Scleroderma-like disorders

Foti, R.; Leonardi, Rosario; Rondinone, R; Gangi, M. Di; Leonetti, Carlo; Canova, Mariagrazia; Doria, Andrea

doi:10.1016/j.autrev.2007.12.004

Cited by 48 publications

(44 citation statements)

References 32 publications

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“…:[1] Warsi, et al "Self-management Education Programs in Chronic Disease: A Our data may support the hypothesis of a possible association between BI and SSc. Furthermore, these results raise questions regarding the safety of saline breast prosthesis.…”

supporting

confidence: 63%

AB0767 Efficacy of subcutaneous tocilizumab in patients with rheumatoid arthritis and systemic sclerosis overlap syndrome

Wakabayashi

Kino

Hasegawa

et al. 2018

Scleroderma, Myositis and Related Syndromes

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BackgroundSystemic sclerosis (SSc) is a connective tissue disease that develops sclerotic changes in the skin and visceral organs. SSc is a disease of uncertain etiology, and is characterised by fibrotic changes. Pulmonary, cardiac, gastrointestinal, and renal complications contribute to patient morbidity and decreased survival1. And patients present with stiffness of the limbs because of sclerosis and joint swelling in the skin and periarticular connective tissues. Interleukin-6 (IL-6) is a pleiotropic factor that plays a major role in inflammation; furthermore, IL-6 overexpression and pathogenicity in SSc have been demonstrated2. IL-6 expression is reportedly high in both the skin and serum of SSc patients3, and its elevation depends on the skin score4. And it is a candidate factor that can reproduce the pathological conditions of SSc as well as RA.ObjectivesWe report the cases of rheumatoid arthritis (RA) patients with SSc who was administered anti-interleukin-6 receptor antibody tocilizumab (TCZ).MethodsTwo RA with refractory SSc patients were administered tocilizumab at 162 mg/kg twice a month for 12 months. RA disease activity is evaluated by DAS28-ESR and CDAI. Skin condition of SSc is evaluated by pinching the skin according to the modified Rodnan total skin score (mRTSS).ResultsThey were both female, and age at the time of SSc diagnosis was 74 (patient 1) and 51 (patient 2) years old. The time lapse since SSc diagnosis was at first visit and 14 years, respectively. And it since RA diagnosis was 14 years and 6 years, respectively. Tocilizumab was administered at 162 mg every 2 weeks, which is equal to the dosage used for RA. Administration of prednisolone at 5 mg/day and DMARDs were continued. Overall, TCZ was well tolerated, and both patients experienced a general improvement in coping with normal daily activities. During the 12 month tocilizumab therapy, both RA disease activity and mRTSS decreased. The patient global assessment improved by 70 (75 to 5) and 44 (68 to 24) in patients 1 and 2 in 12 months, respectively. In RA disease activity, DAS28 decreased from 5.66 to 1.73 in 12 months in patient 1 and 7.14 to 4.43 in patient 2. CDAI decreased from 31.8 to 7.4 in 12 months in patient 1 and 34.6 to 10.7 in patient 2. Skin thickness evaluated with the 17 site modified Rodnan skin score improved in patient 1 (from 23 to 2) and patient 2 (from 15 to 8) in 12 months.Adverse reactions were observed cellulitis in right foot planter at 6 week treatment in patient 2. She did withdrawal tocilizumab for 4 week. After cure cellulitis, she continued tocilizumab treatment.ConclusionsIn the two cases of RA with SSc that we report here, softening of the skin was observed during the treatment with tocilizumab. Tocilizumab may be effective against RA and SSc for which conventional treatment is inadequate.References[1] Best Pract Res Clin Rheumatol2010;24:857–69[2] Inter J Rheumatol2011;2011:721608[3] J Rheumatol;25:308–13[4] J Dermatol Sci2001;27:140–6Disclosure of InterestNone declared

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supporting

confidence: 63%

AB0767 Efficacy of subcutaneous tocilizumab in patients with rheumatoid arthritis and systemic sclerosis overlap syndrome

Wakabayashi

Kino

Hasegawa

et al. 2018

Scleroderma, Myositis and Related Syndromes

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“…Differential diagnoses to consider might include inflammatory arthritis, scleroderma, nephrogenic fibrosing dermopathy, fibroblastic rheumatism, eosinophilic fasciitis and relapsing seronegative symmetrical synovitis with pitting edema (RS3PE). [1][2][3] However, all of these conditions are distinguishable by clinical, histologic, or other investigational means.…”

Section: Discussionmentioning

confidence: 96%

Palmar fasciitis and polyarthritis syndrome associated with transitional cell carcinoma of the bladder

Clarke

Kennedy

Hollingworth

2011

Journal of the American Academy of Dermatology

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“…A correct diagnosis is very important, since SLDs are very different diseases in terms of pathogenesis, clinical course, treatment, and outcome. 1 SLD is quite extensive, including other immune-mediated diseases (eosinophilic fasciitis, graft-versus-host disease), deposition disorders (CREST [calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia] syndrome, scleromyxedema, scleredema, nephrogenic systemic fibrosis/nephrogenic fibrosing der- mopathy, systemic amyloidosis), toxic exposures including occupational and iatrogenic (aniline-denaturated rapeseed oil, L-tryptophan, polyvinyl chloride, bleomycin, carbidopa), and genetic syndromes (progeroid disorders, stiff skin syndrome). 2 Histological examination does not always allow the differentiation among the various subtypes of scleroderma and SLD, and therefore, the diagnosis is often based on the pattern of cutaneous involvement and other clinical features.…”

mentioning

confidence: 97%

Pesticide-Induced Scleroderma and Early Intensive Immunosuppressive Treatment

Sozeri

Gülez

Aksu

et al. 2012

Archives of Environmental & Occupational Health

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The authors report 2 children with generalized cutaneous sclerosis exposed to pesticides containing malathion and diniconazole. Treatment with immunosuppressives resulted in partial improvement in the cutaneous signs, particularly over the face, trunk, and proximal limbs. The considerable exposure to chemicals related with the initiation of symptoms and absence of organ involvement suggested a diagnosis of chemically induced scleroderma-like disorder. Although autoantibodies were negative, previously reported relevant associations of anti-kinetochore and anti-topoisomerase function of active ingredients-diniconazole and phosphorodithioate-and solvents of these pesticides are also discussed. Careful follow-up for systemic involvement is warranted, since these agents may have triggered systemic scleroderma in these patients. Elimination of chemical exposure of children is stressed.

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Scleroderma-like disorders

Cited by 48 publications

References 32 publications

AB0767 Efficacy of subcutaneous tocilizumab in patients with rheumatoid arthritis and systemic sclerosis overlap syndrome

AB0767 Efficacy of subcutaneous tocilizumab in patients with rheumatoid arthritis and systemic sclerosis overlap syndrome

Palmar fasciitis and polyarthritis syndrome associated with transitional cell carcinoma of the bladder

Pesticide-Induced Scleroderma and Early Intensive Immunosuppressive Treatment

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