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Scleroderma pp 533–550Cite as

Overlooked Manifestations

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Abstract

Systemic sclerosis (SSc) is a heterogeneous disease with well-described traditional clinical manifestations, such as Raynaud’s phenomenon, dermal sclerosis, esophageal dysmotility, calcinosis, and telangiectasia. Because the clinical presentation can be complex and involve multiple organ systems, there are several other manifestations that often go unrecognized but cause significant morbidity. This chapter discusses a few such manifestations, including neurological manifestations, audiovestibular disease, oral complications, thyroid dysfunction, liver disease, avascular necrosis of bone, bladder dysfunction, and erectile dysfunction.

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References

  1. Steven JL. Case of scleroderma with pronounced hemi-atrophy of the face, body and extremities- death from ovarian tumor-account of the post-mortem examination: a sequel. Glasgow Med J. 1898;50:401.

    Google Scholar 

  2. Leinwand I, Duryee W, Richter MN. Scleroderma based on a study of over 150 cases. Ann Intern Med. 1954;41:1003–41.

    Article  CAS  PubMed  Google Scholar 

  3. Piper WN, Helwig EB. Progressive systemic sclerosis; visceral manifestations in generalized scleroderma. AMA Arch Dermatol. 1955;72:535–46.

    Article  CAS  Google Scholar 

  4. Tuffanelli DL, Winklemann RK. Systemic scleroderma, a clinical study of 727 cases. AMA Arch Dermatol. 1961;84:357–71.

    Article  Google Scholar 

  5. Gordon RM, Silverstein A. Neurologic manifestations in progressive systemic sclerosis. Arch Neurol. 1970;20:126–34.

    Article  Google Scholar 

  6. D’Angelo WA, Fries J, Masi AT, et al. Pathologic observations in systemic sclerosis, scleroderma. A study of fifty-eight autopsy cases and fifty-eight matched controls. Am J Med. 1969;46:428–40.

    Article  PubMed  Google Scholar 

  7. Lee P, Bruni J, Sukenik S. Neurologic manifestations in systemic sclerosis. J Rheumatol. 1984;1:480–3.

    Google Scholar 

  8. Amaral TN, Peres FA, Lapa AT, et al. Neurologic involvement in scleroderma: a systematic review. Semin Arthritis Rheum. 2013;43:335–47.

    Article  PubMed  Google Scholar 

  9. Lee JE, Haynes JM. Carotid arteritis and cerebral infarction due to scleroderma. Neurology. 1967;17:18–22.

    Article  CAS  PubMed  Google Scholar 

  10. Estey E, Lieberman A, Pinto R, et al. Cerebral arteritis in scleroderma. Stroke. 1979;10:595–7.

    Article  CAS  PubMed  Google Scholar 

  11. Abers MS, Iluonakhamhe EK, Goldsmith G, et al. Central nervous system vasculitis secondary to systemic sclerosis. J Clin Neurosci. 2013;20:1168–70.

    Article  PubMed  Google Scholar 

  12. Wise TN, Ginzler EM. Scleroderma Cerebritis, an unusual manifestation of progressive systemic sclerosis. Dis Nerv Syst. 1975;36:30–62.

    Google Scholar 

  13. Heron E, Fornes P, Rance A, et al. Brain involvement in scleroderma: two autopsy cases. Stroke J Am Heart Assoc. 1998;29:719–21.

    CAS  Google Scholar 

  14. Heron E, Hernigou A, Chatellier G, et al. Intracerebral calcification in systemic sclerosis. Stroke J Am Heart Assoc. 1999;30:2183–5.

    CAS  Google Scholar 

  15. Sardanelli F, Cotticelli B, Losacco C, et al. White matter hyperintensities on brain magnetic resonance in systemic sclerosis. Ann Rheum Dis. 2006;64:777–9.

    Article  Google Scholar 

  16. Terrier B, Charbonneau F, Touze E, et al. Cerebral vasculopathy is associated with severe vascular manifestations in systemic sclerosis. J Rheumatol. 2009;36:1486–94.

    Article  PubMed  Google Scholar 

  17. Hamdy R, Mohammed A, Sabry Y, Nasef. Brain mri screening showing evidences of early central nervous system involvement in patients with systemic sclerosis. Rheumatol Int. 2011;31:667–71.

