) and morphea. As in other autoimmune disorders, two or more connective tissue diseases (CTD) may develop concurrently or sequentially in the same patient. In such overlap syndromes ARA criteria must be fulfilled for each of the disease, and the clinical presentation has features of both. However more frequently overlap syndromes only combine some manifestations of more than one CTD, and present a highly heterogeneous group of disorders with prevailing clinical features of SSc.
Collapse
Affiliation(s)
- S Jablonska
- Department of Dermatology, Warsaw School of Medicine, Poland
| | | |
Collapse
|
40
|
Luostarinen L, Himanen SL, Pirttilä T, Molnar G. Mixed connective tissue disease associated with chronic inflammatory demyelinating polyneuropathy. Scand J Rheumatol 1999; 28:328-30. [PMID: 10568432 DOI: 10.1080/03009749950155544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
We present a patient with mixed connective tissue disease (MCTD) and slowly progressing demyelinating polyradiculoneuropathy (CIDP). To our knowledge, the case described is the first reported MCTD case associated with definite CIDP.
Collapse
Affiliation(s)
- L Luostarinen
- Department of Neurology, Tampere University Hospital, Finland
| | | | | | | |
Collapse
|
41
|
Scheja A, Elborgh R, Wildt M. Decreased capillary density in juvenile dermatomyositis and in mixed connective tissue disease. J Rheumatol 1999; 26:1377-81. [PMID: 10381059] [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: 02/13/2023]
Abstract
OBJECTIVE To assess whether quantitative capillary microscopy is a useful tool to evaluate capillary abnormalities in children with connective tissue diseases. METHODS Eight children with juvenile dermatomyositis (JDM), 6 with mixed connective tissue disease (MCTD) and 23 healthy children were investigated with computer based quantitative capillary microscopy. Median disease duration was 1 year among JDM (1-4) and 3 years (1-7) among MCTD. RESULTS Capillary density was decreased in JDM [median 2.5 (1.4-4.3) loops/mm (p < 0.001)] and in MCTD [median 5.0 (4.1-7.0) loops/mm (p < 0.05)] compared to healthy controls [median 6.8 (5.3-8.0) loops/mm]. Median capillary loop area was increased in JDM [median 8.5 (3.0-15.8) 10(-3) mm2 (p < 0.001)] and in MCTD [median 4.5 (3.0-6.0) 10(-3) mm2 (p < 0.02)] compared to controls [median 2.5 (1.0-4.0) 10(-3) mm2]. CONCLUSION Quantitative nailfold capillary microscopy is a sensitive indicator of JDM. In MCTD this technique is less discriminative.
Collapse
Affiliation(s)
- A Scheja
- Department of Rheumatology, University Hospital at Lund, Sweden
| | | | | |
Collapse
|
42
|
Tojo T. [A viewpoint: overlap syndrome in diffuse collagen diseases]. Ryumachi 1998; 38:685-8. [PMID: 9852744] [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: 02/09/2023]
|
43
|
Abstract
OBJECTIVE The aim of this study was to characterize the clinical and motility findings in 62 patients with systemic sclerosis or related disorders referred for evaluation of upper gastrointestinal (GI) symptoms. METHODS Methods included retrospective clinical record review and quantitation of esophageal, LES antral, and duodenal motility (3 h fasting, 2 h fed) were compared with results of 10 symptomatic patients with normal gastric emptying. RESULTS A total of 46 patients had systemic sclerosis, eight mixed connective tissue disease, and eight polymyositis-systemic sclerosis overlap; systemic manifestations were almost invariably present. GI symptoms were: heartburn (77%), nausea/vomiting (58%), dysphagia (61%), diarrhea (53%), constipation (31%), and fecal incontinence (13%). Anatomical studies showed esophageal erosions or GERD (53%), aperistalsis (34%), stricture (29%), and Barrett's metaplasia (16%); megaduodenum, small bowel dilation, or diverticulae (42%); and pneumatosis intestinalis (8%). A total of 36 patients underwent esophageal and 26 esophagogastrointestinal manometry. Postprandial antral motility index was abnormal in 22 of 26; amplitudes and frequency in the antrum (34 +/- 3 mm Hg and 0.6 +/- 0.1/min, respectively) and duodenum (7.3 +/- 0.9 mm Hg and 1.8 +/- 0.5/min) were significantly lower than controls (p < 0.05). CONCLUSION In patients with GI symptoms associated with systemic sclerosis and related disorders, the amplitude and frequency of intestinal contractions are typically <10 mm Hg and <2/min. Antral amplitude is low (<40 mm Hg) when antral hypomotility is observed.
