Atención de la úlcera de pie como manifestación clínica de la esclerosis sistémica
Keywords:
úlcera de pie, manifestación clínica, esclerosis sistémicaAbstract
Las úlceras pueden aparecer sobre protuberancias óseas, como las falanges proximales o los codos, pero es más probable que sean secundarias a la piel tensa y al trauma y no respondan a la terapia vasodilatadora. Todas las úlceras son muy dolorosas. El propósito de este trabajo es presentar aspectos relacionados con la atención de las úlceras digitales en la esclerodermia, según la experiencia de diferentes autores. En reumatología, se recomienda, en todo paciente con dolor reumático crónico, calcular la intensidad del dolor, tanto para la elección primera del tratamiento analgésico como para la medición de la respuesta. Y, para ello, se han propuesto varios métodos de cuantificación. El manejo de las úlceras digitales en la esclerodermia incluye la intervención no farmacológica, farmacológica y quirúrgica. El uso de nitratos, infusiones de acetilcisteína, el gel de vitamina E, entre otros métodos mejoran el tiempo de curación en pacientes con esclerodermia. La falta de terapias aprobadas por la Administración de Alimentos y Medicamentos de los Estados Unidos para las ulceraciones digitales garantiza un enfoque y una atención renovados para encontrar opciones de tratamiento significativas. Los médicos deberán emplear un enfoque terapéutico multifacético para optimizar el tratamiento de úlceras digitales existente y evitar la formación de nuevas lesiones para proporcionar a los pacientes la mejor calidad de vida.
Downloads
References
Denton CP, Korn JH. Digital ulceration and critical digital ischaemia in scleroderma. Scleroderma Care Res. 2003;1:12-16.
Baron M. Consensus opinion of a North American Working Group regarding the classification of digital ulcers in systemic sclerosis. Clin Rheumatol. 2014;33(2):207-214.
Sunderkotter C, Hergott I, Bruckner C, et al. Comparison of patients with and without digital ulcers in systemic sclerosis: detection of possible risk factors. Br J Dermatol. 2009;160:835-843.
Hachulla E, Clerson P, Launay D, et al. Natural history of ischemic digital ulcers in systemic sclerosis: a single-center retrospective longitudinal study. J Rheumatol. 2007;34:2423-2430.
Steen V, Denton CP, Pope JE, Matucci-Cerinic M. Digital ulcers: overt vascular disease in systemic sclerosis. Rheumatology. 2009;48:19-24.
Ferri C, Sebastiani M, Lo Monaco, et al. Systemic sclerosis evolution of disease pathomorphosis and survival. Our experience on Italian patients' population and review of the literature. Autoimmun Rev. 2014;13(10):1026-1034. doi:10.1016/j.autrev.2014.08.029.
van der Leeden M, Steultjens M, Dekker JH, Prins AP, Dekker J, et al. Forefoot joint damage, pain and disability in rheumatoid arthritis patients with foot complaints: the role of plantar pressure and gait characteristics. Rheumatology, 2006; 45: 465-469.
Dalal S, Widgerow AD, Evans GR. The plantar fat pad and the diabetic foot - a review. Int Wound J, 2013; 12: 1742-1801.
Shanmugam VK, Price P, Attinger CE, Steen VD Lower Extremity Ulcers in Systemic Sclerosis: Features and Response to Therapy. Int J Rheumatol. 2010.
Sari-Kouzel H, Hutchinson CE, Middleton A, Webb F, Moore T, et al. Foot problems in patients with systemic sclerosis. Rheumatology. 2001; 40: 410-413.
Reiber GE, Vileikyte L, Boyko EJ, del Aguila M, Smith DG, et al. Causal pathway for in incident lower extremity ulcers in patients with foot ulcer from two setting. Diabetes care. 1995; 1: 157-162.
Alcacer-Pitarch B, Buch MH, Gray J, Denton CP, Herrick A, et al. Pressure and pain in scleroderma an evaluation ofsimple intervention (PISCES): randomized controlled trial protocol. BMC Musculoskelet Disord, 2012; 13: 11.
Crawford F, Inkster M, Kleijnen J, Fahey T. Predicting foot ulcers in patients with diabetes: A systematic review and meta-analysis. QJM, 2007; 100: 65-86.
Reidy ME, Steen V, Nicholas J. Lower extremity amputation in scleroderma. Arch Phys Med Rehabil; 1992; 73: 811-813.
Chathra N, Bhat RM (2017) Corn in scleroderma. Indian Dermatol Online J; 8: 49-50.
Thompson AE, Pope JE. Calcium channel blockers for primary Raynaud's phenomenon: a meta-analysis. Rheumatology. 2005;44:145-150.
