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Part of the book series: Current Molecular Medicine ((CMM,volume 1))

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Abstract

Systemic sclerosis (SSc) or scleroderma is an autoimmune connective tissue disease of as-yet unknown etiology. Clinically, SSc is one of a group of illnesses that represent a spectrum of inflammatory and fibrotic diseases with related features. These other disorders include eosinophilia myalgia syndrome, toxic oil syndrome, eosinophilic fasciitis, morphea, and linear scleroderma (reviewed in ref. 1). SSc is now generally divided into two major clinical subsets: limited SSc and diffuse SSc, based on the extent of skin involvement. Diffuse SSc involves the skin proximal to the elbow or knee and frequently involves the trunk, whereas limited SSc involves skin of the hands, forearms, legs below the knees, and face. The course and prognosis are quite variable from patient to patient and are related to disease subset, with diffuse disease having a worse prognosis. The overall mortality of SSc is reported to be 50% at 10 yr (2).

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References

  1. Varga, J. and Kahari, V. (1997) Eosinophilia—myalgia syndrome, eosinophilic fasciitis, and related fibrosing disorders. Curr. Opin. Rheum. 9, 562–570.

    Article  CAS  Google Scholar 

  2. Silman, A. J. (1991) Epidemiology of scleroderma. Ann. Rheum. Dis. 50, 846–853.

    Article  PubMed  Google Scholar 

  3. Medsger, T. A., Jr. and Steen, V. D. (1996) Classification, prognosis, in Systemic Sclerosis (Clements, P. J. and Furst, D. E., eds.), Williams & Wilkins, Baltimore, MD, pp. 51–64.

    Google Scholar 

  4. Fleischmajer, R., Perlish, J. S., and Reeves, J. R. T. (1976) Cellular infiltrates in scleroderma skin. Arthritis Rheum. 20, 975–984.

    Article  Google Scholar 

  5. Roumm, A. D., Whiteside, T. L., Medsger, T. A., Jr., and Rodnan, G. P. (1984) Lymphocytes in the skin of patients with systemic sclerosis: quantification, subtyping, and clinical correlations. Arthritis Rheum. 27, 645–653.

    Article  PubMed  CAS  Google Scholar 

  6. Kahaleh, M. B. and Fan P. (1997) Mechanism of serum-mediated endothelial injury in scleroderma: identification of a granular enzyme in scleroderma skin and sera. Clin. Immunol. Immunopathol. 83, 32–40.

    Article  PubMed  CAS  Google Scholar 

  7. Wigley, F. M. (1996) Raynaud’s phenomenon and other features of scleroderma, including pulmonary hypertension. Curr. Opin. Rheum. 8, 561–568.

    Article  CAS  Google Scholar 

  8. Stein, C. M., Tanner, S. B., Awad, J. A., Roberts, L. J., and Morrow, J. (1996) Evidence of free radical-mediated injury (Isoprostane overproduction) in scleroderma. Arthritis Rheum. 39, 1146–1150.

    Article  PubMed  CAS  Google Scholar 

  9. Yamane, K., Miyauchi, T., Suzuki, N., Yuhara, T., Akama, T., Suzuki, H., et al. (1992) Significance of plasma endothelin-1 levels in patients with systemic sclerosis. J. Rheum. 19, 1566–1571.

    PubMed  CAS  Google Scholar 

  10. Kahaleh, M. B. (1995) The vascular endothelium in scleroderma. Int. Rev. Immunol. 12, 227–245.

    Article  PubMed  CAS  Google Scholar 

  11. Yamamoto, T., Katayama, I., and Nishioka, K. (1998) Nitric oxide production and inducible nitric oxide synthase expression in systemic sclerosis. J. Rheum. 25, 314–317.

    PubMed  CAS  Google Scholar 

  12. Kahaleh, B. and Matucci-Cerinic, M. (1995) Raynaud’s phenomenon and scleroderma: dysregulated neuroendothelial control of vascular tone. Arthritis Rheum. 38, 1–4.

    Article  PubMed  CAS  Google Scholar 

  13. Kuwana, M., Medsger, T. A., Jr., and Wright, T. M. (1995) T-B cell collaboration is essential for the autoantibody response to DNA topoisomerase I in systemic sclerosis. J. Immunol. 155, 2703–2714.

    PubMed  CAS  Google Scholar 

  14. Lee, B. and Craft, J. E. (1995) Molecular structure and function of autoantigens in systemic sclerosis. Int. Rev. Immunol. 12, 129–144.

    Article  PubMed  CAS  Google Scholar 

  15. Rosen, A., Casciola-Rosen, L., and Wigley, F. (1997) Role of metal-catalyzed oxidation reactions in the early pathogenesis of scleroderma. Curr. Opin. Rheum. 9, 538–543.

