ABSTRACT
OBJECTIVES: The aim of this study was to assess the overall prevalence of pulmonary hypertension (PH) in an unselected MCTD cohort and review the current knowledge with a systematic database search. METHODS: A nationwide multicentre cohort of 147 adult MCTD patients were initially screened for PH by echocardiography, high-resolution computed tomography (HRCT), pulmonary function tests and N-terminal pro-brain natriuretic peptide (NT-proBNP) and then followed up for a mean of 5.6 years. Right-sided heart catheterization was performed when estimated pulmonary artery systolic pressure was >40 mmHg on echocardiography. PH was diagnosed according to the 2009 European Society of Cardiology and European Respiratory Society guidelines. RESULTS: At inclusion, 2.0% (3/147) had established PH. Two additional PH patients were identified during follow-up, giving a total PH frequency in the cohort of 3.4% (5/147). All five had elevated serum NT-proBNP. Two had isolated pulmonary arterial hypertension (PAH) and three PH associated with interstitial lung disease (PH-ILD). Three PH patients died during follow-up. Nine other patients in the cohort also died, but none of them had echocardiographic signs of PH prior to death. CONCLUSION: The data from the current unselected MCTD cohort suggest that the prevalence of PH is much lower than expected from previous studies but confirm the seriousness of the disease complication.
Subject(s)
Hypertension, Pulmonary/epidemiology , Mixed Connective Tissue Disease/epidemiology , Adult , Cohort Studies , Cross-Sectional Studies , Echocardiography , Female , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Male , Norway/epidemiology , Prevalence , Tomography, X-Ray Computed/methodsABSTRACT
BACKGROUND: Mixed connective tissue disease (MCTD) is an immune-mediated, systemic disorder of unknown cause. OBJECTIVE: To assess the prevalence, pattern and severity of interstitial lung disease (ILD) in a cross-sectional study of the nationwide, Norwegian MCTD cohort. METHODS: 126 patients with MCTD were systematically examined for ILD by high-resolution CT (HRCT), pulmonary function tests (PFT), 6 min walk test (6MWT) and by the New York Heart Association (NYHA) functional classification of dyspnoea. The extent and type of HRCT lung abnormalities were scored according to the CT criteria of ILD recommended by the Fleischner Society. RESULTS: All 126 patients were Caucasian, 75% women. At the time of the cross-sectional ILD study, the patients had a mean disease duration of 9.0 years. 52% of the patients had abnormal HRCT findings, most commonly reticular patterns consistent with lung fibrosis (35%). Lung fibrosis was quantified as minor in 7%, moderate in 9% and severe in 19% of the patients. Fibrosis was uniformly concentrated in the lower parts of the lungs and was not associated with smoking. Patients with severe lung fibrosis had lower PFT values, shorter 6MWT and a higher mean NYHA functional class. After a mean 4.2 years' follow-up, overall mortality was 7.9%. Mortality in patients with normal HRCT was 3.3%, as compared with 20.8% in patients with severe lung fibrosis (p<0.01). CONCLUSIONS: Severe lung fibrosis is common in MCTD, has an impact on pulmonary function and overall physical capacity and is associated with increased mortality.
Subject(s)
Lung Diseases, Interstitial/mortality , Lung Diseases, Interstitial/physiopathology , Mixed Connective Tissue Disease/mortality , Mixed Connective Tissue Disease/physiopathology , Severity of Illness Index , Adult , Cohort Studies , Cross-Sectional Studies , Female , Follow-Up Studies , Humans , Lung Diseases, Interstitial/pathology , Male , Middle Aged , Mixed Connective Tissue Disease/pathology , Motor Activity , Norway/epidemiology , Prevalence , Pulmonary Fibrosis/mortality , Pulmonary Fibrosis/pathology , Pulmonary Fibrosis/physiopathologyABSTRACT
BACKGROUND: Temporal arteritis is a systemic granulomatous vasculitis affecting large and medium sized arteries. Scalp necrosis is a rare complication that can appear before, during and after treatment. MATERIAL AND METHODS: A patient with temporal arteritis and scalp necrosis is presented and relevant literature reviewed. RESULTS: Scalp necrosis is seen in a few patients with temporal arteritis. The skin manifestations are most often bilaterally distributed and localised to the frontal, parietal and temporal parts of the scalp. Scalp necrosis often signifies a severe and extensive vasculitis, and is therefore associated with a high incidence of other disease-related complications, among them visual disturbances and blindness. CONCLUSION: Awareness of scalp necrosis as a complication of temporal arteritis could reduce unnecessary time-consuming assessments and lead to a more rapid diagnosis and start of treatment.
