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Results for “Scleroderma, Diffuse”

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PubMed2000

Severe organ involvement in systemic sclerosis with diffuse scleroderma.

OBJECTIVE: To determine the natural history and timing of severe involvement of the kidney, heart, lung, gastrointestinal (GI) tract, and skin in patients with systemic sclerosis (SSc) and diffuse cutaneous involvement. METHODS: This study used the Pittsburgh Scleroderma Databank and included patients with diffuse scleroderma who were seen between January 1, 1972 and December 31, 1995. Patients had frequent follow-ups, and a 95% accountability for these patients was maintained. Severe organ involvement was defined as the presence of any of the following: 1) in the kidney, scleroderma "renal crisis"; 2) in the heart, cardiomyopathy, symptomatic pericarditis, or an arrhythmia requiring treatment; 3) in the lung, pulmonary fibrosis on chest radiograph and a forced vital capacity of <55% of predicted; 4) in the GI tract, malabsorption, repeated episodes of pseudoobstruction, or severe problems requiring hyperalimentation; and 5) in the skin, a modified Rodnan skin score >40. The timing from disease onset to survival for each case of severe organ involvement was determined. RESULTS: Of the 953 patients with diffuse scleroderma, kidney involvement developed in 177 (19%), heart involvement in 143 (15%), lung involvement in 151 (16%), GI tract involvement in 74 (8%), and skin involvement in 233 (24%). Severe skin and kidney involvement occurred during the first 3 years in 70% of those who ever developed these problems throughout a mean of 10 years of followup. Severe heart, lung, and GI tract involvement developed during the first 3 years in 45-55% of those who were ever affected. The survival of patients with severe organ involvement was poor. The 9-year cumulative survival rate of all patients with severe organ involvement was 38%, compared with 72% in patients without such involvement (P < 0.0001). CONCLUSION: This study demonstrates that severe organ involvement in SSc patients with diffuse scleroderma most often occurs early in the course of the disease. Survival for patients with severe organ involvement is markedly reduced. Patients should therefore be monitored very closely during the first 3 years of disease for signs and symptoms that may signal the subsequent development of severe organ damage. Potential disease-modifying therapies must be initiated early to modify the natural history of SSc and to improve survival. Patients who survive the first few years without developing severe organ involvement are less likely to develop such life-threatening involvement later in the disease course.

Female↗
PubMed1986

Pharmacodynamic effect of dipyridamole on thallium-201 myocardial perfusion in progressive systemic sclerosis with diffuse scleroderma.

We evaluated the effect of dipyridamole on thallium-201 myocardial perfusion in 23 patients with progressive systemic sclerosis (PSS) with diffuse scleroderma. Thallium-201 single photon emission computed tomography (SPECT) was performed at rest and after coronary artery vasodilatation with intravenous dipyridamole (0.14 mg/kg/min for four minutes). The left myocardium was divided into nine segments; each segment was graded as 2.0, 1.5, 1.0, 0.5, 0 (zero represents no activity). Dipyridamole significantly improved resting thallium-201 myocardial perfusion: the mean (SD) number of segments with thallium defects decreased from 6.0 (2.1) at rest to 4.1 (2.5) after dipyridamole (p less than 0.0001); the mean (SD) score in segments with resting defects increased from 0.92 (0.24) at rest to 1.13 (0.38) after dipyridamole (p less than 0.0001); the mean (SD) global score per patient increased from 10.2 (1.8) at rest to 11.4 (2.1) after dipyridamole (p less than 0.02); the global score increased by at least 2.0 in 12 patients and worsened by at least 2.0 in three patients only (p = 0.05). The results of this acute study suggest that some drugs with potent vasodilator activity on small coronary arteries may be beneficial in the treatment of PSS patients with thallium-201 myocardial perfusion abnormalities.

Adult↗
PubMed1981

[Quantitative assessment of labial salivary gland sclerosis in patients with diffuse scleroderma (author's transl)].

Biopsies of the lips were performed on 27 patients (7 male and 20 female; mean age, 58 years) with diffuse scleroderma and on 10 healthy subjects serving as controls. The degree of intralobular sclerosis in labial salivary glands was measured on tissue sections by an automated morphometric analysis technique. Collagenous compared with controls. It was independent from the type of cell infiltrating the gland and from the evolution potential of the disease, but it correlated with its duration and seemed to be specific to scleroderma.

Adult↗
PubMed1982

[Cytogenetic aspects of diffuse scleroderma. Structural anomalies and sister chromatid exchanges].

Structural chromosome anomalies (1 477 cells examined) and sister chromatid exchanges after two replication cycles with BrdU (771 cells studied) were evaluated in 12 patients with diffuse scleroderma and having received no recent or important irradiation. The increase of structural anomalies, chromatidic as well as chromosomal, is always low, inconstant and cannot be considered as having a diagnostic value. Increase of sister chromatid exchanges could be a more sensitive method of investigation. In particular, it is not influenced by low doses of diagnostic X-rays.

Adult↗
PubMed1995

[A prospective study of plasma exchange in the treatment of diffuse scleroderma].

A prospective randomized study to compare the efficacy between plasma exchange (PE) plus D-penicillamine (13 cases) (group I) and D-penicillamine alone (16 cases) (group II) in the treatment of diffuse scleroderma was carried out. Total skin score, the distance between finger and palm, the distance between upper and lower teeth, the index of joint tenderness, grip strength, ESR, IgG, plasma renin and angiotensin II were measured. After 6 times of PE, all parameters in group I showed significant improvement as compared with those before treatment (P < 0.05-P < 0.01). The overall effective rates evaluated by physicians and by patients were 61.1% and 69.2% respectively. One and half year after the 6 times of PE, all parameters in group I were lower than those in group II (P < 0.05). In group I there were less internal organ impairment and hypertension than in group II. The commonest side effect of PE was hypotension; it disappeared after transfusion.