    Article  Google Scholar 

  18. Maclean H, Guthrie W. Retinopathy in scleroderma. Trans Opthamol Soc UK. 1969;89:209–20.

    Google Scholar 

  19. Farkas TG, Sylvester V, Archer D. The choroidopathy of progressive systemic sclerosis (scleroderma). Am J Ophthalmol. 1972;74:875–86.

    Article  CAS  PubMed  Google Scholar 

  20. Grennan D, Forrester J. Involvement of the eye in sle and scleroderma. Ann Rheum Dis. 1977;36:152–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Alarcon-Segovia D, Ibaniez G, Hernandez-Ortiz J, et al. Sjögren’s syndrome in progressive systemic sclerosis (Scleroderma). Am J Med. 1974;57:78–85.

    Article  CAS  PubMed  Google Scholar 

  22. Ashton N, Comes N, Garner A, et al. Retinopathy due to progressive systemic sclerosis. J Pathol Bacteriol. 1968;96:259–68.

    Article  CAS  PubMed  Google Scholar 

  23. Kraus A, Guerra-Bautista G, Espinoza G, et al. Defects of the retinal pigment epithelium in scleroderma. Br J Rheumatol. 1991;30:112–4.

    Article  CAS  PubMed  Google Scholar 

  24. Littlejohn G, Urowitz MB, Palvin CJ. Case report: central retinal vein occlusion and scleroderma: implications for sclerodermatous vascular disease. Ann Rheum Dis. 1981;40:96–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Christianson HB, Dorsey CS, O’Leary PA, et al. Localized scleroderma. A clinical study of 235 cases. Arch Dermatol. 1956;74:629–39.

    Article  CAS  Google Scholar 

  26. Goldberg NC, Duncan SC, Winkelmann RK. Migraine and systemic scleroderma. Arch Dermatol. 1978;114:550–1.

    Article  CAS  PubMed  Google Scholar 

  27. Pal B, Gibson C, Passmore J, et al. A study of headaches and migraine in Sjögren’s syndrome and other rheumatic disorders. Ann Rheum Dis. 1989;48:312–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Beighton P, Gumpel JM, Cornes NG. Prodromal trigeminal sensory neuropathy in progressive systemic sclerosis. Ann Rheum Dis. 1968;27:367–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Ashworth B, Tait GB. Trigeminal neuropathy in connective tissue disease. Neurology. 1971;21:609–14.

    Article  CAS  PubMed  Google Scholar 

  30. Teasdall RD, Frayha RA, Shulman LE. Cranial nerve involvement in systemic sclerosis (scleroderma): a report of 10 cases. Medicine. 1980;59:149–59.

    Article  CAS  PubMed  Google Scholar 

  31. Farrell DA, Medsger TA. Trigeminal neuropathy in progressive systemic sclerosis. Am J Med. 1982;73:57–61.

    Article  CAS  PubMed  Google Scholar 

  32. Richter R. Peripheral neuropathy and connective tissue disease. J Neurol Pathol Exp Neurol. 1954;13:168–80.

    Article  CAS  Google Scholar 

  33. Pawlowski A, Warsaw P. The nerve network of the skin in diffuse scleroderma and clinically similar conditions. Arch Dermatol. 1963;88:868–73.

    Article  CAS  PubMed  Google Scholar 

  34. Fleischmajer R, Perlish JS, Reeves JR. Cellular infiltrates in scleroderma skin. Arthritis Rheum. 1977;20:975–84.

    Article  CAS  PubMed  Google Scholar 

  35. Christopher RP, Robinson H. Studies of nerve conduction in patients with scleroderma. South Med J. 1972;65:668–72.

    Article  CAS  PubMed  Google Scholar 

  36. Poncelet AN, Connolly K. Peripheral neuropathy in scleroderma. Muscle Nerve. 2003;28:330–5.

    Article  PubMed  Google Scholar 

  37. Alonso-Ruiz A, Leiva-Santana C. Carpal tunnel syndrome in scleroderma-like syndromes. J Rheumatol. 1985;12:1030.

    CAS  PubMed  Google Scholar 

  38. Machel L, Machet MC, Khallouf R, et al. Carpal tunnel syndrome and systemic sclerosis. Dermatology. 1992;185:101–3.

    Article  Google Scholar 

  39. Bandinelli F, Kaloudi O, Candelieri A, et al. Early detection of median nerve syndrome at the carpal tunnel with high-resolution 18 MHz ultrasonography in systemic sclerosis patients. Clin Exp Rheumatol. 2010;28:S15–8.

