Dysphagia and other manifestations of oesophageal involvement in the musculoskeletal diseases

Sheehan, N. J.

doi:10.1093/rheumatology/ken029

Cited by 47 publications

(37 citation statements)

References 78 publications

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“…Dysphagia is reported in up to 90% of patients with systemic sclerosis (SSC) and 20 -84% of inflammatory myopathies, and may occur at any stage during the course of the disease 1 . Patients may experience nasal regurgitation, coughing while swallowing and dysphagia for solids and liquids 2 .…”

Section: Introductionmentioning

confidence: 99%

Recovery from severe dysphagia in systemic sclerosis - myositis overlap: a case report

Chinniah¹,

Mody²

2017

Afr H. Sci.

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Background: Dysphagia is common in inflammatory myopathies and usually responds to corticosteroids. Severe dysphagia requiring feeding by percutaneous endoscopic gastrostomy is associated with significant morbidity and high mortality. Clinical case: A 56-year old African Black woman initially presented with systemic sclerosis (SSC) -myositis overlap and interstitial lung disease. She responded to high dose corticosteroids and cyclophosphamide followed by azathioprine, with improvement in her lung function and regression of the skin changes. Six years later she had a myositis flare with severe dysphagia. Her myositis improved after high doses of corticosteroids, azathioprine and two doses of intravenous immunoglobulin (IVIG). As her dysphagia persisted, she was fed via a percutaneous endoscopic gastrostomy (PEG) tube and given a course of rituximab. Her dysphagia gradually resolved and the PEG tube was removed within two months. She received another dose of rituximab six months later and continued low dose prednisone and azathioprine. Her muscle power improved, weight returned to normal and she remained well 20 months after hospital discharge. Conclusion: Our patient with SSC-myositis overlap and severe dysphagia requiring PEG feeding, improved with high dose corticosteroids, azathioprine, two courses of IVIG and rituximab, and remained in remission 20 months after hospital discharge.

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Section: Introductionmentioning

confidence: 99%

Recovery from severe dysphagia in systemic sclerosis - myositis overlap: a case report

Chinniah¹,

Mody²

2017

Afr H. Sci.

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“…Swallowing disorders are relatively common in pSS and increase with disease severity (40). Both oropharyngeal and esophageal swallowing disorders have been reported in this population, often attributed to sicca of the mouth and throat, loss of dentition, cricoarytenoid joint arthritis, neuropathy, esophageal abnormalities, and gastroesophageal reflux.…”

Section: N Swallowing Disorders Gastrointestinal and Liver Manifestamentioning

confidence: 93%

The clinical spectrum of primary Sjögren’s syndrome: beyond exocrine glands

et al. 2017

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SUMMARYAlthough primary Sjögren's syndrome (pSS) is a mild indolent chronic disease mainly characterized by mucosal dryness in the majority of cases, a consistent subgroup of patients display extra-glandular manifestations. Virtually any organs and systems can be affected, leading to a more serious disease prognosis. Therefore, the prompt identification of patients at higher risk of extra-glandular manifestations is necessary to start a thorough follow up and an aggressive treatment. The aim of this review article is to provide an overview of epidemiological, clinical and serological features of extra-glandular manifestations in pSS as well as current knowledge about putative biomarkers useful in clinical practice. Key words:Sjögren's syndrome; Extra-glandular manifestations; Cardiovascular risk. Reumatismo, 2017; 69 (3): 93-100 n INTRODUCION P rimary Sjögren's syndrome (pSS) is a complex and heterogeneous chronic autoimmune disease primarily characterized by a focal lymphocytic chronic inflammation of exocrine glands leading to progressive loss of secretory function (1). Therefore, the specific case-history of pSS is dominated by signs and symptoms of mucosal dryness. However, although salivary and lachrymal glands represent the main target of pSS, several other organs and systems may be affected during the disease course in at least one third of patients, resulting in a plethora of systemic clinical manifestations, serological abnormalities and complications (2). The most severe complication of pSS is non-Hodgkin lymphoma occurring in about 5% of patients (3) and dramatically worsening disease prognosis. In this regard, the prompt identification of pSS patients with higher risk of developing extraglandular manifestations is mandatory for correct management. Low C3 and C4 levels, cryoglobulins, monoclonal component, anti-Ro/ SSA, anti-La/SSB, rheumatoid factor and hypergammaglobulinaemia represent poor prognostic serological factors in pSS associated with lymphoma and severe extraglandular features (2). Furthermore, histological features such as the presence of germinal centre-like structures in the minor salivary glands have been associated with higher risk of developing lymphoma (4). The purpose of this review article is to discuss current knowledge of extra-glandular manifestations in pSS not secondary to mucosal dryness, excluding pathogenesis and clinical manifestations of lymphoproliferative disorders. n MUSCULOSKELETAL INVOLVEMENTMusculoskeletal manifestations such as myalgia, arthralgia and morning stiffness are present in as many as 90% of patients, while clinically evident arthritis is found in up to 17%. In a recent study conducted on 17 female patients with pSS and 18 patients with secondary SS (sSS), ultrasonography (US) was used to confirm the non-erosive nature of joint involvement in pSS and to discriminate between pSS and RA-associated SS. Synovitis was commonly detected in pSS, mainly in metacarpophalangeal joints (MCP), wrists, and knees. Bone erosions also may occur. Power Doppler signal ...

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“…Poor emptying of the esophagus, immunosuppressive therapy, and acid suppression are also predisposing factors to Candida infection [28, 29]. …”

Section: Sclerodermamentioning

confidence: 99%

“…Although involved, the LES is almost spared, if compared with other autoimmune rheumatic diseases. However, dysphagic symptoms are related to GERD due to abnormal peristalsis in both proximal and distal esophagus [29]. …”

Section: Systemic Lupus Erythematosusmentioning

confidence: 99%

The Videofluorographic Swallowing Study in Rheumatologic Diseases: A Comprehensive Review

Piazza

Vernuccio

Costanzo

et al. 2017

Gastroenterology Research and Practice

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Autoimmune connective tissue diseases are a heterogeneous group of pathologies that affect about 10% of world population with chronic evolution in 20%–80%. Inflammation in autoimmune diseases may lead to serious damage to other organs including the gastrointestinal tract. Gastrointestinal tract involvement in these patients may also due to both a direct action of antibodies against organs and pharmacological therapies. Dysphagia is one of the most important symptom, and it is caused by failure of the swallowing function and may lead to aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction. The videofluorographic swallowing study is a key diagnostic tool in the detection of swallowing disorders, allowing to make an early diagnosis and to reduce the risk of gastrointestinal and pulmonary complications. This technique helps to identify both functional and structural anomalies of the anatomic chain involved in swallowing function. The aim of this review is to systematically analyze the basis of the pathological involvement of the swallowing function for each rheumatological disease and to show the main features of the videofluorographic study that may be encountered in these patients.

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Dysphagia and other manifestations of oesophageal involvement in the musculoskeletal diseases

Cited by 47 publications

References 78 publications

Recovery from severe dysphagia in systemic sclerosis - myositis overlap: a case report

Recovery from severe dysphagia in systemic sclerosis - myositis overlap: a case report

The clinical spectrum of primary Sjögren’s syndrome: beyond exocrine glands

The Videofluorographic Swallowing Study in Rheumatologic Diseases: A Comprehensive Review

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