21 results on '"Early systemic sclerosis"'
Search Results
2. Incidence, prevalence and long-term progression of Goh algorithm rated interstitial lung disease in systemic sclerosis in two independent cohorts in flanders: A retrospective cohort study.
- Author
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Vandecasteele, Els, Melsens, Karin, Vanhaecke, Amber, Blockmans, Daniel, Bonroy, Carolien, Carton, Charlotte, Deschepper, Ellen, De Keyser, Filip, Houssiau, Frédéric, Piette, Yves, Vanthuyne, Marie, Verbeke, Koen, Westhovens, Rene, Wuyts, Wim A., De Langhe, Ellen, Brusselle, Guy, and Smith, Vanessa
- Abstract
• Baseline HRCT and PFT are paramount in clinically overt (LcSSc and DcSSc) patients. • The majority of clinically overt SSc patients with ILD progresses within 5 years. • Baseline HRCT and PFT are paramount in patients with "early" SSc. • Only a very small proportion of the "early" SSc develop ILD during follow-up. Objectives: The epidemiology of interstitial lung disease (ILD) in systemic sclerosis (SSc) in Belgium is unknown. In literature, its prevalence varies between 19% and 52% in limited/diffuse cutaneous SSc (LcSSc/DcSSc). However, its prevalence in "early" SSc (pre-clinically overt SSc without [yet] skin involvement), nor its incidence rate in SSc (LcSSc/DcSSc/"early" SSc) has ever been described. Against this background, we aimed to determine the prevalence/incidence (rate) and progression of ILD in SSc. Methods: 12-year follow-up data of consecutive SSc patients, included in two Flemish cohorts (University Hospitals Ghent and Leuven), were retrospectively analysed. ILD was classified according to the simplified Goh algorithm. Progression of ILD was defined as a relative decline of FVC ≥10%, a combined relative decline of FVC 5-10% and DLCO ≥15%, or as an increase in HRCT extent. Results: 722 patients (60% LcSSc/ 20% DcSSc/ 20% "early" SSc, median (IQR) follow-up 39 [12-80] months) had baseline HRCT. 243 were rated to have ILD at baseline and 39 during follow-up (prevalence of 34%/ incidence rate of 20.3/1000PY, 95%CI:14.5-27.8). Amongst those with baseline ILD, 60% had lung functional progression at five years of follow-up. In the "early" SSc subgroup, eight patients were rated to have ILD at baseline and three during follow-up (prevalence of 6%/ incidence rate of 5.8/1000 PY, 95%CI:1.2-17.0). Conclusion: Both LcSSc and DcSSc patients should be monitored for ILD evolution. The low prevalence and incidence of ILD in the "early" SSc subgroup may instruct future decisions on the construction of uniform patient follow-up pathways in "early" SSc. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
3. Targeting very early systemic sclerosis: a case-based review.
- Author
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Melissaropoulos, Konstantinos, Kraniotis, Pantelis, Bogdanos, Dimitrios, Dimitroulas, Theodoros, Sakkas, Lazaros, and Daoussis, Dimitrios
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SYSTEMIC scleroderma , *PULMONARY function tests , *CLINICAL trials , *DISEASE duration , *RETROPERITONEAL fibrosis - Abstract
It is unknown whether treatment in very early/early systemic sclerosis (SSc) can affect long-term outcomes. A case-based review was conducted (i) to assess the effect of rituximab (RTX) in very early SSc and (ii) to explore how many clinical trials in SSc targeted early disease and whether treatment of these patients led to better clinical outcomes. We identified cases of very early SSc from our department and performed a search in MEDLINE and Scopus databases for clinical trials in SSc during 2005–2018. Two cases are reported where RTX was administered within 24 months from the appearance of Raynaud's. In the first case, there was an improvement in interstitial lung disease as indicated by the improvement in pulmonary function tests and the regression of changes in high-resolution chest computed tomography. In the second case, a good clinical response in skin fibrosis was observed. The review revealed the following: (i) only one-third of the studies were specifically designed to target early disease, (ii) there is confusion related to disease duration definition across SSc clinical trials but an obvious trend towards improvement was evident during the past years, (iii) the question of whether early implementation of therapy may lead to better clinical outcomes cannot be definitely answered based on existing data and (iv) there is still a very low level of incorporation of the new classification criteria in SSc trials. This review suggests that there may be a window of opportunity in SSc and highlights the need for clinical trials targeting very early/early disease. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
4. Mise au point sur les sclérodermies très précoces et précoces.
- Author
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Michaud, M., Catros, F., Ancellin, S., and Gaches, F.
- Abstract
Les critères de classification de la sclérodermie systémique ont évolué au cours de trois dernières décennies, permettant une classification de plus en plus précoce. À la fin des années 2000, le groupe européen de recherche sur les sclérodermies (groupe EUSTAR) a validé les notions de sclérodermies très précoces et précoces. Le phénomène de Raynaud, la présence d'anticorps antinucléaires ou de doigts boudinés sont des « drapeaux rouges » qui doivent faire orienter le patient vers un spécialiste, faire réaliser une capillaroscopie et la recherche d'autoanticorps spécifiques de la sclérodermie systémique. Au stade de sclérodermie très précoce, une atteinte cardiaque, pulmonaire ou digestive peut déjà être présente et doit donc être systématiquement recherchée. Nous détaillerons ici les critères de sclérodermie systémique très précoce et précoce, ainsi que les facteurs prédictifs d'évolution vers une sclérodermie systémique. Classification criteria for systemic sclerosis evolved over the last three decades, allowing an earlier classification. In the late 2000s, the EULAR Scleroderma Trials and Research Group validated very early and early systemic sclerosis criteria. Raynaud phenomenon, anti-nuclear antibody positivity and the puffy fingers are "Red flags" that must lead to refer the patient to a specialist and benefit from a capillaroscopy and the specific autoantibodies. At the stage of very early systemic sclerosis, pulmonary, cardiac and digestive involvements may be present and must be screened. Herein, we detail very early and early systemic sclerosis criteria, as well as the predictive factors of evolution towards a systemic sclerosis. [ABSTRACT FROM AUTHOR]
