The Journal of Dermatology

<jats:title>ABSTRACT</jats:title><jats:p>Gastric antral vascular ectasia (GAVE) is a cause of gastrointestinal bleeding in systemic sclerosis (SSc), but its predictors and outcomes in SSc are not fully defined. We aimed to determine the frequency of GAVE in SSc and to compare the clinical characteristics of SSc patients with versus without GAVE in a single‐center Japanese cohort. We retrospectively identified SSc patients who underwent upper gastrointestinal endoscopy at our institution between 2006 and 2015. Clinical data including SSc subtype, extent of skin sclerosis, and autoantibody profiles were collected for patients with endoscopically confirmed GAVE and for those without GAVE. Of 272 SSc patients who underwent endoscopy, 19 patients (7.0%) had GAVE. SSc patients with GAVE were significantly more likely to have diffuse cutaneous SSc and had a shorter disease duration since SSc onset compared to those without GAVE. GAVE patients tended to have more severe skin sclerosis and a markedly higher prevalence of anti‐RNA polymerase III antibody (42% vs. 9.5% in non‐GAVE, <jats:italic>p</jats:italic> &lt; 0.001), with a corresponding lower frequency of anti‐centromere antibody (10.5% vs. 45.4%, <jats:italic>p</jats:italic> &lt; 0.001). Scleroderma renal crisis occurred in 16% of GAVE patients versus &lt; 1% of non‐GAVE patients (<jats:italic>p</jats:italic> &lt; 0.001). Follow‐up endoscopy in GAVE patients showed that in roughly half of the cases the GAVE lesions disappeared over 1–8 years (often after immunosuppressive therapy), whereas the remainder had persistent GAVE changes. GAVE occurred in about 7% of SSc patients, especially those with diffuse, rapidly progressive disease. It was associated with anti‐RNA polymerase III positivity and early severe organ involvement. Patients with early diffuse skin disease and this antibody may be at higher risk, highlighting the importance of early detection to prevent bleeding and anemia.</jats:p>

publication_history

received

accepted

published

Gastric Antral Vascular Ectasia. A Histologic and Morphometric Study of “The Watermelon Stomach”

American Journal of Surgical Pathology

Gastric Antral Vascular Ectasia: The Watermelon Stomach

Gastroenterology

Scleroderma (Systemic Sclerosis): Classification, Subsets and Pathogenesis

Journal of Rheumatology

Inter and Intraobserver Variability of Total Skin Thickness Score (Modified Rodnan TSS) in Systemic Sclerosis

Gastric antral vascular ectasia (GAVE) is a cause of gastrointestinal bleeding in systemic sclerosis (SSc), but its predictors and outcomes in SSc are not fully defined. We aimed to determine the frequency of GAVE in SSc and to compare the clinical characteristics of SSc patients with versus without GAVE in a single-center Japanese cohort. We retrospectively identified SSc patients who underwent upper gastrointestinal endoscopy at our institution between 2006 and 2015. Clinical data including SSc subtype, extent of skin sclerosis, and autoantibody profiles were collected for patients with endoscopically confirmed GAVE and for those without GAVE. Of 272 SSc patients who underwent endoscopy, 19 patients (7.0%) had GAVE. SSc patients with GAVE were significantly more likely to have diffuse cutaneous SSc and had a shorter disease duration since SSc onset compared to those without GAVE. GAVE patients tended to have more severe skin sclerosis and a markedly higher prevalence of anti-RNA polymerase III antibody (42% vs. 9.5% in non-GAVE, p < 0.001), with a corresponding lower frequency of anti-centromere antibody (10.5% vs. 45.4%, p < 0.001). Scleroderma renal crisis occurred in 16% of GAVE patients versus < 1% of non-GAVE patients (p < 0.001). Follow-up endoscopy in GAVE patients showed that in roughly half of the cases the GAVE lesions disappeared over 1-8 years (often after immunosuppressive therapy), whereas the remainder had persistent GAVE changes. GAVE occurred in about 7% of SSc patients, especially those with diffuse, rapidly progressive disease. It was associated with anti-RNA polymerase III positivity and early severe organ involvement. Patients with early diffuse skin disease and this antibody may be at higher risk, highlighting the importance of early detection to prevent bleeding and anemia.

GAVE in Systemic Sclerosis: A Japanese Cohort Study Highlighting Links to Diffuse Cutaneous Subtype and Anti-RNAPIII Antibodies.

