Scleroderma

Naturopathic Rheumatology and Integrative Inflammology—Edition 3.5 combines the recently updated Functional Inflammology and Dr Vasquez’s previous Integrative Rheumatology into a new colorized updated textbook of 900 pages. This work is the culmination of several thousand research publications combined with Dr Vasquez’s many years of clinical experience and teaching graduate-level students and doctorate-level clinicians worldwide. With radiographs, photos, acronyms, illustrations, flowcharts, and detailed-yet-simplifying explanations, Dr Vasquez makes it easier than ever for clinicians to grasp important concepts in integrative care and functional medicine and then to translate the basic science research and molecular biology into treatment plans that can be explained and used in “the real world” of clinical practice with patients. The associated video tutorials and recorded live conference presentations further help students and clinicians “get it” via Dr Vasquez’s effective teaching style which embraces complexity while always emphasizing clinical applicability and psychosocial context. The Inflammation Mastery & Functional Inflammology series of books and videos translates important concepts and nutritional/biomedical science into easy and practical clinical applications for the prevention and treatment of disorders of sustained inflammation, which Dr Vasquez describes as “patterns of metabolic disturbance and inflammatory dysfunction” existing in three sequential and overlapping categories: 1) metabolic inflammation, 2) allergic inflammation, 3) autoimmune inflammation. This book includes access to video presentations which introduce the origin and components of the Functional Inflammology Protocol and FINDSEX® acronym. Post-publication updates to this information and important social and clinical contextualization are made available in videos and online repositories (access provided in the book), and the e-newsletter available from InflammationMastery and FunctionalInflammology.com. This textbook also provides access, via reprints or hyperlinks, to Dr Vasquez’s published articles—an example of which is his recent paradigm-shifting editorial published in the journal Alternative Therapies in Health and Medicine (2014 January). The updated section on pain management allows students and clinicians to understand and apply manual, pharmacologic, nutritional and botanical medicine treatments for musculoskeletal pain, thereby providing better relief for patients and avoiding the hazards of NSAIDs, coxibs, steroids, opioids, immunosuppressants/immunoparalytics and biologics.

Several chronic inflammatory disorders, such as rheumatoid arthritis and systemic lupus erythematosus, have been shown to increase coronary artery disease (CAD) risk but the data on systemic sclerosis (SSc) is unclear. We conducted a systematic review and meta-analysis of observational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio comparing CAD risk in patients with SSc versus non-SSc participants. Pooled risk ratio and 95 % confidence intervals were calculated using a random effect, generic inverse variance method. Four studies were identified and included in our data analysis. The pooled risk ratio of CAD in patients with SSc was 1.82 (95 % CI, 1.40 to 2.36). The statistical heterogeneity of this meta-analysis was moderate with an I (2) of 73 %. Our study demonstrated a statistically significant increased CAD risk among patients with SSc.

The distinction between this normal physiology and Raynaud’s phenomenon (RP) has yet to be well characterized. In anticipation of the 9th International Congress on Autoimmunity, a panel of 12 RP experts from 9 different institutes and four different countries were assembled for a Delphi exercise to establish new diagnostic criteria for RP. Relevant investigators with highly cited manuscripts in Raynaud’s-related research were identified using the Web of Science and invited to participate. Surveys at each stage were administered to participants via the on-line SurveyMonkey software tool. The participants evaluated the level of appropriateness of statements using a scale of 1 (extremely inappropriate) through 9 (extremely appropriate). In the second stage, panel participants were asked to rank rewritten items from the first round that were scored as “uncertain” for the diagnosis of RP, items with significant disagreement (Disagreement Index > 1), and new items suggested by the panel. Results were analyzed using the Interpercentile Range Adjusted for Symmetry (IPRAS) method. A 3-Step Approach to diagnose RP was then developed using items the panelists “agreed” were “appropriate” diagnostic criteria. In the final stage, the panel was presented with the newly developed diagnostic criteria and asked to rate them against previous models. Following the first two iterations of the Delphi exercise, the panel of 12 experts agreed that 36 of the items were “appropriate,” 12 items had “uncertain” appropriateness, and 13 items were “inappropriate” to use in the diagnostic criteria of RP. Using an expert committee, we developed a 3-Step Approach for the diagnosis of RP and 5 additional criteria for the diagnosis of primary RP. The committee came to an agreement that the proposed criteria were “appropriate and accurate” for use by physicians to diagnose patients with RP.

