10 Facts About Scleroderma

Kristine Cruz-Munda is a scleroderma patient who shares her story living with this autoimmune skin condition. Video courtesy of CBS LA.

According to the Scleroderma Foundation, scleroderma is a chronic connective tissue disease, and is generally classified as a rheumatic autoimmune disease. In patients with scleroderma, the body over-produces collagen, reacting as if there were an injury needing repair. This over-production of collagen prevents various organs in the body from functioning normally.

While this condition is poorly understood, there is some information about the disease that we do know. Read on to learn 10 facts about scleroderma.

1. Scleroderma is more common than you think

It’s estimated that 300,000 Americans live with scleroderma. Of these 300,000 patients, approximately 1/3 live with the systemic form of the disease. However, it’s possible that the number of scleroderma patients is actually much higher, since diagnosing this skin condition can be difficult, as the disorder bears a lot of similarities to other autoimmune diseases, such as polymyositis.

2. Localized scleroderma is the first main type

The two main types of scleroderma are localized and systemic. With localized scleroderma, symptoms such as skin thickening and collagen overproduction are limited to a few places on the skin or muscles, and internal organs are usually not affected. In general, localized scleroderma is relatively mild and rarely develops into systemic scleroderma.

Morphea and linear scleroderma are two sub-classifications of this form of the disease, which appear as patches or streaks on the skin, respectively.

3. Systemic scleroderma is the second main type

In contrast to localized scleroderma, systemic scleroderma affects the connective tissue in many parts of the body, including the skin, esophagus, gastrointestinal tract (stomach and bowels), lungs, kidneys, heart, and other internal organs. It can even impact blood vessels, muscles, and joints. These tissues become hard and fibrous, which decreases their function.

There are two sub-classifications of systemic scleroderma – diffuse and limited. Diffuse scleroderma results in a rapid skin thickening across a larger portion of the skin. Patients with this form of the disease have more internal organ involvement as well. Conversely, limited scleroderma occurs when the skin thickening is less widespread, and is usually confined to the fingers, hands and face. It tends to develop slowly over time.

4. Limited scleroderma is also called CREST syndrome

Limited scleroderma is sometimes referred to as CREST syndrome, an acronym which stands for the different symptoms this condition causes:

  • Calcinosis – an accumulation of calcium deposits under the skin, which may cause pain
  • Raynaud’s – a phenomenon in which small arteries that supply blood to the skin constrict excessively in response to cold, limiting blood supply to one’s fingers and toes and changing their color
  • Esophageal dysfunction – a stiffening of the gastrointestinal tract muscles, resulting in reflux and indigestion
  • Sclerodactyly – the hardening of the skin on one’s fingers and/or toes
  • Telangiectasias – round, red spots on the skin’s surface as a result of widened small blood vessels

5. Scleroderma can affect one’s lungs

Pulmonary symptoms can occur in patients with systemic scleroderma. For example, patients may develop pulmonary hypertension, a condition in which the lung’s blood vessels narrow, which results in impaired blood flow in the lungs. This, in turn, causes shortness of breath.

6. Your gender, age, ethnicity and genetics may play a role

Scleroderma affects women up to three to four times more frequently than their male counterparts. According to the Mayo Clinic, the condition most commonly occurs between the ages of 30 and 50, although children can also develop the disease. One’s ethnic background may also influence the risk of developing the disease, the age of onset, and the severity of one’s symptoms. Although it’s believed that genetics play a role in the development of scleroderma, genetic factors are thought to only predispose a person to the disease, rather than cause it.

7. Other autoimmune issues may co-occur

Since scleroderma is an autoimmune disease, it may occur in conjunction with other autoimmune issues. According to the Mayo Clinic, between 15-20% of scleroderma patients have another autoimmune disease, such as rheumatoid arthritis, lupus or Sjogren’s syndrome. This is why it’s important for patients to get evaluated for other potential co-morbidities as well.

8. There is no cure, but treatments do exist

While there is no known cure for scleroderma, treatment options do exist to help patients manage their symptoms and to prevent further complications of the disease. For example, your doctor may prescribe steroids to help you cope with skin symptoms. Blood pressure medications may also be used to treat Raynaud’s phenomenon. Anti-acids and antibiotics can help reduce digestive issues and prevent infections. Immunosuppressants may be prescribed to reduce overactivity of your immune system and to decrease damaging inflammation. And finally, pain medications may also be used to decrease pain if over-the-counter pain medications aren’t effective enough.