    CAS  PubMed  Google Scholar 

  40. Mondelli M, Romano C, Della-Porta P, et al. Electrophysiological evidence of “nerve entrapment syndromes and subclinical peripheral neuropathy in progressive systemic sclerosis (scleroderma). J Neurol. 1995;242:185–94.

    Article  CAS  PubMed  Google Scholar 

  41. Dahlgaard T, Kamp-Nielsen V, Kjeldstrup-Kristensen J. Vibratory perception in patients with generalized scleroderma. Acta Dermatovenerol (Stockholm). 1980;60:119–22.

    CAS  Google Scholar 

  42. Campbell PM, LeRoy EC. Pathogenesis of systemic sclerosis: a vascular hypothesis. Semin Arthritis Rheum. 1975;4:351–68.

    Article  CAS  PubMed  Google Scholar 

  43. Kahaleh MB, Sherer GK, LeRoy EC. Endothelial injury in scleroderma. J Exp Med. 1979;149:1326–35.

    Article  CAS  PubMed  Google Scholar 

  44. Gabrielli A, Avvedimento EV, Krieg T. Mechanisms of disease scleroderma. N Engl J Med. 2009;360:1989–2003.

    Article  CAS  PubMed  Google Scholar 

  45. Matucci-Cerinic M, Kahaleh B, Wigley F. Evidence that systemic sclerosis is a vascular disease. Arthritis Rheum. 2013;65:1953–62.

    Article  CAS  PubMed  Google Scholar 

  46. Sjögren R. Gastrointestinal motility disorders in scleroderma. Arthritis Rheum. 1994;9:1265–82.

    Article  Google Scholar 

  47. Abu-Shakara M, Guillemin F, Lee P. Gastro manifestations of systemic sclerosis. Semin Arthritis Rheum. 1994;24:29–39.

    Article  Google Scholar 

  48. Lally EV, Jimenez S. Impotence in progressive systemic sclerosis. Ann Intern Med. 1981;95:150–3.

    Article  CAS  PubMed  Google Scholar 

  49. Stover SL, Gay RE, Koopman W, et al. Dermal fibrosis in spinal cord injury patients. Arthritis Rheum. 1980;23:1312–7.

    Article  CAS  PubMed  Google Scholar 

  50. Peacock JH. Peripheral venous blood concentrations of epinephrine and norepinephrine in primary raynaud’s disease. Circ Res. 1959;7:821–7.

    Article  CAS  PubMed  Google Scholar 

  51. Kontos HA, Wasserman AJ. Effect of reserpine in raynaud’s phenomenon. Circulation. 1961;39:259–64.

    Article  Google Scholar 

  52. Sapira JD, Rodnan GP, Scheib ET, et al. Studies of endogenous catecholamines in patients with raynaud’s phenomenon secondary to progressive systemic sclerosis (scleroderma). Am J Med. 1972;52:330–6.

    Article  CAS  PubMed  Google Scholar 

  53. Fries JF. Physiologic studies in systemic sclerosis (scleroderma). Arch Intern Med. 1969;123:22–5.

    Article  Google Scholar 

  54. Drake DB, Kesler RW, Morgan RF. Digital sympathectomy for refractory Raynaud’s phenomenon in adolescent. J Rheumatol. 1992;19:1286–8.

    CAS  PubMed  Google Scholar 

  55. Wasserman A, Brahn E. Systemic sclerosis: bilateral improvement of Raynaud’s phenomenon with unilateral digital sympathectomy. J Semin Arthritis. 2009;40:137–46.

    Article  Google Scholar 

  56. Tamaiho MM, Goitz RJ, Medsger TA. Surgery for ischemic pain and Raynaud’s phenomenon in scleroderma: a description of treatment protocol and evaluation of results. Microsurgery. 2001;21:75–9.