<scp>GAVE</scp> in Systemic Sclerosis: A Japanese Cohort Study Highlighting Links to Diffuse Cutaneous Subtype and Anti‐<scp>RNAPIII</scp> Antibodies

Advances in Skin &amp; Wound Care

<jats:title>ABSTRACT</jats:title>
          <jats:sec>
            <jats:title>OBJECTIVE</jats:title>
            <jats:p>To explore the effect of topical cannabidiol (CBD) in treating digital ulcers in patients with systemic sclerosis (SSc).</jats:p>
          </jats:sec>
          <jats:sec>
            <jats:title>METHODS</jats:title>
            <jats:p>In total, 45 patients with SSc who had digital ulcers were consecutively enrolled between January 2019 and December 2019. Of the participants, 25 were treated with CBD during surgical debridement and 20 were treated with standard local therapy. A numeric rating scale for pain and Health Assessment Questionnaire Disability Index were administered at the baseline and at the end of treatment.</jats:p>
          </jats:sec>
          <jats:sec>
            <jats:title>RESULTS</jats:title>
            <jats:p>Local treatment with CBD was significantly associated with lower pain scores, higher health assessment scores, and an increase in participants’ total hours of sleep. Patients in the control group more frequently required additional analgesic therapy.</jats:p>
          </jats:sec>
          <jats:sec>
            <jats:title>CONCLUSIONS</jats:title>
            <jats:p>Topical CBD may be a valuable tool to treat pain related to digital ulcers in patients with SSc.</jats:p>
          </jats:sec>

Scleroderma skin ulcers definition, classification and treatment strategies our experience and review of the literature

Autoimmunity Rev

“Less pain with more gain”—Managing wound-related pain with cannabis-based medicines

Wound Repair Regen

Procedural pain management in the treatment of scleroderma digital ulcers

Clin Exp Rheumatol

Review of local wound management for scleroderma-associated digital ulcers

J Scleroderma Relat Disord

Relationship between opioid treatment and rate of healing in chronic wounds

Medical cannabis in the palliation of malignant wounds—a case report

J Pain Symptom Manage

Classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative

Arthritis Rheum

The IASP classification of chronic pain for ICD-11: functioning properties of chronic pain

Pain

Measures of systemic sclerosis (scleroderma): Health Assessment Questionnaire (HAQ) and Scleroderma HAQ (SHAQ), physician- and patient-rated global assessments, Symptom Burden Index (SBI), University of California, Los Angeles, Scleroderma Clinical Trials Consortium Gastrointestinal Scale (UCLA SCTC GIT) 2.0, Baseline Dyspnea Index (BDI) and Transition Dyspnea Index (TDI) (Mahler’s index), Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR), and Raynaud’s Condition Score (RCS)

Arthritis Care Res

Topical opioids for painful ulcers in systemic sclerosis

Ann Rheum Dis

Oxycodone in the long-term treatment of chronic pain related to scleroderma skin ulcers

Pain Med

Effectiveness and safety of oxycodone/naloxone in the management of chronic pain in patients with systemic sclerosis with recurrent digital ulcers: two case reports

Clin Interv Aging

Topical application of morphine for wound healing and analgesia in patients with oral lichen planus: a randomized, double-blind, placebo-controlled study

Clin Oral Investig

Cannabinoid signaling in the skin: therapeutic potential of the “c(ut)annabinoid” system

Molecules

The epigenetic regulation of wound healing

Adv Wound Care

Cannabidiol restores differentiation capacity of LPS exposed adipose tissue mesenchymal stromal cells

Exp Cell Res

A new treatment paradigm for sickle cell disease leg ulcers: topical cannabis-based medicines

Exp Dermatol

Self-initiated use of topical cannabidiol oil for epidermolysis bullosa

Pediatr Dermatol

Topical medical cannabis: a new treatment for wound pain—three cases of pyoderma gangrenosum

Promoting wound healing of uremic calciphylaxis leg ulcers using topical cannabis-based medicines

Dermatol Ther

Topical cannabis-based medicines—a novel paradigm and treatment for non-uremic calciphylaxis leg ulcers: an open label trial

Int Wound J

Topical cannabis-based medicines—a novel adjuvant treatment for venous leg ulcers: an open-label trial

Therapeutic potential of cannabidiol (CBD) for skin health and disorders

Clin Cosmet Investig Dermatol

To explore the effect of topical cannabidiol (CBD) in treating digital ulcers in patients with systemic sclerosis (SSc).
In total, 45 patients with SSc who had digital ulcers were consecutively enrolled between January 2019 and December 2019. Of the participants, 25 were treated with CBD during surgical debridement and 20 were treated with standard local therapy. A numeric rating scale for pain and Health Assessment Questionnaire Disability Index were administered at the baseline and at the end of treatment.
Local treatment with CBD was significantly associated with lower pain scores, higher health assessment scores, and an increase in participants' total hours of sleep. Patients in the control group more frequently required additional analgesic therapy.
Topical CBD may be a valuable tool to treat pain related to digital ulcers in patients with SSc.

Topical Cannabidiol in the Treatment of Digital Ulcers in Patients with Scleroderma: Comparative Analysis and Literature Review.

Topical Cannabidiol in the Treatment of Digital Ulcers in Patients with Scleroderma: Comparative Analysis and Literature Review

Papers