9. Surgery may be necessary

In extreme cases, surgery may be required for certain scleroderma patients. For example, patients with severe Raynaud’s phenomenon in their fingers or toes may have tissues that die off or develop painful sores; consequently, amputation of these tissues may be required. Also, in patients with heavy lung involvement, a lung transplant may be necessary to help the patient breathe.

10. Scleroderma support groups are here to help

The Scleroderma Foundation offers numerous local chapters and support groups, designed to help patients connect with others living with the disease. These support groups provide a forum to share feelings, concerns, information with others, and act as a place to offer peer support and encouragement. To find your local support group in the US, visit the scleroderma chapter locator.

Do you or someone you love suffer from scleroderma? What has been your experience living with the disease? Let us know in the comments below!

The Link Between Congenital Heart Block and Autoimmune Disease

Congenital Heart Block (CHB) is a rare but serious condition that occurs more frequently in newborns born to mothers with autoimmune disease. Image courtesy of Insider.com.

What is Congenital Heart Block?

According to the National Organization for Rare Disease, Congenital Heart Block, or CHB for short, is the interference of the transfer of electric nerve impulses that regulate the pumping of the heart muscle.

As long as electrical impulses are transmitted normally between the heart’s chambers – the atria and the ventricles – the heart contracts normally, allowing for blood to be pumped throughout the body. If the transmission of the signal is impeded, the blocked electrical transmission is known as heart block, or atrioventricular (AV) block.

Though heart block can happen to anyone of any age, it is called congenital heart block if it occurs in a fetus or newborn up to 28 days old.

Why Does CHB Occur in Children Born to Women with Autoimmune Disease?

Autoimmune-associated CHB has been found in a variety of maternal autoimmune disorders, including Sjogren’s syndrome, systemic lupus erythematosus, rheumatoid arthritis, antiphospholipid syndrome (APS), mixed connective tissue disorders, and undifferentiated connective tissue disease.

It is believed that CHB may result when maternal antibodies cross the placenta, enter the fetus, and attack the fetal cardiac conduction system. The antibodies that were originally produced by the mother’s body to fight infections mistakenly recognize parts of the fetal heart’s conduction system as foreign; for this reason, the immune system attacks and damages the tissues, resulting in inflammation and scarring, which in turn leads to faulty conduction. 

What Is the Risk of Congenital Heart Block if I Have an Autoimmune Disease?

A 2017 study conducted by Chinese medical professionals Kai-Yu Zhou and Yi-Min Hua of the West China Second University Hospital, Department of Pediatric Cardiology, revealed that more than half of CHB cases (between 60 and 90%) are associated with maternal autoimmune disease.

Among the general population, CHB occurs in 1 out of every 20,000 live births – an incidence of only 0.00005%. The study found that autoimmune-associated CHB, however, occurs at much more frequent rates, affecting between 2–5% pregnancies with positive anti-Ro/SSA and La/SSB antibodies. The study also found that when a woman had a child with CHB, the recurrence rate of CHB was 12–25% for a subsequent pregnancy.

Mortality Rate & Treatment for Congenital Heart Block

The perinatal mortality rate of a newborn with CHB is up to 30%, and even higher in the presence of endocardial fibroelastosis (EFE) or dilated cardiomyopathy (DCM), which are other potential complications associated with CHB.

If CHB is detected in utero by a fetal electrocardiography (ECG) and echocardiography, your OB/GYN may prescribe an adrenocorticosteroid such as dexamethasone, which works to decrease inflammation and the number of circulating maternal antibodies in the fetus.

Once born, other studies have shown that between that 64 and 70% of CHB survivors require surgery to permanently implant a pacemaker, a medical device which stimulates the heart to contract so that it can pump blood.

How to Prevent Congenital Heart Block

A 2016 report by the American College of Rheumatology states that there are no official guidelines about the prevention, screening, and treatment of CHB due to maternal Ro antibodies.

However, in the same report, it was stated that in a survey of 330 women with autoimmune conditions, 67% were told by their rheumatologists to use hydroxychloroquine (also known as Plaquenil) to prevent CHB. In addition, 62% were told to start the drug prior to pregnancy, in order to prevent the condition from developing.

