Systemic Sclerosis, Raynauds and Lupus

Attended the Systemic Sclerosis, Raynauds and Lupus CME by Hamilton Scleroderma Group
at Sheraton on Friday, 27 September 2013. I missed the panel discussions in the morning. This was my first CME in North America.

Clinical appearence of acrosclerotic piece-mea...
Clinical appearence of acrosclerotic piece-meal necrosis of the first digit in a patient with systemic sclerosis. (Photo credit: Wikipedia)

The take home message from Dr. Michael Walsh’s talk on Scleroderma Renal Crisis was the adage “Time is Kidney”. He also stressed the need to be cautious about the use of Steroids when a renal involvement is suspected/expected. My memories of SS management dates back to the late nineties, when we (mostly in India) used to consider dexamethasone pulse therapy as the gold standard for treatment of Diffuse cutaneous systemic sclerosis (dcSSc). Are there any renal involvement prediction algorithms in SSc?

Dr Rebecca Amer spoke about the various types of Pulmonary Hypertensions and the risk factors. As we dermatologists are aware, PH is more common in the limited cutaneous type of SSc. However the highlight of her talk was the importance of right heart catheterization (RHC) in the severity assessment.

English: Pulmonary fibrosis induced by amiodarone.
English: Pulmonary fibrosis induced by amiodarone. (Photo credit: Wikipedia)

Prof. Gerard Cox gave a very entertaining and thought provoking talk on pulmonary fibrosis. The take home message from his talk was “treat only if necessary”. He also highlighted the paradox of honeycombing being a better prognostic indicator in SSc induced pulmonary fibrosis. He also stressed the role of methotrexate (MTX) as a causative agent of pulmonary fibrosis. In India MTX is extensively used by dermatologists for the treatment of psoriasis and its complications, but pulmonary fibrosis is not very frequent. Unfortunately he did not comment on the theories of fibrosis, one of my areas of interest. I have started a mindmap for fibrosis here. Take a look and please contribute if you can.

Bell Eapen
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About Bell Eapen 247 Articles
Techie Dermatologist, Information Systems PhD, Supporter of Open-Source Software, Machine Learning and AI geek, loves cricket, Canadian wine and beer. [Resume]

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