Discuss the Pathophysiological Changes that Occur with Scleroderma
Scleroderma begins with an inciting feeling at the endothelium part of the vasculature which escalates into a viral agent, autoimmune, and oxidative stress. Apoptosis and endothelial cell-damage then emerges, escalating into a vascular leakiness that is visible in the initial clinical phases as tissue edema. This stage is characterized by a Th17 and Th1-mediated disease. The vasculature undergoes further compromise by impaired vasculogenesis and angiogenesis. This process is characterized by fewer endothelial progenitor cells due to the presence of antiendothelinal cell antibodies (AECA) (Varga, Denton, Wigley, et al., 2016). The cells then experience elevated levels of pro-angiogenic growth factors such as VEGF and PDGF. Scleroderma Essay.
An off-balance is created between vasoconstriction and vasodilation causing vasoconstriction leaving a damaged endothelium that facilitates the formation of a blood clot. The pathway also contributes to an injury of the ischemia-reperfusion and the TH2 polarity at a later stage of reactive oxygen species (Varga, Denton, Wigley, et al., 2016).
The chemokines and adhesion molecules are upgraded by the damaged endothelium to facilitate the development of adaptive and immune responses such as the loss of its tolerance to oxidized antigens. This reduced immunity escalates the level of autoimmunity thus making the T-cells to differentiate Th2 cell subsets. The result is activation of fibroblasts and myofibroblasts which causes an excessive deposition of proteins and collagen, further escalating into fibrosis. As the level of plasma decreases, vitamin D increases leading to a serve case of scleroderma
Factors From Sara’s History and Physical that Validate Her Diagnosis?
From Sara’s history and physical characteristics, the diagnosis of scleroderma is validated by her feeling of severe fatigue. Her tight and itchy skin around her trunk, face, hand, and arms also justifies this diagnosis. Sara also spends most of her days in the living room, a sign that she needs help to overcome her gastroesophageal reflux disease (GERD-induced) fatigue. Another justification for this diagnosis is the description of a dwindling appetite which has led to a worsening of her nutritional status (Wendahl, Kanazi & Abd-Elsayed, 2019). Besides, Sara’s body temperature is low due to her constant complaint of coldness Scleroderma Essay. Also, her nails and fingertips are severely hyperemic. Her right hand has two small and painful digital ulcers while her fingers are showing signs of curling. Another justification for her diagnosis is that she is not in a position to perform her ADLs and household duties because her hand and fingers are incapacitated.
A Justification for the use of Methotrexate for this Patient
Methotrexate prescription is recommended for Sara because of the immune system of patients with scleroderma a chronically switched-on. Sara could be experiencing high levels of inflammation which builds up scars in his skin. Due to this buildup, Sara’s vital organs are at risk, thus the need to prescribe methotrexate for her. Subjecting Sara to methotrexate will result in the blockage of folic acid production thus slowing down the production of protein and DNA (Wendahl, Kanazi & Abd-Elsayed, 2019) Scleroderma Essay. In particular, the intake of methotrexate will hinder the multiplication of cells of the immune system due to the limited production of protein and DNA. Therefore, the administration of methotrexate in this patient will control the excessive inflammation witnessed in her body.
Varga, J., Denton, C. P., Wigley, F. M., Allanore, Y., & Kuwana, M. (Eds.). (2016). Scleroderma: From pathogenesis to comprehensive management. Springer Scleroderma Essay.
Wendahl, A., Kanazi, G., & Abd-Elsayed, A. (2019). Scleroderma. In Pain (pp. 1219-1222). Springer, Cham.
Sara is a 40-year-old woman whose busy life is at a standstill. She has severe fatigue and tight, itchy skin on her face, arms, hands and trunk. She spends most of her days sitting up in the lounger in the living room to help with the fatigue and gastroesophageal reflux disease (GERD). She describes a dwindling appetite with worsening of her nutritional status. Scleroderma Essay.
Sara is always cold and her fingertips and nails often are severely hyperemic. There are two small, painful digital ulcers on her right hand. Her fingers are beginning to curl, making it difficult for her to perform her ADLs and household duties.
She has seen quite a few specialists about her complaints, including a psychologist, and none of them could be definitive about the diagnosis. Scleroderma Essay (Patients often report a period of 1-3 years from first signs and symptoms to actual diagnosis.)
Sara finally is referred to a rheumatologist at a nearby university medical department, who diagnoses systemic sclerosis. She and her husband are frightened, especially when she is prescribed methotrexate, which they know is a drug used to treat cancer. She types scleroderma into her computer search engine and discovers ads for herbal remedies, the Scleroderma Foundation site and scary articles in various magazines v.
Discuss the pathophysiological changes that occur with scleroderma.
What factors from Sara’s history and physical validate her diagnosis?
Give a justification for the use of methotrexate for this patient
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