    Article  CAS  Google Scholar 

  16. Nelson, J. L. (1998) Microchimerism and the pathogenesis of systemic sclerosis. Curr. Opin. Rheum. 10, 564–571.

    Article  CAS  Google Scholar 

  17. Artlett, C. M., Smith, J. B., and Jimenez, S. A. (1998) Identification of fetal DNA and cells in skin lesions from women with systemic sclerosis. N. Engl. J. Med. 338, 1186–1191.

    Article  PubMed  CAS  Google Scholar 

  18. Kuwana, M., Medsger, T. A., Jr., and Wright, T. M. (1995) T cell proliferative response induced by DNA topoisomerase I in patients with systemic sclerosis and healthy donors. J. Clin. Invest. 96, 586–596.

    Article  PubMed  CAS  Google Scholar 

  19. Yurovsky, V. V., Wigley, F. M., Wise, R. A., and White, B. (1996) Skewing of the CD8+ T-cell repertoire in the lungs of patients with systemic sclerosis. Hum. Immunol. 48, 84–97.

    Article  PubMed  CAS  Google Scholar 

  20. Kuwana, M., Medsger, T. A., Jr., and Wright, T. M. (1997) Highly restricted TCR α/β usage by autoreactive human T cell clones specific for DNA topoisomerase I: recognition of an immunodominant epitope. J. Immunol. 158, 485–491.

    PubMed  CAS  Google Scholar 

  21. Kuwana, M., Medsger, T. A. Jr., and Wright, T. M. (2000) Analysis of soluble and cell surface factors regulating anti-DNA topoisomerase I autoantibody production demonstrates synergy between Th 1 and Th2 autoreactive T cells. J. Immunol., in Press.

    Google Scholar 

  22. Varga, J. and Bashey, R. I. (1995) Regulation of connective tissue synthesis in systemic sclerosis. Int. Rev. Immunol. 12, 187–199.

    Article  PubMed  CAS  Google Scholar 

  23. Hawkins, R. A., Claman, H. N., Clark, R. A., and Steigerwald, J. C. (1985) Increased dermal mast cell populations in progressive systemic sclerosis: a link in chronic fibrosis? Ann. Intern. Med. 102, 182–186.

    PubMed  CAS  Google Scholar 

  24. Postlethwaite, A. E. (1995) Role of T cells and cytokines in effecting fibrosis. Int. Rev. Immunol. 12, 247–258.

    Article  PubMed  CAS  Google Scholar 

  25. Gruber, B. L. (1995) Mast cells: accessory cells which potentiate fibrosis. Int. Rev. Immunol. 12, 259–279.

    Article  PubMed  CAS  Google Scholar 

  26. LeRoy, E. C. (1974) Increased collagen synthesis by scleroderma skin fibroblasts in vitro: a possible defect in the regulation or activation of the scleroderma fibroblast. J. Clin. Invest.54, 880–889.

    Article  PubMed  CAS  Google Scholar 

  27. Buckingham, R. B., Prince, R. K., Rodnan, G. P., and Taylor, F. (1978) Increased collagen accumulation in dermal fibroblast cultures from patients with progressive systemic sclerosis (scleroderma). J. Lab. Clin. Med. 92, 5–21.

    PubMed  CAS  Google Scholar 

  28. Silver, R. M. (1995) Interstitial lung disease of systemic sclerosis. Int. Rev. Immunol. 12, 281–291.

    Article  PubMed  CAS  Google Scholar 

  29. Igarashi, A., Nashiro, K., Kikuchi, K., Sato, S., Ihn, H., Fujimoto, M., et al. (1996) Connective tissue growth factor gene expression in tissue sections from localized scleroderma, keloid, and other fibrotic skin disorders. J. Invest. Dermatol. 106, 729–733.

    Article  PubMed  CAS  Google Scholar 

  30. Kawaguchi, Y., Hara, M., and Wright, T. M. (1999) Endogenous IL-1α from systemic sclerosis fibroblasts induces IL-6 and PDGF-A. J. Clin. Invest. 103, 1253–1260.

    Article  PubMed  CAS  Google Scholar 

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© 2000 Springer Science+Business Media New York

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Wright, T.M. (2000). Systemic Sclerosis. In: Tsokos, G.C. (eds) Principles of Molecular Rheumatology. Current Molecular Medicine, vol 1. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-018-6_23

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  • DOI: https://doi.org/10.1007/978-1-59259-018-6_23

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61737-182-0

  • Online ISBN: 978-1-59259-018-6

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