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Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation01:21

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Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
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Peripheral Artery Disease I: Introduction01:30

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Peripheral artery disease (PAD) predominantly results from atherosclerosis, which involves the accumulation of fatty deposits, or plaques, within the walls of arteries. This causes them to narrow and harden, significantly reducing blood flow. PAD predominantly affects the legs, particularly the arteries supplying the thighs and calves. In rare cases, it may involve other arteries, including those in the arms.Etiology of PAD:The principal cause of PAD is atherosclerosis, which results from fatty...
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Peripheral Artery Disease IV: Nursing Management01:26

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 The nursing management of a patient with peripheral artery disease (PAD) begins with a thorough assessment of the patient’s health history and clinical manifestations.AssessmentHealth History: Evaluate the patient’s history of hypertension, hyperlipidemia, family history of cardiovascular issues, and lifestyle factors such as dietary patterns, smoking, and physical activity.Physical Examination:Assess the affected extremity for decreased or absent peripheral pulses,...
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Peripheral Artery Disease III: Interprofessional Care01:27

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Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
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Assessment of the Cardiovascular System III: Palpation01:27

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Palpation involves feeling the body to evaluate texture, size, consistency, and tenderness for assessing cardiovascular health. The following steps are organized in a head-to-toe order:
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above...
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Controlling the digital ulcerative disease in systemic sclerosis is associated with improved hand function.

Luc Mouthon1, Patrick H Carpentier2, Catherine Lok3

  • 1Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Cochin Hospital, Paris Descartes University, 27, Rue du Faubourg Saint-Jacques, 75679 Paris, France.

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Summary

Controlling digital ulcers in systemic sclerosis (SSc) patients receiving bosentan significantly reduced hand disability and pain. This improvement was most notable in patients who achieved ulcerative disease control over one year.

Keywords:
BosentanDigital ulcersDisabilityHandSystemic sclerosis

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Area of Science:

  • Rheumatology
  • Dermatology
  • Vascular Medicine

Background:

  • Ischemic digital ulcers (DU) are a significant complication of systemic sclerosis (SSc).
  • Bosentan is a treatment option for SSc patients with DU.
  • The impact of controlling DU on patient outcomes requires further investigation.

Purpose of the Study:

  • To investigate the effect of controlling ulcerative disease on disability, pain, and quality of life in SSc patients treated with bosentan.
  • To assess changes in hand function, pain levels, and overall quality of life over a one-year period.

Main Methods:

  • An observational, multicenter study (ECLIPSE) followed 190 SSc patients with a history of DU receiving bosentan.
  • Disability (CHFS, HAQ-DI), pain (VAS), and quality of life (SF-36) were assessed at baseline and 1-year follow-up.
  • Controlled ulcerative disease was defined as the absence of new or ongoing DU episodes at 1 year.

Main Results:

  • Of 120 patients with 1-year data, 38.3% experienced new DU episodes.
  • The number of DU per patient decreased significantly (p < 0.0001).
  • Significant improvements were observed in HAQ-DI (p=0.04), CHFS (p=0.005), and pain scores (p < 0.0001).
  • Patients with controlled ulcerative disease (48.3%) showed significant improvements in HAQ-DI, CHFS, and pain.

Conclusions:

  • Control of ulcerative disease in SSc patients over one year is associated with significant improvements in hand disability.
  • Effective DU management can lead to reduced pain and better functional outcomes in SSc patients.