Systemic sclerosis clinical presentation

Studies by Hawkins et al. (1985) and Nishioka et al. (1987) showed increased numbers of mast cells were present in clinically involved skin in early cutaneous systemic sclerosis but not in later disease. Seibold et al. (1990) however found increased numbers of mast cells in both involved and uninvolved skin in both early and late disease, and also provided evidence of increased mast cell degranulation in early but not late disease, suggesting that increases in mast cell numbers and degranulation precede clinically apparent dermal fibrosis. A study by Falanga and Julien (1990) found elevated H levels in the plasma of patients with systemic sclerosis, providing evidence of mast cell activation. 

COX-2 is constitutively present in the brain, mainly in neurons, and has been shown to play a key role in brain-specific inflammatory episodes linked to the progression of Alzheimer s disease (AD). Epidemiological and clinical studies have observed the influence of NSAID on the evolution of AD, with recent studies showing an inverse correlation between the use of NSAID and the risk of developing AD (Bazan et al., 2002). In the central nervous system, prostanoid levels are normally very low, but they can substantially increase in a variety of pathological conditions such as trauma, ischemia, HIV infection and multiple sclerosis. COX-1 and COX-2 are expressed in the spinal cord. It has been suggested that the antihyperalgesic mechanism of COX-2 inhibitors lies with the modulation of constitutive COX-2 present at the spinal level (S vensson and Yaksh, 2002). 

A comparison of these two diseases in respect to the clinical symptoms may seem impossible at first sight. However, a few details of the syndromes in both diseases may be mentioned. The most evident symptom of toxemia of pregnancy, the elevated blood pressure, is not seen in coronary sclerosis or, at least, not to such an extent. However, according to Brown et oi. (1957), the blood pressure in coronary disease, before infarction has occurred, is slightly raised on an average, compared with that in healthy men of the same age. After the recovery from the acute phase of an infarction, the blood pressure becomes fixed at a lower level than that in the healthy controls. A regulating system to supply the tissues with blood as well as possible is certainly present and substances released from the ischemic and injured tissues must play a role. 

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