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- 2019
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- View/download PDF
5. Very early and early systemic sclerosis in the Spanish scleroderma Registry (RESCLE) cohort.
- Author
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Trapiella-Martínez, Luis, Díaz-López, José Bernardino, Caminal-Montero, Luis, Tolosa-Vilella, Carles, Guillén-Del Castillo, Alfredo, Colunga-Argüelles, Dolores, Rubio-Rivas, Manuel, Iniesta-Arandia, Nerea, Castillo-Palma, María Jesús, Sáez-Comet, Luis, Egurbide-Arberas, María Victoria, Ortego-Centeno, Norberto, Freire, Mayka, Vargas-Hitos, Jose Antonio, Ríos-Blanco, Juan José, Todolí-Parra, Jose Antonio, Rodríguez-Carballeira, Mónica, Marín-Ballvé, Adela, Chamorro-Fernández, Antonio Javier, and Pla-Salas, Xavier
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SYSTEMIC scleroderma , *DISEASE progression , *ANTINUCLEAR factors , *DISEASE risk factors , *DIAGNOSIS , *THERAPEUTICS - Abstract
Objectives According to the existence of subclinical organ involvement pre-scleroderma should be divided into two subsets: very early and early disease. Pre-scleroderma patients included in the Spanish Scleroderma Registry (RESCLE) Cohort were reclassified into subsets. Differences were evaluated and the risk of progression to definite systemic sclerosis was estimated. Methods The characteristics of very early and early SSc patients were compared. A logistic regression model was used to determine the risk factors of progression. Results 1632 patients were included, 36 (2.2%) in the very early subset and 111 (6.8%) in the early subset. There were no differences in sex, age at disease onset, duration of Raynaud's phenomenon, antinuclear antibodies or capillaroscopic findings. Three (8.3%) very early SSc patients evolved to definite SSc, 2 (5.6%) of them meeting the ACR/EULAR 2013 criteria, unlike 31 (28%) early SSc patients, 20 (24%) of them meeting the criteria ( p = 0.034). Digestive involvement was an independent risk factor of progression (OR 17; 95% CI, 6.1–47.2). Conclusions The classification of early forms of scleroderma identifies patients with different prognostic risk of progression. The evolution to definite SSc is more frequent in early than in very early SSc patients. Digestive involvement is a risk factor of progression. An active assessment of organ damage in preclinical stages allows a correct classification and risk stratification, with implications for monitoring and treatment. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
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6. Algorithm for the Diagnosis of Scleroderma. Early Systemic Sclerosis: Definitions and diagnostic criteria
- Author
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Domenico Galasso, Salvatore Mazzuca, and Norma Marigliano
- Subjects
Acquired systemic inflammatory disease of connective tissue ,Scleroderma ,Early systemic sclerosis ,Capillaroscopy ,Early diagnosis. ,Medicine - Abstract
Introduction: The term scleroderma derives from the Greek words skleros, which means hard, and derma, which means skin. It refers to an acquired systemic inflammatory disease of the connective tissue –also known as systemic sclerosis (SSc)– characterized by excessive collagen deposition in the skin and the internal organs that results in fibrosis. The typical vascular lesion in SSc leads to narrowing of the vessel lumen, intimal thickening, medial hypotrophy, and adventitial fibrosis of small muscular vessels, collagen deposition in the other matrix components of interstice, and the Raynaud phenomenon secondary to these widespread microvascular abnormalities. All these characteristics lead to a connective tissue re-modeling. Discussion: Several clinical studies utilize the American Rheumatology Association’s 1980 classification. However, these diagnostic criteria are unsatisfactory because they fail to take into consideration part of the disease spectrum. Early-phase SSc is characterized by the Raynaud phenomenon (in 90% of all patients), sclerodactyly, and positivity for SSc-specific autoantibodies (antinuclear antibodies, anti-topoisomerase I antibodies, anti-RNA polymerase I and III antibodies, anti-centromere antibodies, anti-fibrillarin antibodies, anti-PM-SCL antibodies).. It is necessary to reduce delays in the diagnosis of SSc. Conclusions: Patients with red-flag positivity (Raynaud phenomenon and digital edema) require Phase I SSc screening, which consists in capillaroscopic assessment of possible microvascular abnormalities. The work-up will then focus on inflammatory indices, renal function tests, and internal organ involvement (echocardiography, high-resolution computed tomography of the chest, diffusing capacity of the lungs for carbon monoxide).
- Published
- 2013
- Full Text
- View/download PDF
7. The magnitude of cytokine production by stimulated CD56+ cells is associated with early stages of systemic sclerosis.
- Author
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Cossu, Marta, van Bon, Lenny, Nierkens, Stefan, Bellocchi, Chiara, Santaniello, Alessandro, Dolstra, Harry, Beretta, Lorenzo, and Radstake, Timothy R.D.J.
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SYSTEMIC scleroderma , *RAYNAUD'S disease , *TUMOR necrosis factors , *INTERLEUKIN-6 , *NATURAL immunity , *PULMONARY fibrosis - Abstract
Immune activation is a hallmark of systemic sclerosis (SSc). However, the immunological alterations that occur in preclinical and non-fibrotic SSc and that differentiate these subjects from those with primary Raynaud's phenomenon (PRP) or healthy controls (HC) are poorly defined. We isolated CD56 + (NK/NKT-like) cells from HC, patients with PRP, early SSc (EaSSc) and definite SSc without skin or lung fibrosis. Cytokine production upon different activating stimuli was measured via a multiplex immuno assay. Clearly discriminative patterns among the different stages of SSc were most markedly observed after TLR1/2 stimulation, with increased IL-6, TNF-α and MIP-1α/CCL3 production in definite SSc patients as compared to HC and/or PRP. Initial alterations were observed in EaSSc patients with an intermediate secretion pattern between HC/PRP and definite SSc. CD56 + cells from patients at different stages of SSc differentially respond to TLR stimulation, highlighting the relevance of natural immunity in the developmental and pre-fibrotic SSc. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
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8. Incidence, prevalence and long-term progression of Goh algorithm rated interstitial lung disease in systemic sclerosis in two independent cohorts in flanders: A retrospective cohort study.