Collapse
Affiliation(s)
- S Weston
- Gastroenterology Research Unit, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
| | | | | | | |
Collapse
|
44
|
Margaux J, Hayem G, Palazzo E, Chazerain P, De Bandt M, Haim T, Kahn MF, Meyer O. Clinical usefulness of antibodies to U1snRNP proteins in mixed connective tissue disease and systemic lupus erythematosus. Rev Rhum Engl Ed 1998; 65:378-86. [PMID: 9670329] [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: 02/08/2023]
Abstract
OBJECTIVES To determine whether the anti-68 kDaU1snRNP antibody is associated with mixed connective tissue disease and not with SLE; to evaluate correlations between anti-U1snRNP titers and disease activity; and to look for associations between anti-U1snRNP specificities and specific clinical features. PATIENTS AND METHODS 40 patients with a positive double diffusion test for anti-68 kDa U1snRNP were studied, including 21 with mixed connective tissue disease, 14 with systemic lupus erythematosus and five with other connective tissue diseases. IgGs to 68 kDa U1snRNP were assayed using an ELISA. Clinical features, disease activity and antibody test findings were evaluated longitudinally in nine patients. RESULTS Both proportions of patients with anti-68 kDa U1snRNP and titers of IgG to 68 kDa U1snRNP were similar in the mixed connective tissue disease and systemic lupus erythematosus groups. Patients with mixed connective tissue disease were significantly more likely to have anti-A U1snRNP or anti-C U1snRNP than those with systemic lupus erythematosus (P < 0.03 and P < 0.04, respectively). No significant correlations were found between any of the features of mixed connective tissue disease (e.g., Raynaud's phenomenon, myositis, or sausage digits) and a specific anti-U1snRNP antibody. During follow-up (mean, seven years; range, 1-25 years), changes occurred in the anti-U1snRNP profile and in the anti-68 kDa U1snRNP titer. These changes were not correlated with disease activity. CONCLUSIONS IgGs to 68 kDa U1snRNP are not associated with a specific pattern of anti-RNP-positive connective tissue disease. No useful information can be gained by monitoring anti-68 kDa U1snRNP IgG titers over time. A Western blot profile including anti-A U1snRNP or anti-C U1snRNP indicates a high likelihood of U1snRNP-associated mixed connective tissue syndrome (MCTD).
Collapse
Affiliation(s)
- J Margaux
- Rheumatology Department, Bichat Teaching Hospital, Paris, France
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Berding G, Kirchhoff TD, Burchert W, von der Hoff J, Zeidler H, Hundeshagen H, Knapp WH. [18F]fluoride PET indicates reduced bone formation in severe glucocorticoid-induced osteoporosis. Nuklearmedizin 1998; 37:76-9. [PMID: 9547755] [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: 02/07/2023]
Abstract
A 61-year-old female patient presenting with mixed connective tissue disease (Sharp syndrome), underwent a long-term high dose glucocorticoid treatment because of multiple organ manifestations. Under steroid therapy she developed severe osteoporosis resulting in multiple fractures. A dynamic [18F]fluoride PET study in this patient revealed reduced fluoride influx in non-fractured vertebrae. This finding corresponds to pathogenetic concepts which propose an inhibition of bone formation as major cause of glucocorticoid-induced osteoporosis. In the light of the presented case it seems to be promising to evaluate the diagnostic benefit of [18F]fluoride PET in osteoporosis.