Another study published in The Journal of the American College of Cardiology stated that hydroxychloroquine reduces the recurrence of CHB below the historical rate by more than 50%, further demonstrating the promise of this drug in the prevention of CHB.

Have you or someone you love been affected by congenital heart block (CHB)? Let us know in the comments below!

Professional Soccer Player Describes Life with Autoimmune Diseases

Shannon Boxx, a professional women’s soccer player, secretly battled two autoimmune diseases while winning medals across the globe

Playing Professionally with Invisible Illnesses

In 2012, Shannon Boxx, a professional soccer player on the US national women’s team, was at the top of her career. She had earned medals at three World Cup games and two Olympic gold medals. However, unbeknownst to her teammates and coaches, she had actually been diagnosed with a debilitating autoimmune disease a decade prior, and another autoimmune disease just four years ago.

Boxx, now 42, was first diagnosed with Sjogren’s Syndrome in 2002, which causes widespread dryness, joint pain and fatigue, among other symptoms. She was later diagnosed in 2008 with systemic lupus erythematosus (SLE), or simply, lupus, which also causes a myriad of symptoms, including joint pain, muscle pain, fatigue, skin rashes, brain fog and major organ involvement.

Treatment for Lupus and Sjogren’s Symptoms

When interviewed by the publication The Undefeated, Boxx said that she manages her lupus flares by wearing compression pants, which help with the joint pain that she experiences in her knees. She also takes hydroxychloroquine, also known as Plaquenil, an anti-malarial drug that helps her to manage the joint pain associated with both of her autoimmune conditions. Boxx describes her joint pain as severe; “There were times, even when I was playing on the national team, I was having teammates cut my steak for me because it hurt so much on my wrist to actually hold onto a fork or a knife.”

Fatigue and brain fog are other symptoms that Boxx battles daily. “I used to be able to run forever, and now I can barely walk sometimes for a mile or two. And that’s pretty heartbreaking,” she confessed. Boxx has children, and she wants to be able to run around with her kids for as long as possible. “To know that there’s days that I can’t do it, it puts you in a really bad place, mentally,” she said. When asked about how the fatigue feels, she commented, “It is this feeling of a weight just sitting on you and just even to lift your head off the pillow takes so much effort and your eyes don’t want to open. When I was playing it felt like my feet were in quicksand.”

Autoimmune Disease Triggers

Boxx explained that one of the main triggers for her autoimmune flares is stress. Now that the coronavirus is grappling the world, the global pandemic has added another layer of anxiety to the mix, especially given that she is immunocompromised. As a result, the professional athlete is following local shelter-in-place orders, wearing masks diligently and ensuring to frequently wash her hands and stay six feet apart from others.

Another source of anxiety is the fact that hydroxychloroquine, the medication that she takes, has become more scarce as a result of it being explored for its potential use in treating COVID-19. “It makes me sad that there are a lot of people that are suffering or even worse because they now can’t get the medication that they need,” she said.

Boxx believes another potential source of her flares is over-exposure to the sun, though thankfully, most days are overcast in her home of Portland, Oregon in the Pacific Northwest. She also frequently experiences the so-called ‘butterfly rash‘ that is a hallmark of lupus, and can arise following exposure to sunlight.

Two other factors that must be considered in the pathogenesis of autoimmune disease are sex and race. According to the Sjogren’s Foundation, nine out of 10 Sjogren’s patients are women; similarly, the US National Library of Medicine states that nine out of 10 lupus patients are women. Lupus is also three times more likely to occur in African American women than white women. Boxx, for her part, is a biracial woman, so her gender and ethnic background may have played a part in developing autoimmune diseases.

Moving Forward with Chronic Illness

Shannon Boxx plays in a friendly soccer match against Brazil’s women’s team.

Though living with two different autoimmune conditions is undeniably challenging, Shannon Boxx is determined to live her best life. She retired from playing professional soccer in 2015, and is focusing on taking care of her own health, and spending time with her husband and kids. Though she has retired from professional soccer, she enjoys playing non-competitive games with other international teams and coaching kids’ soccer teams.

Boxx is also an advocate for those living with chronic illnesses, and actively participates in awareness campaigns for the Lupus Foundation of America. Commenting on her conditions, she said, “I’ve been able to deal with it, and still do something that I love…[lupus] has shown me that I can’t take [soccer] for granted, because that’s something that I love to do. If anything it’s given me perspective.”