Efficacy of anorectal biofeedback in scleroderma patients with fecal incontinence: a case–control study

Objective: To determine whether anorectal biofeedback therapy can improve the symptoms of fecal incontinence (FI) in patients with scleroderma when compared to patients with functional FI, and also whether there is any effect on anorectal physiology or quality of life (QOL). FI in patients with scleroderma is highly prevalent and is associated with significant loss of QOL. Biofeedback has been proven to be an effective treatment for functional FI, but there are no data to support its use in scleroderma.

Materials and methods: 13 consecutive female patients (median age 59, IQR 47–65 years) with scleroderma, and 26 age- and parity-matched female patients with functional FI (disease controls, 2:1), underwent biofeedback therapy for management of FI. Fecal incontinence severity index (FISI), anorectal physiology, feeling of control and QOL were collected before and after 6 weeks of biofeedback therapy, with additional scoring repeated at 6-month follow-up.

Results: After biofeedback treatment FISI, feeling of control and QOL significantly improved in both groups (p?scleroderma patients and functional FI patients. Long-term improvement in FISI and control were seen in both groups and for QOL only in the scleroderma cohort (p?Conclusions: Patients with scleroderma benefit from biofeedback therapy to the same extent as that achieved in patients with functional FI. There are significant improvements in symptoms, physiology and QOL. Biofeedback is an effective, low-risk treatment option in this patient group.     

Three cases of bullous morphea: histopathologic findings with implications regarding pathogenesis

Bullous morphea is a rare variant and is not frequently reported. We present three cases of bullous morphea. Although lymphangiectases have been suggested as the most likely mechanism for the development of the bullae in cases of morphea, none of the cases presented with lymphangiectases. To the contrary, all of our cases showed hemorrhagic content in the bullae, which suggests local trauma as a mechanism involved in bulla formation.     

Factors related to oral hygiene in persons with scleroderma

Objectives: The purpose of this study was to assess potential risk factors for the development of poor oral hygiene and increased dental caries in individuals with scleroderma. Methods: Twenty‐two subjects with scleroderma participated in this study. All subjects were examined with the Patient Hygiene Performance (PHP) Index, which assesses the extent of plaque and debris over a tooth surface. In addition, oral aperature, xerostomia and dominant upper extremity strength, motion, skin thickness, and dexterity were measured. Results: None of the subjects had good or excellent hygiene. Fifteen subjects had fair oral hygiene and seven subjects had poor oral hygiene as measured by the PHP Index. Significant differences were seen between these two groups for oral aperture, percentage of teeth with caries, skin thickness, dexterity and finger flexion. Dexterity and joint motion correlated significantly with the number of decayed surfaces and number of caries. Oral aperture correlated with the PHP Index and the number of dental caries. Conclusions: Subjects with poor oral hygiene required more time to complete manual dexterity task and had decreased hand strength and joint motion. Moreover, these same subjects had more contractures, scars, ulcers, and higher skin scores (more disease activity) than subjects in the fair hygiene group. In addition to frequent dental exam and routine cleaning, dental personnel may want to consider exercises to increase oral aperature and investigate toothbrush and dental floss selection used by persons with scleroderma.     

Periodontal status of adults with systemic sclerosis: case-control study

Background: Systemic sclerosis (SSc) is a systemic autoimmune disease that affects connective tissue in the skin, blood vessels, and major organs of the body. This project aims to compare the periodontal status of dentate Hong Kong Chinese with and without SSc. Methods: Thirty‐six non‐smoking adults with SSc (one male and 35 females: aged 50.6 ± 11.7 years; free from Sjögren syndrome) attending a teaching hospital were age‐ and sex‐matched to systemically healthy controls attending a dental hospital. Both groups had similar demographic characteristics but a lower proportion of patients with SSc were working or studying (P <0.05). Twenty‐three (32%) of all participants were regular dental attendees. Orthopantomogram radiographs were taken. Participants were surveyed and periodontally examined. Results: Both groups had a similar number of erupted teeth, proportion of sites with detectable plaque, and mean full‐mouth clinical attachment level, whereas controls had less bleeding on probing (49.3% ± 22.6% versus 78.4% ± 19.6%; P <0.001) and a shallower mean full‐mouth probing depth (1.92 ± 0.44 mm versus 2.52 ± 0.58 mm; P <0.001). Radiographically, patients with SSc had wider periodontal ligament spaces (0.36 ± 0.06 mm versus 0.33 ± 0.03 mm; P <0.01). Conclusions: Hong Kong Chinese adults with SSc seem to exhibit higher levels of periodontal inflammation and wider radiographic periodontal ligament spaces than age‐ and sex‐matched controls. Future studies are warranted to further investigate any associations between these periodontal features and SSc.     

温肾健脾汤联合背俞穴针刺对脾肾阳虚型系统性硬皮病的效果

目的探讨自拟温肾健脾汤联合背俞穴针刺对脾肾阳虚型系统性硬皮病的效果分析。方法选取2018年1月—2019年1月在辽宁省大连市大连市中医医院针灸门诊的80例脾肾阳虚型系统性硬皮病患者,随机分为试验组和对照组。对2组患者采用临床常规的治疗方法,对照组40例系统性硬皮病患者采用临床常规口服D-青霉胺治疗;试验组40例系统性硬皮病患者采用自拟温肾健脾汤联合背俞穴针刺治疗方法,比较2组患者治疗后的临床有效率和2组患者血清抗核抗体谱、血清抗着丝点抗体转阴累积人数。结果试验组患者治疗后临床总有效率高于对照组患者,差异有统计学意义(P<0.05);试验组患者治疗后血清抗核抗体谱、血清抗着丝点抗体转阴人数多于对照组患者,差异有统计学意义(P<0.05)。结论对脾肾阳虚型系统性硬皮病患者采取自拟温肾健脾汤联合背俞穴针刺进行治疗的临床效果较好,可以增加系统性硬皮病患者疗效,值得推广。     

Localized scleroderma and regional inflammatory myopathy

Inflammatory myopathy is rare in localized scleroderma. We report 2 new cases of regional inflammatory myopathy associated with localized scleroderma and review 10 reported cases of localized scleroderma associated with an inflammatory myopathy with regional muscle involvement, more often in the upper extremities. Serum creatine kinase was mildly elevated or normal. Histopathology often showed perimysial inflammation and plasma cell infiltration. These cases demonstrate that inflammatory myopathy should be considered in patients with localized scleroderma and regional muscle weakness, pain or atrophy. Muscle biopsy can confirm the diagnosis of myositis, which if identified, will require anti-inflammatory and/or immunosuppressive therapy.