Gore J, Silver R. Oral sildenafil for the treatment of Raynaud's phenomenon and digital ulcers secondary to systemic sclerosis. Ann Rheum Dis. 2005;64(9):1387.
Caglayan E, Huntgeburth M, Karasch T, et al. Phosphodiesterase type 5 inhibition is a novel therapeutic option in Raynaud's disease. Arch Intern Med. 2006;166(2):231-233.
Garcia de la Pena-Lefebvre P, Rodriguez Rubio S, Valero Expositio M, et al. Long term experience of bosentan for treating ulcers and healed ulcers in systemic sclerosis patients. Rheumatology (Oxford). 2008;47:464-466.
Anderson ME, Moore TL, Hollis S, Jayson MIV, King TA, Herrick AL. Digital vascular response to topical glyceryl trinitrate, as measured by laser Doppler imaging, in primary Raynaud's phenomenon and systemic sclerosis. Rheumatology. 2002;41(3):324-328.
Sambo P, Amico D, Giacomelli R, et al. Intravenous N-acetylcysteine for treatment of Raynaud's phenomenon secondary to systemic sclerosis: a pilot study. J Rheumatol. 2001;28(10):2257-2262.
Fiori G, Galluccio F, Braschi F, et al. Vitamin E gel reduces time of healing of digital ulcers in systemic sclerosis. Clin Exp Rheumatol. 2009;27(3):51-54.
Matsumoto Y, Ueyama T, Endo M, et al. Endoscopic thoracic sympathectomy for Raynaud's phenomenon. J Vasc Surg. 2002;36(1):57-61.
Momeni A, Sorice S, Valenzuela A. Surgical treatment of systemic sclerosis - is it justified to offer peripheral sympathectomy earlier in the disease process? Microsurgery. Epub 2015 Jan 14. doi:10.1002/micr.22379.
Iorio M, Masden D, Higgins J. Botulinum toxin a treatment of Raynaud's phenomenon: a review. Semin Arthritis Rheum. 2012;41:599-603.
Uppal L, Dhaliwal K, Butler PE. A prospective study of the use of botulinum toxin injections in the treatment of Raynaud's syndrome associated with scleroderma. J Hand Surg. 2014;39:876-880.
Granel B, Daumas A, Jouve E, et al. Safety, tolerability and potential efficacy of injection of autologous adipose-derived stromal vascular fraction in the fingers of patients with systemic sclerosis: an open-label phase 1 trial. Ann Rheum Dis. Epub 2014 Aug 11. doi:10.1136/annrheumdis-2014-205681.
Del Bene MD, Pozzi MR, Rovati L, et al. Autologous fat grafting for scleroderma-induced digital ulcers. An effective technique in patients with systemic sclerosis. Handchir Mikrochir Plast Chir. 2014;46:242-247.
Taylor MH, McFadden JA, Bolster MB, et al. Ulnar artery involvement in systemic sclerosis (scleroderma). J Rheumatol. 2002;29(1):102-106.
Downloads
Published
How to Cite
Issue
Section
License
Warning of rights of author
The authors that publish in this journal agree with the following terms:
The authors conserve the rights of author and concede to the journal the right of the first publication, fulfilling with the license Creative Commons Attribution License that allows to others share the work with recognition of the authorship of their articles, and the initial publication in this journal.
The authors can establish separately additional agreements for the no exclusive distribution of the version of the work published in the journal (for example, situate it in an institutional repository, in a personal blog or publish it partial or totally in a book), with a recognition of their initial publication in this journal.
To be able to send the manuscript or part of him passed three months of published, for his evaluation to other publishers, identifying it or not with the same title; whenever allusion is made to our journale and know it the new publisher.
The publishing committee of the Cuban Journal of Rheumatology authorizes to other publishers, to reproduce the articles published in our magazine, whenever it indicate the origin of the same.
The authors should send a document in Office Word application format through the electronic address of the magazine with a similar format to that we include next:
---------------------------------------------------------------------------------------------------------------------
Statement of authorship and cede of articles for the publication of the scientific work in the Cuban Journal of Rheumatology
Date:
Those who subscribe certify that are the authors of the work:
Of this form communicate the originality of our article clearing that the concepts and knowledges of other authors that have included in the text of the article, have been quoted properly in the bibliography.
We do proof besides that the article in question is original and has not been published, total neither partially, in another journal.
To be approved for his publication in the Cuban Journal of Rheumatology, do secession of the rights of publication to the same one through the method that realizes it usually.
In front of any catchword that exist by the article that send to evaluate, relieve of of the responsibility to the Cuban Journal of Rheumatology holding us responsible with all the difficulties that can berelated by any situation.
We include to continuation the name and the signature of all authors and collaborators of this article.
Name: Signature:
