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The Videofluorographic Swallowing Study in Rheumatologic Diseases: A Comprehensive Review 时间:2017-07-03 13:14 来源:未知作者:admin 点击: 次 Abstract:Autoimmune connective tissue diseases are a heterogeneous group of pathologies that affect about 10% of world population with chronic evolution in 20%–80%. Inflammation in autoimmune diseases may lead to serious damage to other organs including the gastrointestinal tract. Gastrointestinal tract involvement in these patients may also due to both a direct action of antibodies against organs and pharmacological therapies. Dysphagia is one of the most important symptom, and it is caused by failure of the swallowing function and may lead to aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction. The videofluorographic swallowing study is a key diagnostic tool in the detection of swallowing disorders, allowing to make an early diagnosis and to reduce the risk of gastrointestinal and pulmonary complications. This technique helps to identify both functional and structural anomalies of the anatomic chain involved in swallowing function. The aim of this review is to systematically analyze the basis of the pathological involvement of the swallowing function for each rheumatological disease and to show the main features of the videofluorographic study that may be encountered in these patients.
1. Introduction
Autoimmune connective tissue diseases are a heterogeneous group of pathologies that affect about 10% of world population with chronic evolution in 20% up to 80% [1, 2]. Rheumatic diseases, arthritis and other diseases of muscles, joints, and bones, are common and have an important impact on the health and well-being of nearly 50 million Americans [1, 2]. Children maybe also be affected: it has been reported that nearly 300,000 American children suffer from rheumatic diseases and the most common is juvenile idiopathic arthritis [2].
Inflammation and damage to joints may also lead to serious damage to other organs, being responsible of coexisting disease and disability. For this reason, rheumatic diseases are a more frequent cause of activity limitation than heart disease, cancer, or diabetes [3].
The latest figures regarding rheumatic diseases show that they led to $127.8 billion in medical costs in the U.S [2], more than the $124.6 billion in costs for cancer care [4]. During the early stages of rheumatic disease, most of the costs are related to direct medical expenses for aggressive treatment regimens. Thereafter, the cost profile shifts with the incorporation of indirect costs related to work limitations. Reducing indirect costs, such as work limitations or even loss of work, can save the U.S. more than $47 billion per year [5].
As described before, rheumatic diseases can cause damage to vital organs, including the lungs, heart, nervous system, kidneys, skin, and eyes [6], and the majority of patients affected develops gastrointestinal tract involvement that may be caused by a direct action of antibodies against organs but also depends on pharmacological therapies [7].
In order to prevent life-threatening complications, early diagnosis and treatment of dysphagia is very important, considering also that it can lead to pneumonia, malnutrition, dehydration, and increased mortality [8].
There are over 30 autoimmune rheumatic diseases. Some of the most common are rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), gout, systemic scleroderma (SSc), inflammatory myopathies (IM), juvenile idiopathic arthritis (JDM), Sjogren’s syndrome (SS), sarcoidosis, spondylarthritides, and polymyalgia rheumatic and systemic vasculitis. Among them, esophageal function is more often impaired in SSc, IM, sarcoidosis, and SS [9, 10].
Moreover, orofacial manifestations occur frequently in rheumatic diseases and usually represent the early signs of disease or of its activity that are still neglected in clinical practice.