Understanding Peripheral Vertigo: A Common Cause of Dizziness

 LIVING LIFE WITH SCLERODERMA     

Dr. Prathyusha Manikuppam &  Dr Shivraj Padiyar

Consultant Rheumatologists, KMC Hospital, Attavar, Mangalore

What is Scleroderma ? 

Scleroderma means " hard skin”. It occurs due to the abnormal growth of fibrous tissue under the skin which leads to skin tightening. What causes it ? The exact cause of scleroderma is not known. It occurs due to an abnormal immune response against the body, which causes tightening of the skin and affects the other organ systems like lung, heart and kidney.

Symptoms

1) Skin tightening : This is usually the first symptom of scleroderma. There is hardening of the skin over the fingers, hand, legs and face. This might lead to difficulty in forming a fist, or difficulty in opening of mouth.

2) Bluish discolouration of fingers: Fingers and toes turn whitish or bluish on exposure to cold , water or in response to emotional stimuli. This occurs due to constriction of blood vessels in fingers leading to decrease in blood supply. If it is not treated at this stage, it may lead to permanent blackening of fingers which is called as gangrene.

3) Calcinosis: Calcium deposits can form under the skin or in the muscles. These deposits may cause recurrent ulcers on the overlying skin.

4) Joint pains and muscle pain: Pain and stiffness of the joints and muscles are common symptoms early in the course of systemic sclerosis. Later in the disease course, muscle atroply and weakness are common.

5) Dental disease: Due to tightening of skin around the mouth, poor dental hygiene, dry mouth and loose teeth may occur.

6) Reflux disease: Patients might complaint of heart burn and stickiness in the chest and difficulty in swallowing foods.

7) Stomach problems: Patients may have feeling of fullness, abdominal pain and loose stools, weight loss.

8) Lung disease: Patients may have initially on and off cough followed by difficulty in breathing. Some have lung problems without any symptoms. So an early diagnosis of lung disease by a CT scan is necessary.

9) Kidney disease: Very rarely some patients can have sudden rise in blood pressure leading to kidney failure. This problem is usually seen in the first few years of disease.

10) Heart disease: Scleroderma can cause increase in pressure inside the heart which is called pulmonary hypertension. This problem is seen in after 4-5 years of initial diagnosis of scleroderma. So all patients need to undergo ECHO test routinely for evaluation of heart disease.

Is it a contagious disease? No.

How to confirm the diagnosis? A diagnosis is confirmed after a careful examination by a rheumatologist. Some blood tests and X ray and CT scan will help to identify various organs which are involved in the disease.

How do you treat this disease? Unlike the previous time, where hardly any treatment was available, in current times a lot of new advances in treatment is possible. With proper medications in the early stage disease can be controlled adequately. However the medications need to be taken for a longer period of time. The commonly used drugs are nifedipine, tadalafil, mycophenolate, cyclophosphamide, methotrexate.

What are the precautions to be taken by the patient?

• For those with bluish discolouration of fingers- Avoid contact with cold water. 
• Use only warm water for bath. 
• Always wear cotton gloves during rainy and winter season. 
• Avoid sitting in AC rooms Avoid stress/ smoking/ vibrating instruments like mixers.

Skin problems like dry skin Apply moisturizing creams and lotions frequently, especially after bathing. Apply sunscreen before going outdoors. Itching can be treated with oral antihistamines like cetirizine.

Stiff muscles and joints Get regular exercise to maintain range of motion and muscle strength. See a physiotherapist to stretch contracted joints.

Dental problems Practice good oral hygience- brush and floss regularly. See your dentist regularly. Keep your mouth moist by taking frequent sips of water, chewing sugarless gum or using saliva substitutes. Perform facial exercises to help keep your mouth and face flexible.

Gastrointestinal problems- Reflux and burning sensation in chest 

• Eat small, frequent meals. 
• Remain standing or sitting at least one hour after eating. 
• Avoid late-night meals. 
• Chew food well. 
• Try to use 2 pillows or keep the head end of bed elevated.

Life expectancy 

Systemic sclerosis patients are at risk of serious complications, kidney disease, Pulmorary Arterial Hypertension (PAH) (high blood pressure in the arteries around the lugs), alveolitis ( inflammation of the lungs), Gastro-intestinal ( GI ) disease and heart damage that can be fatal and adversely affect the quality of life. So early detection of these problems can lead to better outcomes.

Pregnancy 

Any female diagnosed with scleroderma needs to check with her physician and obstetrician to discuss possible complications associated with having children. If scleroderma has stabilized and without major organs like heart and, lung and kidney being involved, possibility of successful outcome is higher.