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Clinical Rheumatology

, Volume 39, Issue 1, pp 5–8 | Cite as

Systemic sclerosis and urinary symptoms: a complex pathophysiology

  • Gregor JohnEmail author
Perspectives in Rheumatology
Part of the following topical collections:
  1. Updates in Systemic Sclerosis

Abstract

Lower urinary tract symptoms (LUTS) have long been overlooked in systemic sclerosis (SSc). However, they are out of proportion of what would be expected based on age, sex, and presence of usual risk factors. Thus, there must be specific scleroderma-related mechanisms to result in LUTS. Fibrosis, nervous involvement (notably, dysautonomia), early signs of menopauses, and functional restriction play certainly a role, but available evidence shows inconsistent results. Thus, these factors are not sufficient to explain all aspect of LUTS in SSc. In vitro experiments point out a promising alternative mechanism, already observed in other rheumatologic diseases: an antibody-mediated etiology. However, more research is needed to better understand the pathophysiology of LUTS in SSc and develop specific treatment.

Keywords

Antibodies Fibrosis Pathophysiology Systemic sclerosis Urinary incontinence 

Notes

Compliance with ethical standards

Disclosures

None.

References

  1. 1.
    Beigelman PM, Goldner F Jr, Bayles TB (1953) Progressive systemic sclerosis (scleroderma). N Engl J Med 249:45–58CrossRefGoogle Scholar
  2. 2.
    Leinwand I, Duryee AW, Richter MN (1954) Scleroderma; based on a study of over 150 cases. Ann Intern Med 41:1003–1041CrossRefGoogle Scholar
  3. 3.
    John G, Avouac J, Piantoni S, Polito P, Fredi M, Cozzi F et al (2017) Prevalence and disease-specific risk factors for lower urinary tract symptoms in systemic sclerosis: an international multi-centric study. Arthritis Care Res 70:1218–1227CrossRefGoogle Scholar
  4. 4.
    Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S, Coyne K, Kelleher C, Hampel C, Artibani W, Abrams P (2006) Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 50:1306–1314CrossRefGoogle Scholar
  5. 5.
    Zigman JYJ, Trinidad J, Yazdany T (2017) Scleroderma and pelvic organ prolapse: a multidisciplinary approach to patient care and surgical planning. J Gynecol Surg 33:198–201.  https://doi.org/10.1089/gyn.2017.0014 CrossRefGoogle Scholar
  6. 6.
    La Civita L, Fiorentini L, Tognetti A, Pasero G, Ferri C (1998) Severe urinary bladder involvement in systemic sclerosis. Case report and review of the literature. Clin Exp Rheumatol 16:591–593PubMedGoogle Scholar
  7. 7.
    Minervini R, Morelli G, Minervini A, Pampaloni S, Tognetti A, Fiorentini L, Ciompi ML (1998) Bladder involvement in systemic sclerosis: urodynamic and histological evaluation in 23 patients. Eur Urol 34:47–52CrossRefGoogle Scholar
  8. 8.
    Gong R, Xia Z (2019) Collagen changes in pelvic support tissues in women with pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol 234:185–189CrossRefGoogle Scholar
  9. 9.
    Bertinotti L, Bracci S, Nacci F, Colangelo N, Del Rosso A, Casale R et al (2004) The autonomic nervous system in systemic sclerosis. A review. Clin Rheumatol 23:1–5CrossRefGoogle Scholar
  10. 10.
    Lazzeri M, Beneforti P, Benaim G, Corsi C, Ciambrone V, Marrapodi E, Mincione G, Turini D (1995) Vesical dysfunction in systemic sclerosis (scleroderma). J Urol 153:1184–1187CrossRefGoogle Scholar
  11. 11.
    Raz S, Boxer R, Waisman J, Sukov RJ (1977) Scleroderma of lower urinary tract. Urology 9:682–683CrossRefGoogle Scholar
  12. 12.
    Singh J, Mehendiratta V, Del Galdo F, Jimenez SA, Cohen S, DiMarino AJ et al (2009) Immunoglobulins from scleroderma patients inhibit the muscarinic receptor activation in internal anal sphincter smooth muscle cells. Am J Physiol Gastrointest Liver Physiol 297:G1206–G1213CrossRefGoogle Scholar
  13. 13.
    Wang F, Jackson MW, Maughan V, Cavill D, Smith AJ, Waterman SA, Gordon TP (2004) Passive transfer of Sjogren’s syndrome IgG produces the pathophysiology of overactive bladder. Arthritis Rheum 50:3637–3645CrossRefGoogle Scholar
  14. 14.
    John G, Allanore Y, Polito P, Piantoni S, Fredi M, Avouac J, Franceschini F, Truchetet ME, Cozzi F, Airo P, Chizzolini C (2017) The limited cutaneous form of systemic sclerosis is associated with urinary incontinence: an international multicentre study. Rheumatology (Oxford) 56:1874–1883CrossRefGoogle Scholar
  15. 15.
    Motegi SI, Sekiguchi A, Sekine Y, Nakayama H, Suzuki K, Ishikawa O (2019) Prevalence and clinical characteristics of over-active bladder in systemic sclerosis. Mod Rheumatol 5:1–5.  https://doi.org/10.1080/14397595.2019.1589913
  16. 16.
    Kucharz EJ, Jonderko G, Rubisz-Brzezinska J, Konca A, Jarczyk R (1996) Premictional volume and contractility of the urinary bladder in patients with systemic sclerosis. Clin Rheumatol 15:118–120CrossRefGoogle Scholar
  17. 17.
    Kondo A, Susset JG (1974) Viscoelastic properties of bladder II. Comparative studies in normal and pathologic dogs. Investig Urol 11:459–465Google Scholar
  18. 18.
    Susset JG, Servot-Viguier D, Lamy F, Madernas P, Black R (1978) Collagen in 155 human bladders. Investig Urol 16:204–206Google Scholar
  19. 19.
    D'Angelo WA, Fries JF, Masi AT, Shulman LE (1969) Pathologic observations in systemic sclerosis (scleroderma). A study of fifty-eight autopsy cases and fifty-eight matched controls. Am J Med 46:428–440CrossRefGoogle Scholar
  20. 20.
    Comperat E, Reitz A, Delcourt A, Capron F, Denys P, Chartier-Kastler E (2006) Histologic features in the urinary bladder wall affected from neurogenic overactivity--a comparison of inflammation, oedema and fibrosis with and without injection of botulinum toxin type A. Eur Urol 50:1058–1064CrossRefGoogle Scholar
  21. 21.
    Thoua NM, Abdel-Halim M, Forbes A, Denton CP, Emmanuel AV (2012) Fecal incontinence in systemic sclerosis is secondary to neuropathy. Am J Gastroenterol 107:597–603CrossRefGoogle Scholar
  22. 22.
    Fetscher C, Fleichman M, Schmidt M, Krege S, Michel MC (2002) M(3) muscarinic receptors mediate contraction of human urinary bladder. Br J Pharmacol 136:641–643CrossRefGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  1. 1.Department of Internal MedicineHôpital neuchâteloisNeuchâtelSwitzerland
  2. 2.Department of Internal MedicineGeneva University Hospitals (HUG)GenevaSwitzerland
  3. 3.Geneva UniversityGenevaSwitzerland

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