News Rheum - Vol 4 No 1 - July 2023

Introduction

Scleroderma, more than skin deep

Systemic sclerosis (SSc) or scleroderma is a rare systemic autoimmune rheumatic disorder characterised by fibrosis, vasculopathy and inflammation of the skin and internal organs, notably the lungs, kidneys and gastrointestinal tract. Known to occur in all populations worldwide, the prevalence varies with the highest prevalence in Choctaw Indians of North America.

The cardiologist on diagnosing and managing pulmonary arterial hypertension in the connective tissue diseases.

What is the role of echocardiography in connective tissue disease (CTD)-associated pulmonary hypertension (PH)?

In general, echocardiography is a tremendously valuable imaging modality in patients with PH. Not only is it the only non-invasive method of detecting and semi-quantitatively measuring the severity of PH, it also offers the opportunity of determining the aetiology of the disease and the impact on right ventricular function.

Battling burnout - basic needs, breathing and finding balance

Healthcare workers face overwhelming challenges in their work environment such as long work hours, bed pressures, increased sense of responsibility and exposure to human suffering and death. This puts them at increased risk of mental health problems including burnout, depression, anxiety, substance use disorders and suicide.

Time wasted, lung lost!

The clinical course of interstitial lung disease (ILD) varies from clinically insignificant to severe and fatal. An analysis conducted over a 12-year period of 940 deaths in systemic sclerosis (SSc) patients from the EUSTAR registry showed that ILD was the most common cause of death (16.8%). This article will focus on the early diagnosis of ILD in SSc. Some general principles will apply to ILD in other rheumatic diseases.

“HAD” we known... A reminder of the triad of Haemoptysis, Aanaemia and Dyspnoea

Updated epidemiological studies of the systemic vasculitides demonstrate increasing incidence rates for all AAV and an increase in peak age at diagnosis.

The most feared, diffuse alveolar haemorrhage (DAH), has both immune and non-immune causes. Immune mediated pulmonary vasculitis ranges from asymptomatic clinical presentation with only radiological abnormalities, to catastrophic respiratory failure requiring mechanical ventilation. In hospital mortality of DAH from any cause is reported between 20-100% but noted to be higher in immune mediated diseases.