Digital ulcer debridement in systemic sclerosis: a systematic literature review

AbstractOptimal wound care is an essential component in the management of systemic sclerosis (SSc) digital ulcers (DUs). DU debridement has been suggested to reduce ulcer-related pain and improve tissue healing. However, only a minority of rheumatologists perform DU debridement, and there is no standard of care/protocol. Our objectives were to (i) evaluate the current evidence for the use of debridement in DU management and (ii) assess whether there are any specific protocols. A systematic literature review was performed searching the PubMed database (between 01/01/1950 –01/03/2019) in accordance with PRISMA guidelines. Two independent reviewers screened and extracted the abstracts/full manuscripts. Articles in English, which focussed on SSc-DU debridement/curettage, were included. Exclusion criteria included studies of juvenile/paediatric patients and basic/non- clinical research. Our search identified 1497 studies of which 4 studies were included in our final analysis. Three studies used scalpel debridement, and one study used this in combination with autolytic debridement. No studies specifically reported the effect on DU healing from debridement. Autolyt ic debridement with hyaluronate-based products was associated with significant ulcer pain and inflammation. Local anaesthetic significantly reduces pain both during and after debridement. Combined local and oral analgesia is often required for more severe or infected DUs. DU (scalpel and autolytic) debridement is be...
Source: Clinical Rheumatology - Category: Rheumatology Source Type: research

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CONCLUSION: Patients consistently reported a positive effect of treatment with prostacyclin derivatives on Raynaud's phenomenon, acral ulcerations, pain and daily restrictions and felt well and safely cared for during inpatient treatment. These positive effects in the patients' perceptions provide crucial information supporting and confirming the current European and international treatment recommendations. PMID: 32040755 [PubMed - as supplied by publisher]
Source: Zeitschrift fur Rheumatologie - Category: Rheumatology Authors: Tags: Z Rheumatol Source Type: research
CONCLUSIONS: The CSF-17 is a new patient-reported outcome assessing activities and participation specifically in people with SSc. Its content and construct validities are very good. PMID: 32017013 [PubMed - as supplied by publisher]
Source: The British Journal of Dermatology - Category: Dermatology Authors: Tags: Br J Dermatol Source Type: research
CONCLUSIONS: This is the first qualitative study of HRQoL in LS to include all major LS subtypes. We identified domains of HRQoL impacted by LS, some of which replicate earlier findings and some which were novel. As impact also changed with developmental stage, our findings support the need for ongoing, formal evaluation of HRQoL in children and adolescents with LS. PMID: 31955419 [PubMed - as supplied by publisher]
Source: The British Journal of Dermatology - Category: Dermatology Authors: Tags: Br J Dermatol Source Type: research
ConclusionsOur results suggest that a combined exercise protocol was feasible for people with lcSSc, with no adverse events,  resulting in high adherence and low attrition rates, high enjoyment levels and intentions for future engagement to this exercise. Thus, the specific protocol is a safe adjunct therapy for people with lcSSc.Trial (NCT number): NCT03058887, February 23, 2017, Points• High-intensity interval training in combination with resistance training constitutes a feasible exercise protocol for peop...
Source: Clinical Rheumatology - Category: Rheumatology Source Type: research
We report an original case of intra- and extra-articular pseudotumoral calcinosis of the wrist diagnosed in a patient followed for mild systemic scleroderma. The calcinosis was revealed in a highly unusual way via ductal syndrome secondary to compression of the radial nerve in the wrist. Surgical treatment resulted in marked clinical and functional improvement. COMMENT: Although subcutaneous calcinoses are a fairly common complication of systemic scleroderma, the pseudo-tumoral form remains extremely rare. It may be complicated by pain, recurrent infection, and functional restriction, but literature contains only very...
Source: Annales de Dermatologie et de Cenereologie - Category: Dermatology Authors: Tags: Ann Dermatol Venereol Source Type: research
Abstract Objective: Despite being a cardinal clinical sign of systemic sclerosis (SSc), digital pitting has been little studied. Our objective was to test, in a pilot study, the hypothesis that pitting is painful and associated with digital vascular disease severity.Method: Fifty patients with SSc were recruited: 25 with and 25 without digital pitting. Fingertip pain was assessed on a 0-10 scale. Thermography of both hands assessed surface temperature, allowing calculation of the distal-dorsal difference (temperature gradient) for each finger. Nailfold capillaroscopy was performed in each finger using a dermatosco...
Source: Scandinavian Journal of Rheumatology - Category: Rheumatology Authors: Tags: Scand J Rheumatol Source Type: research
Authors: Mohamed AA, Lu XL, Mounmin FA Abstract Esophageal candidiasis (EC) is the most common type of infectious esophagitis. In the gastrointestinal tract, the esophagus is the second most susceptible to candida infection, only after the oropharynx. Immunocompromised patients are most at risk, including patients with HIV/AIDS, leukemia, diabetics, and those who are receiving corticosteroids, radiation, and chemotherapy. Another group includes those who used antibiotics frequently and those who have esophageal motility disorder (cardiac achalasia and scleroderma). Patients complained of pain on swallowing, difficu...
Source: Canadian Journal of Gastroenterology - Category: Gastroenterology Tags: Can J Gastroenterol Hepatol Source Type: research
Publication date: November–December 2019Source: Reumatología Clínica (English Edition), Volume 15, Issue 6Author(s): Joana Sousa-Neves, Marcos Cerqueira, Daniela Santos-Faria, Carmo Afonso, Filipa TeixeiraAbstractObjectivesTo investigate if patients with Systemic Sclerosis (SSc) show a higher prevalence of neuropathic pain (NP) in comparison with controls. To study the relationship between clinical variables of the disease and NP among SSc patients.Material and methods48 patients and 45 controls were included. Presence of NP was assessed applying the DN4 “Douleur Neuropathique en 4 Questions&rdquo...
Source: Reumatologia Clinica - Category: Rheumatology Source Type: research
We report a rare case of overlap syndrome (SSc and polymyositis) who presented with sudden chest pain secondary to myocardial fibrosis. Although the etiology of chest symptoms in collagen disease was difficult to identify, cardiac magnetic resonance imaging (MRI) revealed not myocarditis but myocardial fibrosis in our case. Synthetic judgement of serum brain natriuretic peptide/ troponin T levels and cardiac MRI is useful in the search for the cause of chest symptoms even in patients with collagen diseases. PMID: 31723102 [PubMed - in process]
Source: Drug Discoveries and Therapeutics - Category: Drugs & Pharmacology Tags: Drug Discov Ther Source Type: research
Abstract Raynaud's phenomenon is a common vasospastic condition which carries a significant burden of pain and hand-related disability (Hughes and Herrick, 2016). The prevalence of Raynaud's phenomenon in the general population has been reported to be approximately 5% (Garner et al, 2015). Raynaud's phenomenon can occur either as a primary ('idiopathic') phenomenon or secondary to a wide range of underlying medical conditions and drug causes. Therefore, hospital-based specialists are frequently involved in the care of patients with Raynaud's phenomenon and need to be aware of associated conditions and prescribed m...
Source: British Journal of Hospital Medicine - Category: Internal Medicine Authors: Tags: Br J Hosp Med (Lond) Source Type: research
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