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Results for “Scleroderma, Systemic”

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PubMed1996

[Clinical aspects, pathophysiology, diagnosis and therapy of gastrointestinal manifestations of progressive systemic scleroderma].

About 50% of patients with progressive systemic sclerosis develop significant clinical involvement of the alimentary tract. In decreasing order of frequency esophagus (75%), anorectum (50-70%), small bowel (50%), colon (40%) and stomach (40%) can exhibit characteristic morphological or functional features. Typical symptoms of reluxesophagitis and severe constipation are often reported. Beside this, diarrhea, steatorrhea and malnutrition are common complaints. Manometric and electrophysiological studies brought evidence of a neuropathy of the enteric nervous system in the early stages of the disease, resulting in disturbances of the digestive and interdigestive peristalsis and therefore e.g. leading to gastroparesis, bacterial overgrowth of the small intestine or constipation. In late PSS collagen deposition and atrophy of the smooth muscle layer of the bowel wall cause loss of function of sphincters as the lower esophageal sphincter or the anal sphincter and marked atony of parts of the intestine. The diagnostic procedures consist of esophageal manometry, 24-h pH-metry, esophageal and gastric radionuclide transit studies, H2-breath tests, barium enemas, anorectal manometry and endoscopy. Therapeutic options include H2-antagonists, proton-pump inhibitors, prokinetic drugs, octreotides and antibiotics. Nutritional supplementation and surgical interventions are often of limited therapeutic value. Finally in some cases long-term total parenteral nutrition is warranted.

Digestive System↗
PubMed1980

The fascia in systemic scleroderma.

Diffuse fasciitis (DF) shares clinical and pathologic features with systemic (SS) and localized scleroderma. The distinct pathologic feature in DF is involvement of the deep fascia, but it is not known if these changes consistently occur in SS. In this study, ten patients with SS underwent deep biopsies for evaluation of the fascia. All cases showed typical dermal histologic findings of scleroderma, and five cases showed thickening and fibrosis of the fascia. This study provides evidence that fascial involvement is not distinctive of DF but may occur in SS. It appears that thickening of the fascia is another morphologic feature shared between DF and SS.

Adult↗
PubMed1989

[HLA-A, B, C phenotype frequencies in progressive systemic scleroderma].

In 41 patients suffering from progressive systemic sclerosis (PSS) the phenotype frequencies of 28 HLA-A, B, C antigens were determined. Compared to 2947 blood donors the PSS patients exhibited an increase in the HLA-B8 frequency (37% versus 19%). This difference revealed to be not significant after the correction according to the number of antigens tested. The same was with the increase in the frequency of HLA-B5, B13, B27, Cw2 and the decrease in the frequency of HLA-A2, B12, B14, B15, B4 and Cw3. The results were compared with the data reported in the literature. Additionally, there were no differences when compared the diffuse PSS with the acral form and CREST, respectively.

Adolescent↗
PubMed1987

[Nuclear antibodies as serologic markers in progressive systemic scleroderma].

In all, 36 patients with progressive systemic sclerosis (29 women, 7 men) were studied clinically and immunologically; 15 patients had acrosclerosis (type I) and 21, sclerosis extending beyond the wrist (type II). The sera of all patients were evaluated for ANA (HEp-2-cells), Scl-70, centromere and other ENA antibodies. The centromere antigen was characterized by immunoblotting. All patients had high-titer ANA antibodies (100%); 36% of patients had the Scl-70 antibody (a marker antibody for PSS); and in 22% of our patients a centromere antibody was detected. In all cases the anti-centromere sera reacted with a 19.5-kd polypeptide and in 2 cases they reacted with 23- and 25.5-kd proteins in addition. In patients with centromere antibodies there was increased organ involvement (heart, lung, kidney) compared with patients who had anti-Scl-70 or other nuclear antibodies.

Antibodies, Antinuclear↗
PubMed1990

[Quartz crystals in the skin as a cause of progressive systemic scleroderma].

There is a close correlation between the systemic sclerosis and the exposure to crystalline silica in the GDR. The silica content was investigated in the skin of the patients. Silica particles were found using phase-contrast and polarizing microscopy. The size of the crystals varied from 1 to 90 micrometer. Below a silica content of 10% in the dust it is unlikely that systemic sclerosis is developing.

Biopsy↗
PubMed1990

Elevated plasma histamine levels in systemic sclerosis (scleroderma).

Systemic sclerosis is characterized by excessive deposition of collagen and other matrix proteins in the skin and internal organs. One hypothesis supports fibroblast stimulation for production of excess amounts of collagen by factors present in the blood or released by cells composing inflammatory tissue infiltrates. Increased numbers of mast cells are present in the involved skin of patients with systemic sclerosis, and histamine has been thought to be a possible mediator of fibrosis in this and other fibrotic conditions. We therefore measured plasma histamine levels in 32 patients with systemic sclerosis and found elevated levels in 18 patients (56%). Elevated plasma histamine levels were more common in patients with diffuse disease (74%), in contrast to limited disease (31%). The degree of clinical activity and the duration of disease could not be correlated with histamine levels.

Adult↗
PubMed1999

HLA haplotypes and microsatellite polymorphisms in and around the major histocompatibility complex region in a Native American population with a high prevalence of scleroderma (systemic sclerosis).