    Article  Google Scholar 

  57. Matsumoto Y, Ueyama T, Endo M, et al. Endoscopic thoracic sympathectomy for Raynaud’s phenomenon. J Vasc Surg. 2002;36:57–61.

    Article  PubMed  Google Scholar 

  58. Kotsis SV, Chung KC. A systematic review of the outcomes of digital sympathectomy for treatment of chronic distal ischemia. J Rheumatol. 2003;30:1788–92.

    PubMed  Google Scholar 

  59. Feldman M, Schiller LR. Disorders of gastrointestinal motility associated with diabetes mellitus. Ann Intern Med. 1983;98:378–84.

    Article  CAS  PubMed  Google Scholar 

  60. Yang R, Arem R, Chan L. Gastrointestinal tract complication of diabetes mellitus. Arch Intern Med. 1984;144:1251–6.

    Article  CAS  PubMed  Google Scholar 

  61. Schiller LR, Santa Ana CA, Schmulen C, et al. Pathogenesis of fecal incontinence in diabetes mellitus: evidence for internal-anal-sphincter dysfunction. N Engl J Med. 1982;307:1666–71.

    Article  CAS  PubMed  Google Scholar 

  62. Camilleri M. Diabetic gastroparesis. N Engl J Med. 2007;356:820–30.

    Article  CAS  PubMed  Google Scholar 

  63. Nathan DM. Long-term complications of diabetes mellitus. N Engl J Med. 1993;328:1676–86.

    Article  CAS  PubMed  Google Scholar 

  64. Rosenbloom AL, Silverstein JH, Lezotte DC, et al. Limited joint mobility in childhood diabetes mellitus indicates increased risk for microvascular disease. N Engl J Med. 1981;305:191–4.

    Article  CAS  PubMed  Google Scholar 

  65. Elizondo-Garza MA, Diaz-Jouanen E, Franco-Casique J, et al. Joint contractures and scleroderma-like skin changes in the hands of insulin-dependent juvenile diabetics. J Rheumatol. 1983;10:797–800.

    Google Scholar 

  66. Fitzcharles MA, Duby S, Waddell WR, Banks E. Limitation of joint mobility (cheiroarthropathy) in adult noninsulin-dependent diabetic patients. Ann Rheum Dis. 1984;43:251–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Starkman HS, Gleason RE, Rand LI, et al. Limited joint mobility (LJM) of the hand in patients with diabetes mellitus: relation to chronic complications. Ann Rheum Dis. 1986;45:130–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Schulte L, Roberts MS, Zimmerman C, et al. A quantitative assessment of limited joint mobility in patients with diabetes. Arthritis Rheum. 1993;36:1429–43.

    Article  CAS  PubMed  Google Scholar 

  69. Seibolds JR, Uitto J, Dorwart BB, Prockop DJ. Collagen synthesis and collagenase activity in dermal fibroblasts from patients with diabetes and digital sclerosis. J Lab Clin Med. 1985;105:664–7.

    Google Scholar 

  70. Burner TW, Rosenthal AK. Diabetes and rheumatic diseases. Curr Opin Rheumatol. 2009;20:50–4.

    Article  Google Scholar 

  71. O’Brien IAD, O’Hare JP, Lewin IG, et al. The prevalence of autonomic neuropathy in insulin- dependent diabetes & mellitus: a controlled study based on heart rate variability. Q J Med. 1986;61:957–67.

    PubMed  Google Scholar 

  72. Watkins PJ. Diabetic autonomic neuropathy. N Engl J Med. 1990;322:1078–9.

    Article  CAS  PubMed  Google Scholar 

  73. Sonnex C, Paice E, White AG. Autonomic neuropathy in systemic sclerosis: a case report and evaluation of six patients. Ann Rheum Dis. 1986;45:957–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Suarez-Almazor ME, Bruera E, Russel AS. Normal cardiovascular autonomic function in patients with systemic sclerosis (CREST variant). Ann Rheum Dis. 1988;47:672–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  75. Dessein PH, Gledhill RF. More on autonomic neuropathy in systemic sclerosis. Ann Rheum Dis. 1988;47:261–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Klimiuk PS, Taylor L, Baker RD, Jayson MI. Autonomic neuropathy in systemic sclerosis. Ann Rheum Dis. 1988;47:542–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  77. Dessein PH, Joffe BI, Metz R, et al. Autonomic dysfunction in systemic sclerosis: sympathetic overactivity and instability. Am J Med. 1992;93:143–50.

