Treatment of digital ulcers in systemic sclerosis: Case series study of thirteen patients and discussion on outcome
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Revista da Associação Médica Brasileira (Online) |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302017000500422 |
Resumo: | Summary Introduction: In systemic sclerosis (SSc), digital ulcers (DU) are debilitating and recurrent. They are markers of prognosis and are associated with disability and mortality. Treatment strategies have been developed to block the proposed mechanisms of this complication. Objective: Clinical description of a population of SSc patients with DU, treatment, complications and outcome. Method: Analysis of 48 SSc patients meeting 2013 ACR-EULAR criteria, followed between 1999-2015; 13 patients had DU. Treatment protocol applied included cycles of 21 days of alprostadil, which can be repeated in the absence of DU healing. After DU healing, bosentan was initiated. Results: DU healing was achieved with intravenous prostanoid in 12 patients; seven patients required repeated treatment for DU healing. Twelve patients were later treated with bosentan; three of them experienced recurrence of DU, while one was anti-B2-GPI positive. Four patients had soft tissue loss and three other suffered digital amputation, these being late diagnosis. Conclusion: Younger patients and early referrals had better outcomes. Endothelin receptor antagonist toxicity should be monitored, particularly in patients previously exposed to hepatotoxic drugs. |
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Revista da Associação Médica Brasileira (Online) |
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Treatment of digital ulcers in systemic sclerosis: Case series study of thirteen patients and discussion on outcomesystemic sclerosisdigital ulcersSummary Introduction: In systemic sclerosis (SSc), digital ulcers (DU) are debilitating and recurrent. They are markers of prognosis and are associated with disability and mortality. Treatment strategies have been developed to block the proposed mechanisms of this complication. Objective: Clinical description of a population of SSc patients with DU, treatment, complications and outcome. Method: Analysis of 48 SSc patients meeting 2013 ACR-EULAR criteria, followed between 1999-2015; 13 patients had DU. Treatment protocol applied included cycles of 21 days of alprostadil, which can be repeated in the absence of DU healing. After DU healing, bosentan was initiated. Results: DU healing was achieved with intravenous prostanoid in 12 patients; seven patients required repeated treatment for DU healing. Twelve patients were later treated with bosentan; three of them experienced recurrence of DU, while one was anti-B2-GPI positive. Four patients had soft tissue loss and three other suffered digital amputation, these being late diagnosis. Conclusion: Younger patients and early referrals had better outcomes. Endothelin receptor antagonist toxicity should be monitored, particularly in patients previously exposed to hepatotoxic drugs.Associação Médica Brasileira2017-05-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302017000500422Revista da Associação Médica Brasileira v.63 n.5 2017reponame:Revista da Associação Médica Brasileira (Online)instname:Associação Médica Brasileira (AMB)instacron:AMB10.1590/1806-9282.63.05.422info:eu-repo/semantics/openAccessAbuowda,YahiaAlmeida,Raquel SousaOliveira,Ana AlvesPego,PetraSantos,CristinaMatos-Costa,Joãoeng2017-07-10T00:00:00Zoai:scielo:S0104-42302017000500422Revistahttps://ramb.amb.org.br/ultimas-edicoes/#https://old.scielo.br/oai/scielo-oai.php||ramb@amb.org.br1806-92820104-4230opendoar:2017-07-10T00:00Revista da Associação Médica Brasileira (Online) - Associação Médica Brasileira (AMB)false |
dc.title.none.fl_str_mv |
Treatment of digital ulcers in systemic sclerosis: Case series study of thirteen patients and discussion on outcome |
title |
Treatment of digital ulcers in systemic sclerosis: Case series study of thirteen patients and discussion on outcome |
spellingShingle |
Treatment of digital ulcers in systemic sclerosis: Case series study of thirteen patients and discussion on outcome Abuowda,Yahia systemic sclerosis digital ulcers |
title_short |
Treatment of digital ulcers in systemic sclerosis: Case series study of thirteen patients and discussion on outcome |
title_full |
Treatment of digital ulcers in systemic sclerosis: Case series study of thirteen patients and discussion on outcome |
title_fullStr |
Treatment of digital ulcers in systemic sclerosis: Case series study of thirteen patients and discussion on outcome |
title_full_unstemmed |
Treatment of digital ulcers in systemic sclerosis: Case series study of thirteen patients and discussion on outcome |
title_sort |
Treatment of digital ulcers in systemic sclerosis: Case series study of thirteen patients and discussion on outcome |
author |
Abuowda,Yahia |
author_facet |
Abuowda,Yahia Almeida,Raquel Sousa Oliveira,Ana Alves Pego,Petra Santos,Cristina Matos-Costa,João |
author_role |
author |
author2 |
Almeida,Raquel Sousa Oliveira,Ana Alves Pego,Petra Santos,Cristina Matos-Costa,João |
author2_role |
author author author author author |
dc.contributor.author.fl_str_mv |
Abuowda,Yahia Almeida,Raquel Sousa Oliveira,Ana Alves Pego,Petra Santos,Cristina Matos-Costa,João |
dc.subject.por.fl_str_mv |
systemic sclerosis digital ulcers |
topic |
systemic sclerosis digital ulcers |
description |
Summary Introduction: In systemic sclerosis (SSc), digital ulcers (DU) are debilitating and recurrent. They are markers of prognosis and are associated with disability and mortality. Treatment strategies have been developed to block the proposed mechanisms of this complication. Objective: Clinical description of a population of SSc patients with DU, treatment, complications and outcome. Method: Analysis of 48 SSc patients meeting 2013 ACR-EULAR criteria, followed between 1999-2015; 13 patients had DU. Treatment protocol applied included cycles of 21 days of alprostadil, which can be repeated in the absence of DU healing. After DU healing, bosentan was initiated. Results: DU healing was achieved with intravenous prostanoid in 12 patients; seven patients required repeated treatment for DU healing. Twelve patients were later treated with bosentan; three of them experienced recurrence of DU, while one was anti-B2-GPI positive. Four patients had soft tissue loss and three other suffered digital amputation, these being late diagnosis. Conclusion: Younger patients and early referrals had better outcomes. Endothelin receptor antagonist toxicity should be monitored, particularly in patients previously exposed to hepatotoxic drugs. |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-05-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302017000500422 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302017000500422 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.1590/1806-9282.63.05.422 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Associação Médica Brasileira |
publisher.none.fl_str_mv |
Associação Médica Brasileira |
dc.source.none.fl_str_mv |
Revista da Associação Médica Brasileira v.63 n.5 2017 reponame:Revista da Associação Médica Brasileira (Online) instname:Associação Médica Brasileira (AMB) instacron:AMB |
instname_str |
Associação Médica Brasileira (AMB) |
instacron_str |
AMB |
institution |
AMB |
reponame_str |
Revista da Associação Médica Brasileira (Online) |
collection |
Revista da Associação Médica Brasileira (Online) |
repository.name.fl_str_mv |
Revista da Associação Médica Brasileira (Online) - Associação Médica Brasileira (AMB) |
repository.mail.fl_str_mv |
||ramb@amb.org.br |
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1754212832483737600 |