- Author
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UCL - SSS/IREC/RUMA - Pôle de Pathologies rhumatismales, UCL - (SLuc) Service de rhumatologie, Vandecasteele, Els, Melsens, Karin, Vanhaecke, Amber, Blockmans, Daniel, Bonroy, Carolien, Carton, Charlotte, Deschepper, Ellen, De Keyser, Filip, Houssiau, Frédéric, Piette, Yves, Vanthuyne, Marie, Verbeke, Koen, Westhovens, Rene, Wuyts, Wim A, De Langhe, Ellen, Brusselle, Guy, Smith, Vanessa, UCL - SSS/IREC/RUMA - Pôle de Pathologies rhumatismales, UCL - (SLuc) Service de rhumatologie, Vandecasteele, Els, Melsens, Karin, Vanhaecke, Amber, Blockmans, Daniel, Bonroy, Carolien, Carton, Charlotte, Deschepper, Ellen, De Keyser, Filip, Houssiau, Frédéric, Piette, Yves, Vanthuyne, Marie, Verbeke, Koen, Westhovens, Rene, Wuyts, Wim A, De Langhe, Ellen, Brusselle, Guy, and Smith, Vanessa
- Abstract
The epidemiology of interstitial lung disease (ILD) in systemic sclerosis (SSc) in Belgium is unknown. In literature, its prevalence varies between 19% and 52% in limited/diffuse cutaneous SSc (LcSSc/DcSSc). However, its prevalence in "early" SSc (pre-clinically overt SSc without [yet] skin involvement), nor its incidence rate in SSc (LcSSc/DcSSc/"early" SSc) has ever been described. Against this background, we aimed to determine the prevalence/incidence (rate) and progression of ILD in SSc. 12-year follow-up data of consecutive SSc patients, included in two Flemish cohorts (University Hospitals Ghent and Leuven), were retrospectively analysed. ILD was classified according to the simplified Goh algorithm. Progression of ILD was defined as a relative decline of FVC ≥10%, a combined relative decline of FVC 5-10% and DLCO ≥15%, or as an increase in HRCT extent. 722 patients (60% LcSSc/ 20% DcSSc/ 20% "early" SSc, median (IQR) follow-up 39 [12-80] months) had baseline HRCT. 243 were rated to have ILD at baseline and 39 during follow-up (prevalence of 34%/ incidence rate of 20.3/1000PY, 95%CI:14.5-27.8). Amongst those with baseline ILD, 60% had lung functional progression at five years of follow-up. In the "early" SSc subgroup, eight patients were rated to have ILD at baseline and three during follow-up (prevalence of 6%/ incidence rate of 5.8/1000 PY, 95%CI:1.2-17.0). Both LcSSc and DcSSc patients should be monitored for ILD evolution. The low prevalence and incidence of ILD in the "early" SSc subgroup may instruct future decisions on the construction of uniform patient follow-up pathways in "early" SSc.
- Published
- 2021
9. Incidence, prevalence and long-term progression of Goh algorithm rated interstitial lung disease in systemic sclerosis in two independent cohorts in flanders: A retrospective cohort study
- Author
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Frédéric Houssiau, Filip De Keyser, Yves Piette, Koen Verbeke, Carolien Bonroy, Amber Vanhaecke, Rene Westhovens, Ellen De Langhe, Daniel Engelbert Blockmans, Wim A. Wuyts, Karin Melsens, Guy Brusselle, Charlotte Carton, Vanessa Smith, Marie Vanthuyne, Els Vandecasteele, Ellen Deschepper, UCL - SSS/IREC/RUMA - Pôle de Pathologies rhumatismales, and UCL - (SLuc) Service de rhumatologie
- Subjects
INVOLVEMENT ,medicine.medical_specialty ,SUBSETS ,Epidemiology ,Interstitial lung disease ,CLASSIFICATION ,FEV1/FVC ratio ,6-MINUTE WALK TEST ,Rheumatology ,DLCO ,medicine ,Medicine and Health Sciences ,Prevalence ,Humans ,CRITERIA ,skin and connective tissue diseases ,Lung ,Retrospective Studies ,Scleroderma, Systemic ,integumentary system ,business.industry ,Incidence (epidemiology) ,Incidence ,MORTALITY ,Retrospective cohort study ,respiratory system ,Early systemic sclerosis ,medicine.disease ,respiratory tract diseases ,Anesthesiology and Pain Medicine ,medicine.anatomical_structure ,Incidence and progression ,Systemic sclerosis ,business ,Lung Diseases, Interstitial ,Algorithm ,Algorithms ,Incidence prevalence - Abstract
Objectives: The epidemiology of interstitial lung disease (ILD) in systemic sclerosis (SSc) in Belgium is unknown. In literature, its prevalence varies between 19% and 52% in limited/diffuse cutaneous SSc (LcSSc/ DcSSc). However, its prevalence in "early" SSc (pre-clinically overt SSc without [yet] skin involvement), nor its incidence rate in SSc (LcSSc/DcSSc/"early" SSc) has ever been described. Against this background, we aimed to determine the prevalence/incidence (rate) and progression of ILD in SSc. Methods: 12-year follow-up data of consecutive SSc patients, included in two Flemish cohorts (University Hospitals Ghent and Leuven), were retrospectively analysed. ILD was classified according to the simplified Goh algorithm. Progression of ILD was defined as a relative decline of FVC >10%, a combined relative decline of FVC 5-10% and DLCO >15%, or as an increase in HRCT extent. Results: 722 patients (60% LcSSc/ 20% DcSSc/ 20% "early" SSc, median (IQR) follow-up 39 [12-80] months) had baseline HRCT. 243 were rated to have ILD at baseline and 39 during follow-up (prevalence of 34%/ incidence rate of 20.3/1000PY, 95%CI:14.5-27.8). Amongst those with baseline ILD, 60% had lung functional progression at five years of follow-up. In the "early" SSc subgroup, eight patients were rated to have ILD at baseline and three during follow-up (prevalence of 6%/ incidence rate of 5.8/1000 PY, 95%CI:1.2-17.0). Conclusion: Both LcSSc and DcSSc patients should be monitored for ILD evolution. The low prevalence and incidence of ILD in the "early" SSc subgroup may instruct future decisions on the construction of uniform patient follow-up pathways in "early" SSc. (c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