    Article  CAS  PubMed  Google Scholar 

  78. Hermosillo AG, Ortiz R, DaBague J, Casanova JM, Martinez-Lavin M. Autonomic dysfunction in diffuse scleroderma vs crest: an assessment by computerized heart rate variability. J Rheumatol. 1994;21:1849–54.

    CAS  PubMed  Google Scholar 

  79. Stacher G, Merio R, Budka C, et al. Cardiovascular autonomic function, autoantibodies, and esophageal motor activity in patients with systemic sclerosis and mixed connective tissue disease. J Rheumatol. 2000;27:692–7.

    CAS  PubMed  Google Scholar 

  80. Lock G, Straub RH, Zeuner M, et al. Association of autonomic nervous dysfunction and esophageal dysmotility in systemic sclerosis. J Rheumatol. 1998;25:1330–5.

    CAS  PubMed  Google Scholar 

  81. Morelli S, Piccirillo G, Fimongnari F, Screccia A, et al. Twenty-four hour heart period variability in systemic sclerosis. J Rheumatol. 1996;23:643–5.

    CAS  PubMed  Google Scholar 

  82. Gigante A, Rosato E, Liberatori M, et al. Autonomic dysfunction in patients with systemic sclerosis: correlation with intrarenal arterial stiffness. Int J Cardiol. 2014;177:578–80.

    Article  CAS  PubMed  Google Scholar 

  83. Othman KM, Assaf NY, Farouk HM, Hassan Aly IM. Autonomic dysfunction predicts early cardiac affection in patients with systemic sclerosis. Clin Med Insights Arthritis Musculoskelet Disord. 2010;3:45–54.

    Google Scholar 

  84. Malandrini A, Selvi E, Villanove M, Berti G, et al. Autonomic nervous system and smooth muscle cell involvement in systemic sclerosis: ultrastructural study of 3 cases. J Rheumatol. 2000;27:1203–6.

    CAS  PubMed  Google Scholar 

  85. Amor-Dorado JC, Arias-Nunez MC, Miranda-Filloy JA, et al. Audiovestibular manifestations in patients with limited systemic sclerosis and centromere protein-B (CENP-B) antibodies. Medicine (Baltimore). 2008;87:131–41.

    Article  CAS  Google Scholar 

  86. Berrettini S, Ferri C, Pitaro N, et al. Audiovestibular involvement in systemic sclerosis. ORLO J Otorhinolaryngol Relat Spec. 1994;56:195–8.

    Article  CAS  Google Scholar 

  87. Kastanioudakis I, Ziavra N, Politi EN, et al. Hearing loss in progressive systemic sclerosis patients: a comparative study. Otolaryngol Head Neck Surg. 2001;124:522–5.

    Article  CAS  PubMed  Google Scholar 

  88. Tosti A, Patrizi A, Veronesi S. Audiologic involvement in systemic sclerosis. Dermatologica. 1984;168:206.

    Article  CAS  PubMed  Google Scholar 

  89. Teasdall RD, Frayha RA, Shulman LE. Cranial nerve involvement in systemic sclerosis (scleroderma): a report of 10 cases. Medicine (Baltimore). 1980;59:149–59.

    Article  CAS  Google Scholar 

  90. Abou-Taleb A, Linthicum Jr FH. Scleroderma and hearing loss: (histopathology of a case). J Laryngol Otol. 1987;101:656–62.

    Article  CAS  PubMed  Google Scholar 

  91. Bassyouni IH, Emad Y, Rafaat HA, et al. Relationship between nailfold capillary abnormalities and vestibular dysfunction in systemic sclerosis. Joint Bone Spine. 2011;78:266–9.