La esclerosis sistémica se caracteriza por un engrosamiento cutáneo generalizado con mayor o menor afectación visceral; precisamente, la evolución de ésta es lo que determina la gravedad de la enfermedad. Cuando la progresión es lenta, pueden tardar varias décadas en manifestarse el desarrollo de enfermedad visceral; esta forma lentamente progresiva es conocida como esclerodermia cutánea limitada, y su pronóstico varía en función de la extensión de la enfermedad. Por el contrario, los cuadros de esclerosis sistémica rápidamente progresivos son a menudo fatales. Además, la esclerosis sistémica puede superponerse con otras afecciones reumáticas de origen autoinmune, como la esclerodermatomiositis y la enfermedad mixta del tejido conjuntivo. La patogénesis de la esclerosis sistémica se caracteriza por tres características esenciales: vasculopatía de vasos pequeños, desregulación de la inmunidad innata y adaptativa, y fibrosis extensa de la piel y de las vísceras. Por el momento no se dispone de ningún tratamiento etiológico; ni siquiera estamos en condiciones de inhibir eficazmente o retrasar la progresión de la enfermedad. Por ello, el tratamiento está dirigido al control de los síntomas y de las disfunciones orgánicas, lo que permite incrementar la calidad de vida de los pacientes. Los farmacéuticos españoles han mantenido un interés permanente en el ámbito de las enfermedades raras, colaborando desde hace muchos años con las organizaciones de pacientes, tanto desde una perspectiva profesional sanitaria como en la sensibilización social sobre grave problema. La participación profesional de los farmacéuticos, más allá de sus obvias responsabilidades asistenciales y de control de los medicamentos en el ámbito de su actuación (comunitaria u hospitalaria), se complementa particularmente en el caso de los farmacéuticos comunitarios con la posibilidad de suministrar información a la población y redirigir a posible pacientes no diagnosticados y a sus cuidadores a los centros sanitarios y dependencia oficiales, donde pueden recibir una respuesta especializada y eficaz a su problema.

Background: Systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) are systemic autoimmune connective
tissue diseases that share overlapping clinico-pathological features. It is highly probable that there is an overlap in
epigenetic landscapes of both diseases. This study aimed to identify similarities in DNA methylation changes in genes
involved in SLE and SSc. Global DNA methylation and twelve genes selected on the basis of their involvement in
inflammation, autoimmunity and/or fibrosis were analyzed using PCR arrays in three groups, each of 30 Black South
Africans with SLE and SSc, plus 40 healthy control subjects.
Results: Global methylation in both diseases was significantly lower (<25 %) than in healthy subjects (>30 %, p =
0.0000001). In comparison to healthy controls, a similar gene-specific methylation pattern was observed in both SLE
and SSc. Three genes, namely; PRF1, ITGAL and FOXP3 were consistently hypermethylated while CDKN2A and CD70
were hypomethylated in both diseases. The other genes (SOCS1, CTGF, THY1, CXCR4, MT1-G, FLI1, and DNMT1) were
generally hypomethylated in SLE whereas they were neither hyper- nor hypo-methylated in SSc.
Conclusions: SSc and SLE patients have a higher global hypomethylation than healthy subjects with specific genes
being hypomethylated and others hypermethylated. The majority of genes studied were hypomethylated in SLE
compared to SSc. In addition to the commonly known hypomethylated genes in SLE and SSc, there are other
hypomethylated genes (such as MT-1G and THY-1) that have not previously been investigated in SLE and SSc though
are known to be hypermethylated in cancer.