Diagnosis And Treatment In Rheumatology

Diagnosis And Treatment In Rheumatology

Diagnosis and Treatment in Rheumatology is a clear and concise handbook of all rheumatic diseases. The book presents organized information about current diagnosis, treatment and statistics (where ...
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Scleroderma

Pp. 123-142 (20)

Małgorzata Wisłowska

Abstract

Systemic sclerosis (SSc) is a connective tissue disease characterized by fibrosis of the skin and internal organs, changes in the microvasculature and in cellular and humoral immunity. The types of disorders include: localized scleroderma (morphea, linear scleroderma, en coup de sabre) and systemic sclerosis (diffuse cutaneous systemic sclerosis [dsSSc], limited cutaneous systemic sclerosis [lcSSc] and systemic sclerosis sine scleroderma). LcSSc is a milder form with slow progression of skin involvement and visceral complications after 10-15 years, but with serious pulmonary arterial hypertension. DsSSc has fast progression of skin sclerosis, from weeks to months, and includes injuries to organs such as the lung, heart and kidney, which may lead to organ failure. The presence of ANA was found in more than 90% of patients with SSc, anti-Scl-70 antibodies in patients with dcSSc in 30-40%, anticentromere antibodies (ACA) in patients with lcSSc in 80-90%. Fibrosis is the end-stage representation of SSc pathogenesis. Severe forms of the disease and rapidly progressive diffuse SSc with pulmonary, cardiac, and renal involvement, are associated with very high mortality rates, estimated at 40-50% in 5 years. No treatment effective therapy exists to stop fibrosis and disease progression beside autologous haemopoietic stem cell transplantation (AHSCT). Cyclophospamide has moderate efficacy in patients with ILD. Methotrexate may be used for the treatment of arthritis. Oesophageal dysmotility and reflux are treated with promotility agents, and proton pump inhibitors. In PAH endothelin receptor antagonists, with PDE5 inhibitor and prostaglandins are used. The most important manifestation is scleroderma renal crisis and is now treated using ACE inhibitors.

Keywords:

ACE inhibitors, AHSCT, ANA, Anticentromere antibodies (ACA), Anti-RNA polymerases II and III antibodies, Anti-Scl-70 antibodies, Calcinosis, CREST syndrome, Cyclophospamide, Diffuse cutaneous systemic sclerosis (dsSSc), Endothelin receptor antagonists, Fibrosis, Limited cutaneous systemic sclerosis (lcSSc), Localized scleroderma, Oesophageal dysmotility, PAH, PDE5 inhibitor, Prostaglandins, Proton pump inhibitors, Raynaud’s phenomenon, Sclerodactyly, Systemic sclerosis (SSc), Teleangiectasis, TGFβ.

Affiliation:

Head of Rheumatology and Internal Diseases Department CSK MSWiA Warsaw Poland.