Scleroderma is an autoimmune disease of a rheumatological nature that belongs to the group of connective tissue diseases or collagenosis (collagen involvement); characterized by skin disorders, blood vessels, and various internal organs. It usually causes swelling and pain in the muscles and joints.
Can Scleroderma Go Away?
There are medications that slow the progression of the scleroderma disease and help control its symptoms, but at present, scleroderma has no cure and spot cannot go away. It is worth mentioning that the collagen produced in excess interferes with normal functioning and sometimes generates organic insufficiency. However, in many cases, the process goes into remission after some years of activity.
Scleroderma is a serious disease that can evolve in three distinct ways, the localized form, the limited and the diffuse. Common to the last two is Raynaud’s Syndrome, a condition that consists of the appearance of circulatory disorders triggered by the cold, with pallor, paresthesia (tingling sensation of a limb), coldness and cyanosis (bluish coloration), caused by spasms in the capillaries, and subsequent flushing, caused by a phase of reactive hypothermia, on the fingers and, in a lesser degree, the feet. Joint signs are also common, with polyarthralgia or arthritis. Raynaud syndrome is more frequent in patients whose serological study shows positivity for the anti-RNP antibody (characteristic of the mixed connective tissue disease).
Localized scleroderma is normally circumscribed to some places on the skin. It occurs most often in children and young people. Two main types of Scleroderma are known: Morphea (with patches of bulging skin and increased or decreased pigmentation) and Linear Scleroderma (band or line of bulging skin that appears on legs and arms, and can also affect the subcutaneous tissue and the muscle below). This form is the least severe and remissions are often observed after a long evolution.
Slowly progressing systemic scleroderma is characterized because pulmonary fibrosis does not occur initially, kidney involvement is rare, and a good number of patients have detectable anticentromere antibodies. Raynaud’s syndrome can occur many years before skin involvement. The skin involvement is limited to the distal part of the limbs (up to the elbows and/or knees) and to the face. It includes the CREST syndrome (Calcinosis, Raynaud, Esophagus, Sclerodactyly, Telangiectasia) and all its variants. It also includes Systemic Scleroderma without skin involvement, the so-called Sine Scleroderma.
Diffuse Systemic Scleroderma, progressing much faster, is more serious than the previous one. Raynaud’s Syndrome begins before one year after skin involvement, pulmonary fibrosis is early, there is kidney disease characterized by the so-called scleroderma renal crisis, which is associated with high blood pressure: Between 20 and 30% of patients with this type of Scleroderma have anti-Scl 70 antibodies (Antitopoisomerase I). It is vitally important to monitor the lung, kidney, and heart for their progressive evolution to insufficiencies or severe conditions.
The diagnosis can be difficult, particularly in the early stages, because many of the symptoms are very common and require differentiation with other diseases, especially connective tissue, such as systemic lupus erythematosus. In addition, different symptoms can develop in stages over a long period, and few people experience exactly the same symptoms and effects.
The biological aspect barely shows anything. Erythrocyte sedimentation rate (ESR) may be high, but it is inconstant. The most obvious signs are some characteristic antinuclear antibodies. For the evaluation, several tests are necessary: total skin score, capillaroscopy, chest X-ray, EKG, high-resolution CT, respiratory tests, CO diffusion, echocardiogram with Doppler, esophagogram, creatinine clearance, proteinuria, ANA study, etc. All forms seem related to HLA-DR3 and HLA-DR5.
For its treatment, immunosuppressants, azathioprine, cyclosporine, methotrexate, cyclophosphamide, D-penicillamine, and several other specific drugs are used, depending on the affected organs and their severity.
Multiple cases of systemic scleroderma (and less frequently, rheumatoid arthritis, undifferentiated disease and polymyositis-dermatomyositis) have been described after silicone implants. The majority of the patients present a non-specific clinical presentation of fatigue, arthralgias, dry syndrome and Fibromyalgia. The usual treatment is to remove the prosthesis, although the results are variable, from the complete disappearance of the symptoms to the reactivation of the disease.
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