- Published
- 2021
10. Early systemic sclerosis-opportunities for treatment.
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Sakkas, Lazaros, Simopoulou, Theodora, Katsiari, Christina, Bogdanos, Dimitrios, and Chikanza, Ian
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SYSTEMIC scleroderma , *FIBROSIS , *MICROCIRCULATION disorders , *PHYSIOLOGICAL effects of collagen , *IMMUNOSUPPRESSIVE agents , *AUTOANTIBODIES , *RANDOMIZED controlled trials , *DIAGNOSIS , *THERAPEUTICS - Abstract
Systemic sclerosis (SSc) is characterized by microvasculopathy (Raynaud's phenomenon and fibrointimal proliferation), presence of autoantibodies and collagen deposition in skin (scleroderma) and internal organs. Microvasculopathy, detected by nailfold capillaroscopy, and disease-specific autoantibodies (anti-topoisomerase I, anti-centromere, anti-RNA polymerase III antibodies) usually appear earlier, even years before scleroderma. At that stage of the disease, immune activation with T cells and B cells promote fibrosis. Diagnosis of SSc has been relied on scleroderma, and by this time, internal organs may have developed fibrosis, a lethal feature with no available treatment. The new EULAR/ACR 2013 criteria for the classification of SSc will help identify SSc patients before fibrosis of internal organs. The early diagnosis of SSc, before the development of fibrosis in internal organs, will allow the introduction of immunosuppressive medications in these patients in a controlled setting (randomized trials). It is anticipated that this approach will change the hitherto grim prognosis of SSc for the better. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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11. Genomic instability in early systemic sclerosis.
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Gniadecki, Robert, Iyer, Aishwarya, Hennessey, Dylan, Khan, Lamia, O'Keefe, Sandra, Redmond, Desiree, Storek, Jan, Durand, Caylib, Cohen-Tervaert, Jan Willem, and Osman, Mohammed
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SYSTEMIC scleroderma , *TUMOR suppressor genes , *CANCER genes , *RNA polymerases , *BASE pairs , *GASTROINTESTINAL tumors - Abstract
Systemic sclerosis (SSc) is associated with secondary malignancies. Previous studies have suggested that mutated cancer proteins, such as RNA polymerase III, are autoantigens promoting an inflammatory response in SSc. However, it has never been previously investigated whether non-neoplastic tissue in SSc harbors mutations which may play a role in SSc pathogenesis. Skin biopsies were obtained from 8 sequential patients with a progressive form of early stage SSc (with severe skin and/or lung involvement). Areas of dermal fibrosis were microdissected and analyzed with deep, whole exome sequencing. Gene mutation patterns were compared to autologous buccal mucosal cells as a control. SSc skin biopsies were hypermutated with an average of 58 mutations/106 base pairs. The mutational pattern in all samples exhibited a clock-like signature, which is ubiquitous in cancers and in senescent cells. Of the 1997 genes we identified which were mutated in at least two SSc patients, 39 genes represented cancer drivers (i.e. tumor suppressor genes or oncogenes) which are commonly found in gynecological, squamous and gastrointestinal cancer signatures. Of all the mutations, the most common mutated genes were important in regulating pathways related to epigenetic histone modifications, DNA repair and genome integrity. Somatic hypermutation occurs in fibrotic skin in patients with early progressive SSc. Cancer driver gene mutations may potentially play a fundamental role in the pathogenesis of SSc. • Non-synonymous genomic mutations are common in the dermis of patients with early systemic sclerosis. • Genomic mutations have a clock-like signature, which is commonly present in cancer. • Many mutated genes are important in the maintenance of genomic integrity. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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12. EXAMENUL CAPILAROSCOPIC LA PACIENȚII CU FENOMEN RAYNAUD DE CAUZĂ NECUNOSCUTĂ.