Collapse
Affiliation(s)
- G Berding
- Klinik für Nuklearmedizin, Medizinischen Hochschule Hannover, Germany.
| | | | | | | | | | | | | |
Collapse
|
46
|
Affiliation(s)
- Y Farhey
- Department of Medicine, University of Cincinnati, Ohio 45267-0563, USA
| | | |
Collapse
|
47
|
Kashiwagi H. [Mixed connective tissue disease: Progress in diagnosis and treatment. IV. Its clinical course and prognosis]. Nihon Naika Gakkai Zasshi 1996; 85:1265-8. [PMID: 8965026] [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: 02/03/2023]
|
48
|
Mier R, Ansell B, Hall MA, Hasson N, Levinson J, Lovell D, Passo M, Rennebohm R, Woo P. Long term follow-up of children with mixed connective tissue disease. Lupus 1996; 5:221-6. [PMID: 8803894 DOI: 10.1177/096120339600500310] [Citation(s) in RCA: 4] [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] [Indexed: 02/02/2023]
Abstract
Mixed connective tissue disease (MCTD) is characterized by features of more than one of the rheumatic disorders with antinuclear antibodies in a speckled pattern and with antibodies to nuclear ribonucleoprotein (nRNP). MCTD is uncommon in children and long-term follow-up studies in children are infrequently reported. A retrospective review of clinical experience at five pediatric rheumatology centers provided 11 patients who met the following inclusion criteria: (1) Kasukawa's criteria for MCTD1; (2) presentation younger than 18th birthday; (3) greater than five years of follow-up; (4) completion of data collection form. The widely varying outcomes of these 11 children with MCTD on long-term follow-up may lend doubt that this is a unique and distinctive rheumatologic disorder.
Collapse
Affiliation(s)
- R Mier
- Shriners Hospital, Lexington, Kentucky 40502, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Abstract
Connective tissue is ubiquitous and subject to alterations that result in changes in the extracellular matrix of vessels and tissues leading to the long-term complications of diabetes. This article reviews only those abnormalities of interstitial connective tissue involving skeleton, joints, skin, and periarticular tissues. Abnormalities in the skin and periarticular tissues result in syndromes limiting joint movement, including limited joint mobility, Dupuytren disease, flexor tenosynovitis, carpal tunnel syndrome, stiff-hand syndrome, and shoulder-hand reflex dystrophy. Of these, only limited joint mobility and stiff-hand syndrome occur exclusively in patients with diabetes. In all of these conditions, advanced glycation end products are thought to form as a result of nonenzymatic reaction of glucose with proteins, causing stiffening.
Collapse
Affiliation(s)
- A L Rosenbloom
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, USA
| | | |
Collapse
|
50
|
Abstract
Mixed connective tissue disease (MCTD) was described as a distinct clinical syndrome in 1972. Since then many cases have been reported in the literature worldwide. In this study we present our experience with a group of 17 Mexican patients with this syndrome, and we analyze their clinical and serological features, as well as the causes of death in these patients. The patients are Mexican mestizos living in Guadalajara and most of them have been followed-up at Hospital General de Occidente for a period of 1-10 years. The female/male ratio was 16:1, and their age ranged from 14-55 years with a mean of 29 years. The disease duration has ranged from 1-17 years, with a mean of 6 years. Among the clinical manifestations we have found a high frequency of lymphadenopathy when compared with published series (13/17 or 76%), and the laboratory findings in our patients included a very high polyclonal increase of gammaglobulins (93%), lymphopenia (76%), direct immunofluorescence speckled nuclear epidermal deposits in skin biopsies (75%) and positive rheumatoid factor (65%). Other clinical and serological features were similar to those reported in other series of patients with MCTD. Six of the 17 patients have died (35%), and in 3 of them (17.5%) the cause of death was due to an infectious disease that suddenly presented, and apparently was not related to a concomitant high dose of steroids or malnutrition in the patients. It seems that in addition to the already well known autoimmune abnormalities that occur in MCTD, there are other features like the presence of lymphadenopathy, the high polyclonal increase of gammaglobulins, and the lymphopenia, that reflect the profound disturbance of the immune system in this syndrome, possibly contributing to the sudden appearance of a severe infectious disease in some of our patients.
Collapse
|