Adult↗
PubMed1982

[Cytogenetic aspects of diffuse scleroderma : structural anomalies and sister chromatid exchanges (author's transl)].

Structural chromosome anomalies (1 477 cells examined) and sister chromatid exchanges after two replication cycles with BrdU (771 cells studied) were evaluated in 12 patients with diffuse scleroderma and having received no recent or important irradiation. The increase of structural anomalies, chromatidic as well as chromosomal, is always low, inconstant and cannot be considered as having a diagnostic value. Increase of sister chromatid exchanges could be a more sensitive method of investigation. In particular, it is not influenced by low doses of diagnostic X-rays.

Adult↗
PubMed1990

Clinical association of autoantibodies to fibrillarin with diffuse scleroderma and disseminated telangiectasia.

Circulating autoantibodies against a variety of nuclear and nucleolar antigens are characteristic serologic findings in systemic scleroderma. Some of these antibodies correlate with clinical subsets of the disease. We describe three patients with systemic scleroderma and high autoantibody titers against U3 ribonucleoprotein-associated fibrillarin, a recently identified 34 kD nucleolar protein. These patients showed a progressive course with multiple organ and diffuse skin involvement with disseminated telangiectasia.

Adult↗
PubMed2000

Increased alpha2-adrenergic constriction of isolated arterioles in diffuse scleroderma.

OBJECTIVE: Vasospasm and ischemic organ injury are important in the pathogenesis of systemic sclerosis (SSc; scleroderma). The present study was performed to determine whether SSc arterioles have an intrinsic disturbance in vasoconstrictor activity. METHODS: Skin biopsy samples were obtained from the upper arm of 11 patients with diffuse SSc (clinically uninvolved skin) and 8 age- and sex-matched control subjects. Dermal arterioles were dissected from the biopsy sample and mounted in a myograph for continuous monitoring of arteriolar diameter. The resting internal diameter of control and SSc arterioles was similar (mean +/- SEM 164+/-15 micro and 166+/-18micro, respectively). RESULTS: Dermal arterioles displayed no spontaneous constrictor activity in the absence of stimulation. Vasoconstriction in response to KCI, a receptor-independent activator of smooth muscle, or to phenylephrine, a selective alpha1-adrenergic receptor (alpha1-AR) agonist, was similar in control and SSc arterioles. However, constrictor responses to UK 14,304, a selective alpha2-AR agonist, were increased in SSc compared with control arterioles (maximal constriction responses of 25+/-5% and 67+/-4% [mean +/- SEM] in control and SSc arterioles, respectively; P = 0.000014). Mechanical denudation of the endothelium did not alter reactivity to alpha2-AR activation, indicating that the enhanced constriction in SSc was not mediated by changes in endothelial dilator activity. Indeed, in arterioles constricted with phenylephrine, the endothelial stimuli acetylcholine or bradykinin evoked endothelium-dependent relaxation that was similar in control and SSc arterioles. CONCLUSIONS: Vascular smooth muscle in SSc arterioles displayed a selective increase in alpha2-AR reactivity. The endothelial dilator function appeared normal. Altered activity of smooth muscle alpha2-ARs may contribute to the vasospastic activity that is a prominent feature of the SSc disease process.

Adrenergic alpha-2 Receptor Agonists↗
PubMed1994

Genetic and immunological differences between Japanese patients with diffuse scleroderma and limited scleroderma.

OBJECTIVE: To study the association between HLA-DR and scleroderma (SSc), subsets of SSc, and autoantibodies in SSc. METHODS: HLA-DR antigens were determined in 45 Japanese patients with SSc. The association between HLA-DR and SSc, subsets of SSc, and autoantibodies was analyzed in 22 patients with SSc excluding mixed connective tissue disease (MCTD)/overlap syndrome (OL). RESULTS: When the 20 patients with MCTD and 3 patients with OL were excluded from the original patient group, a significant increase of HLA-DR2 was observed (59 vs 29% of controls, p < 0.01). The frequency of DR2 increased to 69% in patients with diffuse SSc (p < 0.01). DR1, which was not found in diffuse SSc, was found in 2 of 9 patients with limited SSc. The frequency of DR2 was significantly higher in patients with antitopoisomerase I (10/12, 83%, p < 0.05). In contrast, DR1 was found only in 2 patients with anticentromere antibodies (ACA), and all 5 patients with ACA had no HLA-DR2 (p < 0.01). CONCLUSION: Our results suggest that different HLA-DR markers may be associated with the production of distinct autoantibodies in diffuse SSc and limited SSc.

Antibodies↗
PubMed1991

A double-blind randomized controlled trial of ketotifen versus placebo in early diffuse scleroderma.

To determine the efficacy of the mast cell-stabilizing drug ketotifen in scleroderma, we conducted a 6-month, randomized, prospective, double-blind, placebo-controlled trial in 24 patients. No significant improvement in the clinical parameters, pulmonary function, global assessments, and mast cell releasability was noted. Pruritus tended to improve in the group taking the active drug. Six months of treatment with ketotifen (6 mg/day), therefore, produced no apparent benefit in patients with early scleroderma. We were unable to address the role of mast cells in scleroderma since mast cell suppression was not achieved.

Adult↗