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Dobrotă, Rucsandra-Cristina, Gherghe, Ana Maria, Giurescu, Elena, Ionițescu, Răzvan C., and Mihai, Carina
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RAYNAUD'S disease , *CAPILLAROSCOPY , *AUTOIMMUNE diseases , *MICROCIRCULATION disorders , *CHI-squared test , *EPIDEMIOLOGY , *IMMUNITY - Abstract
Introduction. Raynaud's phenomenon (RP) can be idiopathic, benign, or associated with a series of causes among which the most reserved prognosis have the systemic autoimmune diseases. Autoimmune Raynaud's is frequently an early sign of scleroderma spectrum diseases (SSD), associated with a high morbidity. Nailfold capillaroscopy (NC) can identify a specific pattern in SSD, reflecting the early microvascular involvement. Objectives. To evaluate the ability of NC to differentiate non-immune RP from immune-associated RP (immune RP) and to reveal the role of NC in the early etiological diagnosis of RP. Materials and methods. This transversal descriptive study included all the patients with unclassified RP who visited the clinic between October 2009 -- May 2011. The etiology of RP was established through clinical, paraclinical assessment and NC. The statistical analysis used the chi-square test and logistic regression. Sensitivity (Se), specificity (Sp), negative predictive value (NPV) and positive predictive value (PPV) for immune RP were calculated for each capillaroscopic parameter studied, as well as for the exam itself. Results. 49 patients were included, 41 women (83,7%) and 8 men (16,3%), aged 18-71 years (mean±SD 41.46 ± 15.02 years); 11 patients with non-immune RP and 29 with immune RP were identified. The etiology was diverse: overlap syndromes (n = 10; 20.4%), early systemic sclerosis (n = 7; 14.3%), undifferentiated connective tissue disease (n = 5; 10.2%), systemic lupus erythematosus and rheumatoid arthritis (2 cases each, 4.1%), dermatomyositis, Sjogren's syndrome and other autoimmune diseases (1 case each, 2%). Pathologic NC, megacapillaries and microhaemorrhages were significantly associated with immune RP. Logistic regression showed the association between the same parameters and immune RP (odds ratio, p): pathologic NC (5.75; 0.014), megacapillaries (8; 0.039) and microhaemorrhages (8; 0.039). NC exam had Se = 79.3%, Sp = 63.6%, PPV = 85% and NPV = 53.8% in the diagnosis of immune RP. The parameters with the highest specificity and PPV were architectural derangement, reduced capillary density and ramified capillaries, followed by megacapillaries and microhaemorrhages. Conclusions. NC can efficiently discriminate between non-immune RP and immune RP, facilitating the early diagnosis of underlying systemic conditions. The capillaroscopic examination of RP patients identified not only early scleroderma cases, but also a significant number of other connective tissue diseases. [ABSTRACT FROM AUTHOR]
- Published
- 2013
13. Early systemic sclerosis: assessment of clinical and pre-clinical organ involvement in patients with different disease features.
- Author
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Valentini, Gabriele, Cuomo, Giovanna, Abignano, Giuseppina, Petrillo, Ambrogio, Vettori, Serena, Capasso, Alessia, Cozzolino, Domenico, Del Genio, Gianmattia, and Santoriello, Carlo
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SYSTEMIC scleroderma , *SCLERODERMA (Disease) , *CAPILLAROSCOPY , *AUTOANTIBODIES , *TELANGIECTASIA , *DOPPLER echocardiography , *ARTHRITIS - Abstract
Objective. To assess internal organ involvement in early SSc at presentation.Methods. One hundred and fifteen patients admitted to a tertiary centre because of RP, who did not present any routinely detectable scleroderma-related internal organ involvement, were investigated for ANA and videocapillaroscopy, and underwent history and physical examination to detect symptoms/signs suggestive of SSc. Patients were then subdivided into three groups: (i) early SSc, constituted by patients without clinical manifestations other than RP, but with scleroderma marker autoantibodies and/or typical capillaroscopic abnormalities; (ii) probable SSc, constituted by patients with the same autoantibody and/or capillaroscopic status as early SSc patients, but with any of the following manifestations: digital ulcers/scars, puffy fingers, arthritis, telangiectasia, dysphagia/heartburn, shortness of breath; (iii) UCTD, constituted by patients with a specific (i.e. disease antibody marker) ANA and capillaroscopic findings plus any disease manifestation. All patients were investigated by lung functional study and B-mode echo-Doppler-cardiography. Patients who consented underwent oesophageal manometry.Results. An inverted mitral E : A ratio (i.e. early scleroderma cardiac involvement) and/or a diffusing lung capacity for CO <80% of the predictive value (i.e. early lung involvement) and/or basal low oesophageal sphincter pressure <15 mmHg (i.e. early oesophageal involvement) were detected in 37/51 probable SSc patients (72%), 8/19 early SSc patients (42%) and 12/45 UCTD patients (27%).Conclusion. A scleroderma-related internal organ involvement was detected in patients from each group and, more importantly, was pre-clinical in a number of cases. [ABSTRACT FROM AUTHOR]
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- 2011
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14. Algoritmo diagnostico della sclerodermia. Early Systemic Sclerosis: criteri di definizione e valutazione diagnostica
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Galasso, Domenico, Mazzuca, Salvatore, and Marigliano, Norma
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SYSTEMIC scleroderma , *ALGORITHMS , *FIBROSIS , *CAPILLAROSCOPY , *MICROCIRCULATION disorders , *COLLAGEN diseases , *IMMUNOGLOBULINS , *DIAGNOSIS - Abstract
Summary: Introduction: The term scleroderma derives from the Greek words skleros, which means hard, and derma, which means skin. It refers to an acquired systemic inflammatory disease of the connective tissue --also known as systemic sclerosis (SSc)-- characterized by excessive collagen deposition in the skin and the internal organs that results in fibrosis. The typical vascular lesion in SSc leads to narrowing of the vessel lumen, intimal thickening, medial hypotrophy, and adventitial fibrosis of small muscular vessels, collagen deposition in the other matrix components of interstice, and the Raynaud phenomenon secondary to these widespread microvascular abnormalities. All these characteristics lead to a connective tissue re-modeling. Discussion: Several clinical studies utilize the American Rheumatology Association''s 1980 classification. However, these diagnostic criteria are unsatisfactory because they fail to take into consideration part of the disease spectrum. Early-phase SSc is characterized by the Raynaud phenomenon (in 90% of all patients), sclerodactyly, and positivity for SSc-specific autoantibodies (antinuclear antibodies, anti-topoisomerase I antibodies, anti-RNA polymerase I and III antibodies, anti-centromere antibodies, anti-fibrillarin antibodies, anti-PM-SCL antibodies).. It is necessary to reduce delays in the diagnosis of SSc. Conclusions: Patients with red-flag positivity (Raynaud phenomenon and digital edema) require Phase I SSc screening, which consists in capillaroscopic assessment of possible microvascular abnormalities. The work-up will then focus on inflammatory indices, renal function tests, and internal organ involvement (echocardiography, high-resolution computed tomography of the chest, diffusing capacity of the lungs for carbon monoxide). [Copyright &y& Elsevier]