Choctaw Native Americans in southeastern Oklahoma have the highest prevalence of scleroderma or systemic sclerosis yet found (469/100,000). An Amerindian HLA DR2 haplotype (DRB1*1602) was significantly associated with scleroderma in this population in a previous study. It is not known, however, if other disease genes are linked to this HLA haplotype. The regions flanking the HLA loci were studied with polymorphic microsatellite markers. An extended HLA DR2 (DRB1*1602, DQA1*0501, DQB1*0301, DPB1*1301) haplotype that includes the class I and III regions was identified which was significantly associated with scleroderma in the Oklahoma Choctaw. No other significant associations with microsatellite marker alleles immediately flanking the HLA region were found.

Autoimmune Diseases↗
PubMed2000

Endothelial injury in internal organs of University of California at Davis line 200 (UCD 200) chickens, an animal model for systemic sclerosis (Scleroderma).

Systemic sclerosis (SSc) is a multisystem disorder characterized by mononuclear cell infiltration and fibrosis. Using skin samples from human SSc and UCD 200 chickens, which spontaneously develop a hereditary disease closely resembling human SSc, we have shown previously that endothelial cell apoptosis is a primary event in the pathogenesis of SSc. The aim of the present study was to investigate the initial disease stage in visceral organs of UCD 200 chickens with special emphasis on endothelial apoptosis, mononuclear cell infiltration and collagen deposition using tissue samples from oesophagus, lung, heart, kidney and liver. Apoptotic endothelial cells were detected by terminal deoxynucleotidyl transferase-mediated FITC-dUTP nick end labeling (TUNEL), mononuclear cell infiltrates were stained with hematoxylin and eosin, and increased collagen deposition was demonstrated by Goldner staining. Apoptotic endothelial cells were detected in oesophagus, lung and kidney of UCD 200 chickens at the initial stage of the disease. No apoptotic endothelial cells were found in heart or liver of UCD 200 or in visceral organs of healthy normal UCD 058 control chickens. Oesophagus of UCD 200 chickens, which was the most affected internal organ, showed mononuclear cell infiltrations and increased deposition of collagen. Perivascular inflammatory infiltrates and collagen deposition appeared later than endothelial cell apoptosis. These data support the hypothesis that endothelial cell apoptosis initiates the disease process, followed by mononuclear cell infiltration and fibrosis.

Animals↗
PubMed1985

Osteolysis of the shaft of tubular bones in systemic scleroderma.

This case report describes a woman with progressive systemic sclerosis who, in addition to the more classical acro-osteolysis, demonstrated destruction of the shafts of the phalanges and the ulna. The literature on bone lysis in atypical sites in scleroderma is reviewed and the etiology discussed.

Bone Resorption↗
PubMed1998

Increased cutaneous immunoreactive stem cell factor expression and serum stem cell factor level in systemic scleroderma.

Skin hyperpigmentation and itching are characteristic findings in systemic sclerosis (SSC) patients. Stem cell factor (SCF, c-kit ligand) is a multifunctional cytokine which can promote melanocyte and mast cell development. We investigated the SCF expression histopathologically in normal and SSC skin, and compared the expression with the serum SCF levels measured with a specific enzyme-linked immunosorbent assay. The epidermal and dermal immunoreactive SCF expression was markedly higher in the forearm skin of edematous phase SSC patients than in that of normal subjects. Tissue SCF expression declined from the sclerotic phase to the atrophic phase, where it was close to the normal level. In contrast, the elevated serum SCF level seen in the edematous phase samples was further increased in the sclerotic phase samples. The serum SCF level decreased in the atrophic phase, but it still remained at a level higher than that of the normal controls. Itching and increase of dermal mast cell number are characteristic of edematous phase SSC, and are in bears a parallel to the presently observed dermal SCF expression profile. Pigmentation is significant in sclerotic phase SSC and lasts to the atrophic phase, which may correspond to the serum SCF level observed here. These results indicate a contribution of the fibroblast membrane integral SCF in dermal mast cell development, and of the soluble serum SCF to melanocyte activation in SSC.

Adult↗
PubMed1982

Pathogenesis of scleroderma (systemic sclerosis).

Increasing interest in the vascular features of scleroderma has led to the hypothesis that the blood vessel is the major target tissue and that the endothelial cell is the principal cell target. Useful observations stemming from the vascular hypothesis include the use of microvascular abnormalities in the early detection of the patient destined to develop classical scleroderma, the discovery of a serum protease selectively cytotoxic to endothelial cells, and the study of a serum mitogenic activity for fibroblasts in scleroderma patients. Immune events related to the vascular lesions are under active study but have not as yet provided a unique immunological lesion in scleroderma patients. The possibility that immunity to basement membrane (type IV) collagen may be selective for scleroderma patients deserves further study. Persistent immunity to endothelial basement membrane structures would provide a basis for continued endothelial injury. Techniques to quantify endothelial injury are useful to assess activity of the vascular lesions and to monitor therapies designed to block further vascular injury. The definition of pre-fibrotic vascular lesions may have future therapeutic and preventive implications for scleroderma.

Blood Vessels↗