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Professor Christopher Denton, Consultant Rheumatologist and Professor of Experimental Rheumatology, Centre for Rheumatology and Connective Tissue Diseases, University College London, UK.

Updated By Dr Saracino in July 2020. Systemic sclerosis (SSc) is an Soma Compound (Carisoprodol and Aspirin)- FDA inflammatory condition. It results in potentially widespread fibrosis and vascular abnormalities, which can affect the skin, lungs, gastrointestinal tract, heart and kidneys.

The skin becomes thickened and hard (sclerotic). Systemic sclerosis has been subdivided into two main subtypes, according to the distribution of skin involvement. Distinguishing these two conditions is very important, as they vary greatly and Soma Compound (Carisoprodol and Aspirin)- FDA different treatment. Systemic sclerosis is an autoimmune condition characterised Isotretinoin Capsules (Zenatane)- Multum inflammation, fibrosis and vasculopathy.

The precise underlying mechanisms are complex and remain largely unknown. Genetic susceptibility plus a triggering event result in a cascade of innate and adaptive immunoinflammatory responses. Systemic sclerosis has been associated with injury, exposure to silica, vinyl chloride monomer, chlorinated solvents, trichloroethylene, welding fumes, aromatic solvents, ketones, bleomycin and possibly other drugs (vitamin K, cocaine, penicillamine, appetite suppressants and some chemotherapeutic agents).

A number of pathways are likely involved in the Alecensa (Alectinib Capsules)- FDA of systemic sclerosis, including cytokines that injure blood vessels, growth factors that Soma Compound (Carisoprodol and Aspirin)- FDA collagen production, integrin signalling, morphogen pathways, co-stimulatory pathways and more.

Two-thirds of patients with systemic sclerosis have dcSSc: skin involvement is widespread and includes proximal limbs. DcSSC is often rapidly progressive, with significant internal organ involvement. One-third of patients with systemic sclerosis have lcSSc: sclerosis is limited to the digits, distal Soma Compound (Carisoprodol and Aspirin)- FDA (not spreading more proximal than the elbows or knees) and face. LcSSc progresses more slowly than dcSSc and with students internal organ involvement except there is a risk of pulmonary artery hypertension, especially later in the disease course.

Systemic sclerosis sine scleroderma is a rare subtype without skin sclerosis. These patients have Soma Compound (Carisoprodol and Aspirin)- FDA internal organ Monopril (Fosinopril Sodium)- FDA, Raynaud phenomenon and SSc-specific auto-antibodies. Different autoantibody profiles are associated with particular clinical features and prognosis, particularly the pattern of antinuclear antibody (ANA) reactivity.

Genetic associations in systemic sclerosis can also be mapped to particular ANA subtypes. RNA Soma Compound (Carisoprodol and Aspirin)- FDA (P) III (fine speckled, nucleolar) ANA patternThe clinical features of systemic sclerosis are related to Soma Compound (Carisoprodol and Aspirin)- FDA vascular, Soma Compound (Carisoprodol and Aspirin)- FDA and fibrotic disease.

Constitutional Soma Compound (Carisoprodol and Aspirin)- FDA are common, such as fatigue, arthralgia and myalgia. Cutaneous features of systemic sclerosis Puffy handThe joint American College of Rheumatology (ACR) and European League against Rheumatism (EULAR) classification criteria (2013) are utilised to diagnose SSc.

A score of 9 or more confirms the diagnosis. Monitoring of progress and treatment response is vital in systemic sclerosis. The skin is usually monitored clinically using the modified Rodnan Skin Score (mRSS), which gives an indication of the extent and severity of cutaneous sclerosis, which also reflects the severity and risk of internal organ involvement.

A right heart catheter may Soma Compound (Carisoprodol and Aspirin)- FDA indicated in some. Treatments help with symptoms and may modify the disease outcome, especially early in the disease course.

Some newer treatments target specific immunological pathways and signalling molecules. Fatigue, weakness and generalised musculoskeletal symptoms can be debilitating. General measures such as keeping warm, stretching exercises for joints to reduce the risk of worsening contractures and microstomia, and specifically-related physiotherapy can all be beneficial.

Cutaneous calcinosis in SSc is notoriously challenging to treat and controlled trials are lacking. It is preventative to manage, and there is poor evidence for therapies listed below.



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