- Published
- 2010
- Full Text
- View/download PDF
15. Progress in understanding the diagnostic and pathogenic role of autoantibodies associated with systemic sclerosis
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Marvin J. Fritzler and May Y. Choi
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0301 basic medicine ,autoantibodies ,clinical care pathway ,Scleroderma ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,medicine ,Humans ,skin and connective tissue diseases ,RAYNAUD PHENOMENON, SCLERODERMA, OVERLAP SYNDROMES AND OTHER FIBROSING SYNDROMES: Edited by John Varga ,030203 arthritis & rheumatology ,Scleroderma, Systemic ,integumentary system ,business.industry ,Critical pathways ,pathogenesis ,Autoantibody ,medicine.disease ,Organ damage ,Early Diagnosis ,030104 developmental biology ,Immunology ,Critical Pathways ,early systemic sclerosis ,functional autoantibodies ,business ,Biomarkers - Abstract
Purpose of review At the time of diagnosis, systemic sclerosis (SSc) is often well established with significant irreversible tissue and organ damage. Definitions of ‘early SSc’ have been proposed, which include the presence of SSc-associated autoantibodies. In addition, functional autoantibodies that are believed to be involved in SSc pathogenesis need to be considered. In this review, recent advances in the diagnostic utility and pathogenic role of autoantibodies in early SSc are summarized. Moreover, we propose a clinical care pathway illustrating how autoantibody testing along with key clinical features can be used to make an earlier diagnosis of SSc. Recent findings Recent evidence has helped to develop a clearer understanding of the natural history, early clinical features, and autoantibodies that are predictors of SSc. The role of functional autoantibodies is leading to innovative approaches to evidence-based interventions and therapies that are based on mechanisms of disease. Summary Despite substantial advances, the high morbidity and mortality that currently characterizes SSc can largely be attributed to a delay in diagnosis, gaps in our understanding of the role of autoantibodies in early disease, and limited effective therapeutic options. An early and accurate diagnosis of SSc and use of autoantibody testing embedded in evidence-based clinical care pathways will help improve SSc-associated clinical outcomes and healthcare expenditures.
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- 2016
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16. The magnitude of cytokine production by stimulated CD56+ cells is associated with early stages of systemic sclerosis
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Marta Cossu, Harry Dolstra, Chiara Bellocchi, Stefan Nierkens, Alessandro Santaniello, Lenny van Bon, Lorenzo Beretta, and Timothy R D J Radstake
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Pathology ,medicine.medical_specialty ,medicine.medical_treatment ,Cancer development and immune defence Radboud Institute for Molecular Life Sciences [Radboudumc 2] ,Immunology ,CCL3 ,Stimulation ,Immuno assay ,03 medical and health sciences ,0302 clinical medicine ,CD56+ cells ,Journal Article ,Medicine ,Immunology and Allergy ,Secretion ,skin and connective tissue diseases ,Toll like receptors ,030203 arthritis & rheumatology ,Innate immune system ,integumentary system ,business.industry ,Lung fibrosis ,Early systemic sclerosis ,Cytokine ,Systemic sclerosis ,Cytokines ,business ,030215 immunology ,Immune activation - Abstract
Immune activation is a hallmark of systemic sclerosis (SSc). However, the immunological alterations that occur in preclinical and non-fibrotic SSc and that differentiate these subjects from those with primary Raynaud's phenomenon (PRP) or healthy controls (HC) are poorly defined. We isolated CD56+ (NK/NKT-like) cells from HC, patients with PRP, early SSc (EaSSc) and definite SSc without skin or lung fibrosis. Cytokine production upon different activating stimuli was measured via a multiplex immuno assay. Clearly discriminative patterns among the different stages of SSc were most markedly observed after TLR1/2 stimulation, with increased IL-6, TNF-α and MIP-1α/CCL3 production in definite SSc patients as compared to HC and/or PRP. Initial alterations were observed in EaSSc patients with an intermediate secretion pattern between HC/PRP and definite SSc. CD56+ cells from patients at different stages of SSc differentially respond to TLR stimulation, highlighting the relevance of natural immunity in the developmental and pre-fibrotic SSc.
- Published
- 2016
17. Caracterización Clínica y Paraclínica de una Cohorte de pacientes con diagnostico de esclerosis sistémica temprana en la ciudad de Bogotá que asistieron a la consulta externa de la Unidad de Reumatología de la Universidad Nacional de Colombia entre 2010 y 2014
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Martínez Lozano, Diego Javier and Rondón Herrera, Federico
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Tratamiento inmunosupresor ,Organ specific commitment ,Esclerosis sistémica ,compromiso órgano especifico ,Immunosuppressive therapy ,Biomarcadores ,61 Ciencias médicas ,Medicina / Medicine and health ,Esclerosis sistémica temprana ,Systemic sclerosis ,Early systemic sclerosis ,Escleroderma ,Biomarkers ,Scleroderma - Abstract
La esclerosis sistémica en es una enfermedad rara del tejido conectivo, que se caracteriza por deposito excesivo de colágeno y fibrosis progresiva de la piel, que puede ser órgano especifica. Objetivo: Describir el comportamiento clínico y paraclínico de una cohorte de pacientes con esclerosis sistémica temprana de la Universidad Nacional de Colombia y establecer asociaciones entre las diferentes variables, y de la misma manera evaluar el desarrollo de complicaciones y describir su evolución en un seguimiento a 2 años. Se realizo una serie de casos retrospectiva con datos extraídos de la historia clínica. Resultados: De un total de 125 pacientes que cumplían criterios del colegio americano de reumatología y de la sociedad europea de reumatología (ACR/EULAR) para esclerosis sistémica, 30 cumplían criterios EUSTAR para esclerosis sistémica temprana, la edad promedio fue 54 años, 96.6% fueron mujeres. La edad media de al diagnóstico fue 52.3 años. El patrón de auto anticuerpos más común fue anti centrómero, todos los pacientes tuvieron anticuerpos antinucleares positivos, al examen físico el hallazgo más común fue edema en manos, adicionalmente todos los pacientes recibieron tratamiento para fenómeno de Raynaud, el tratamiento inmunomodulador mas utilizado fue metrotexate (11 pacientes). Conclusiones: Se requieren estudios prospectivos que permitan no solo caracterizar la población, sino evaluar la respuesta a los diferentes esquemas de tratamientos propuestos, y el impacto sobre la población colombiana. Abstract. Systemic sclerosis is a rare connective tissue disease, characterized by excessive collagen deposition and progressive fibrosis of the skin, which can be specified organ. Objective: To describe the clinical and paraclinical behavior of a cohort of patients with early systemic sclerosis of the Universidad Nacional de Colombia, and partnerships between different variables in the same way and evaluate the development of complications and describe its evolution in track 2 years. A series of retrospective cases with data from medical records was performed. Results: From a total of 125 patients who met the criteria of the American College of Rheumatology and the European Society of Rheumatology (ACR / EULAR) for systemic sclerosis, 30 met criteria for early systemic sclerosis EUSTAR, the average age was 54 years, 96.6% They were women. The average age at diagnosis was 52.3 years. The pattern was more common autoantibodies anti centromere, all patients had positive antinuclear antibodies, the physical examination the most common finding was swelling in hands, all patients received further treatment for Raynaud's phenomenon, the more immunomodulatory therapy used was methotrexate (11 patients). Conclusions: Prospective studies to characterize not only the population, but to assess the response to different treatment schemes proposed, and impact on the Colombian population are required. Otra
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- 2015
18. RANA SKLERODERMA
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Silvia Bellando Randone and Marco Matucci Cerinic
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sustavna skleroza ,rana dijagnoza ,liječenje ,klasifikacijski kriteriji ,rana sustavna skleroza ,systemic sclerosis ,early diagnosis ,treatment ,classification criteria ,early systemic sclerosis - Abstract
Sustavna skleroza (SSc) kronična je autoimuna bolest obilježena visokim stupnjem heterogenosti i povezana s visokim morbiditetom, kao i s najvišim mortalitetom specifičnim za samu bolest, u odnosu na sve druge autoimune bolesti vezivnog tkiva. SSc moguće je jednostavno dijagnosticirati u uznapredovaloj fazi, dakle kad se već razvila obliterativna vaskulopatija te fibroza kože i unutrašnjih organa, ali teško je postaviti dijagnozu u ranoj fazi bolesti. Ta činjenica ograničuje mogućnost ranog liječenja i potencijalnog preveniranja razvoja bolesti i oštećenja tkiva. Raynaudov fenomen (engl. skr. RP) predložen je kao jedno od definirajućih kliničkih obilježja za dijagnozu „rane“ SSc te stoga pozornost valja poglavito usmjeriti na taj simptom, čak i u slučaju odsustva drugih znakova bolesti. Na temelju prethodnih dijagnostičkih kriterija dijagnoza SSc može biti postavljena nakon više godina od početka RP, pa i nakon pojave prvih simptoma nevezanih za RP. Ovaj je vremenski raskorak između pojave simptoma i postavljanja dijagnoze, ponajprije temeljen na fibrozi kože i unutrašnjih organa, „prozor mogućnosti“ koji bi mogao biti vrijeme za intervenciju u ranoj fazi bolesti te time potencijalno prevenirati oštećenje organa. Prijedlog definicije vrlo rane SSc jest stanje obilježeno RP-om, difuznom oteklinom prstiju, pozitivnim protutijelima specifičnima za bolest i patognomoničnim mirkovaskularnim promjenama vidljivima na kapilaroskopiji, a bez zahvaćenosti kože i unutrašnjih organa. U bolesnika s navedenim simptomima, radi otkrivanja pretkliničkih promjena na unutarašnjim organima u SSc, mogu se provesti i pretrage kao što su ezofagealna manometrija, ehokardiografija u B-modu i funkcijski testovi pluća. Nedavno su predloženi novi klasifikacijski kriteriji radi identificiranja bolesnika u najranijoj fazi bolesti. Međutim, prediktori tijeka bolesti i dalje su nepoznati te je stoga potrebno redovito praćenje, iako idealna učestalost kontrolnih pregleda nije utvrđena., Systemic sclerosis (SSc) is a chronic autoimmune disease, characterized by a high level of clinical heterogeneity and associated with a high morbidity along with the highest disease-specific mortality of all autoimmune connective tissue diseases. SSc is quite easy to diagnose in the advanced phase, i.e., when it has already evolved to obliterative vasculopathy and skin and internal organ fibrosis, but it is difficult to establish a diagnosis in the early phase. This limits the possibility to start early treatment, as well as the potential for prevention of disease evolution and tissue damage. Raynaud’s phenomenon (RP) has been proposed as one of the defining clinical features for the diagnosis of “early” SSc, so that particular attention should be paid to this symptom, even in the absence of other signs of the disease. Based on previous diagnostic criteria, the diagnosis of SSc can be delayed for several years after the onset of RP, and even after the onset of the first non-RP symptom. This time gap between symptoms and diagnosis, mainly based on dermal or internal organ fibrosis, is a ‘‘window of opportunity’’ that could represent a chance to intervene earlier in the disease course, thus potentially preventing organ damage. The definition of Very early SSc has been proposed as a state characterized by RP, puffy fingers, disease-specific autoantibodies, and pathognomonic microvascular alterations at capillaroscopy, without skin and internal organ involvement. In patients with the above symptoms further investigations such as esophageal manometry, B-mode echocardiography, and lung function tests are recommended to detect preclinical alterations of internal organs in SSc. Recently, new classification criteria have been proposed with the goal to identify patients in the earliest phase of the disease. However, as predictors of the future course of the disease are still unknown, patients must be followed up regularly, even though the ideal frequency of visits has not yet been established.
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- 2015
19. [Very early and early systemic sclerosis: An update].
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Michaud M, Catros F, Ancellin S, and Gaches F
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- Antibodies, Antinuclear blood, Autoantibodies blood, Decision Trees, Disease Progression, Early Diagnosis, Humans, Scleroderma, Systemic classification, Scleroderma, Systemic diagnosis
- Abstract
Classification criteria for systemic sclerosis evolved over the last three decades, allowing an earlier classification. In the late 2000s, the EULAR Scleroderma Trials and Research Group validated very early and early systemic sclerosis criteria. Raynaud phenomenon, anti-nuclear antibody positivity and the puffy fingers are "Red flags" that must lead to refer the patient to a specialist and benefit from a capillaroscopy and the specific autoantibodies. At the stage of very early systemic sclerosis, pulmonary, cardiac and digestive involvements may be present and must be screened. Herein, we detail very early and early systemic sclerosis criteria, as well as the predictive factors of evolution towards a systemic sclerosis., (Copyright © 2019 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)
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- 2019
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20. Early systemic sclerosis: marker autoantibodies and videocapillaroscopy patterns are each associated with distinct clinical, functional and cellular activation markers
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Aldo Ciani, Filiberto Vitelli, Serena Vettori, Alberto Spanò, Giovanni Maria De Matteis, Gabriele Valentini, Antonella Marcoccia, Francesco Bondanini, Giovanna Cuomo, Michele Iudici, Carlo Santoriello, Domenico Cozzolino, Salvatore Cappabianca, Valentini, Gabriele, Marcoccia, A, Cuomo, Giovanna, Vettori, Serena, Iudici, M, Bondanini, F, Santoriello, C, Ciani, A, Cozzolino, D, De Matteis, Gm, Cappabianca, Salvatore, Vitelli, F, and Spanò, A.
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Adult ,Lung Diseases ,Male ,Pathology ,medicine.medical_specialty ,Adolescent ,Immunology ,Alpha (ethology) ,Arthritis ,soluble IL-2 receptor alpha ,Osteoarthritis ,Autoantigens ,Scleroderma ,Microscopic Angioscopy ,systemic sclerosis marker autoantibodies ,puffy fingerscirculating activation markers ,Young Adult ,Rheumatology ,soluble E-selectin ,Internal medicine ,preclinical organ involvement ,medicine ,Prevalence ,Immunology and Allergy ,Humans ,Young adult ,Receptor ,skin and connective tissue diseases ,Aged ,Autoantibodies ,Scleroderma, Systemic ,integumentary system ,business.industry ,nailfold videocapillaroscopy ,carboxyterminal propeptide of collagen I ,Autoantibody ,Raynaud Disease ,Middle Aged ,medicine.disease ,Raynaud's phenomenon ,Disease Progression ,early systemic sclerosis ,Female ,business ,Biomarkers ,Research Article - Abstract
INTRODUCTION: Early systemic sclerosis (SSc) is characterized by Raynaud's phenomenon together with scleroderma marker autoantibodies and/or a scleroderma pattern at capillaroscopy and no other distinctive feature of SSc. Patients presenting with marker autoantibodies plus a capillaroscopic scleroderma pattern seem to evolve into definite SSc more frequently than patients with either feature. Whether early SSc patients with only marker autoantibodies or capillaroscopic positivity differ in any aspect at presentation is unclear. METHODS: Seventy-one consecutive early SSc patients were investigated for preclinical cardiopulmonary alterations. Out of these, 44 patients and 25 controls affected by osteoarthritis or primary fibromyalgia syndrome were also investigated for serum markers of fibroblast (carboxyterminal propeptide of collagen I), endothelial (soluble E-selectin) and T-cell (soluble IL-2 receptor alpha) activation. RESULTS: Thirty-two of the 71 patients (45.1%) had both a marker autoantibody and a capillaroscopic scleroderma pattern (subset 1), 16 patients (22.5%) had only a marker autoantibody (subset 2), and 23 patients (32.4%) had only a capillaroscopic scleroderma pattern (subset 3). Patients with marker autoantibodies (n = 48, 67.6%) had a higher prevalence of impaired diffusing lung capacity for carbon monoxide (P = 0.0217) and increased serum levels of carboxyterminal propeptide of collagen I (P = 0.0037), regardless of capillaroscopic alterations. Patients with a capillaroscopic scleroderma pattern (n = 55, 77.5%) had a higher prevalence of puffy fingers (P = 0.0001) and increased serum levels of soluble E-selectin (P = 0.0003) regardless of marker autoantibodies. CONCLUSION: These results suggest that the autoantibody and microvascular patterns in early SSc may each be related to different clinical-preclinical features and circulating activation markers at presentation. Longitudinal studies are warranted to investigate whether these subsets undergo a different disease course over time.
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- 2012
21. [Early systemic sclerosis: diagnostic criteria and work-up]
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Valentini G and Valentini, Gabriele
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lcsh:Internal medicine ,Scleroderma, Systemic ,Time Factors ,business.industry ,Diagnostic Tests, Routine ,lcsh:R ,lcsh:Medicine ,Raynaud Disease ,Echocardiography, Doppler ,Autoimmune Diseases ,Respiratory Function Tests ,Rheumatology ,Antibodies, Antinuclear ,Medicine ,Humans ,early systemic sclerosis ,Esophagogastric Junction ,business ,lcsh:RC31-1245 ,Humanities - Abstract
La Sclerosi Sistemica (SSc) e una malattia generalizzata del tessuto connettivo caratterizzata da vasculopatia obliterante dei vasi del microcircolo, iperplasia dell’intima, ipotrofia della media e fibrosi dell’avventizia delle arterie muscolari di piccolo calibro e da deposizione di collageno e di altri componenti della matrice nell’interstizio. Questi tre ordini di alterazioni colpiscono, sia pure con una espressivita variabile, la cute e gli organi interni bersaglio: apparato digerente, polmoni, cuore, reni (1)...
- Published
- 2002
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