    Article  PubMed  Google Scholar 

  92. Amor-Dorado JC, Barreira-Fernandez MP, Arias-Nunez MC, et al. Benign paroxysmal positional vertigo and clinical test of sensory interaction and balance in systemic sclerosis. Otol Neurotol. 2008;29:1155–61.

    Article  PubMed  Google Scholar 

  93. Rauch SD. Clinical practice. Idiopathic sudden sensorineural hearing loss. N Engl J Med. 2008;359:833–40.

    Article  CAS  PubMed  Google Scholar 

  94. Deroee AF, Huang TC, Morita N, et al. Sudden hearing loss as the presenting symptom of systemic sclerosis. Otol Neurotol. 2009;30:277–9.

    Article  PubMed  Google Scholar 

  95. Santarelli R, Scimemi P, Dal Monte E, et al. Auditory neuropathy in systemic sclerosis: a speech perception and evoked potential study before and after cochlear implantation. Eur Arch Otorhinolaryngol. 2006;263:809–15.

    Article  PubMed  Google Scholar 

  96. Van Lankveld WG, Vonk MC, Teunissen H, et al. Appearance self-esteem in systemic sclerosis-subjective experience of skin deformity and its relationship with physician-assessed skin involvement, disease status and psychological variables. Rheumatology (Oxford). 2007;46:872–6.

    Article  Google Scholar 

  97. Mouthon I, Rannou F, Bérezné A, et al. Development and validation of a scale for mouth handicap in systemic sclerosis: the Mouth Handicap in Systemic Sclerosis Scale. Ann Rheum Dis. 2007;66:1651–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  98. Marmary Y, Glaiss R, Pisanty S. Scleroderma: oral manifestations. Oral Surg Oral Med Oral Pathol. 1981;52:32–7.

    Article  CAS  PubMed  Google Scholar 

  99. Vitali C, Borghi E, napoletano A, et al. Oropharyngolaryngeal disorders in scleroderma: development and validation of the SLS scale. Dysphagia. 2010;25:127–38.

    Article  PubMed  Google Scholar 

  100. Eversole LR, Jacobsen PL, Stone CE. Oral and gingival changes in systemic sclerosis (scleroderma). J Periodontol. 1984;55:175–8.

    Article  CAS  PubMed  Google Scholar 

  101. Poole JL, Brewer C, Rossie K, et al. Factors related to oral hygiene in persons with scleroderma. Int J Dent Hyg. 2005;3:13–7.

    Article  CAS  PubMed  Google Scholar 

  102. Naylor WP, Douglass CW, Mix E. The nonsurgical treatment of microstomia in scleroderma: a pilot study. Oral Surg Oral Med Oral Pathol. 1984;57:508–11.

    Article  CAS  PubMed  Google Scholar 

  103. Pizzo G, Scardina GA, Messina P. Effects of a nonsurgical exercise program on the decreased mouth opening in patients with systemic scleroderma. Clin Oral Investig. 2003;7:175–8.

    Article  CAS  PubMed  Google Scholar 

  104. Yuen HK, Marlow NM, Reed SG, et al. Effect of orofacial exercises on oral aperture in adults with systemic sclerosis. Disabil Rehabil. 2012;34:84–9.

    Article  PubMed  Google Scholar 

  105. Yuen HK, Weng Y, Bandyopadhyay D, et al. Effect of a multi-faceted intervention on gingival health among adults with systemic sclerosis. Clin Exp Rheumatol. 2011;29 Suppl 65:526–32.

    Google Scholar 

  106. Wood RE, Lee P. Analysis of the oral manifestations of systemic sclerosis (scleroderma). Oral Surg Oral Med Oral Pathol. 1988;65:172–8.

    Article  CAS  PubMed  Google Scholar 

  107. Rout PG, Hamburger J, Potts AJ. Orofacial radiological manifestations of systemic sclerosis. Dentomaxillofac Radiol. 1996;25:193–6.

    Article  CAS  PubMed  Google Scholar 

  108. Avouac J, Sordet C, Depinay C, et al. Systemic sclerosis-associated Sjögren’s syndrome and relationship to the limited cutaneous subtype: results of a prospective study of sicca syndrome in 133 consecutive patients. Arthritis Rheum. 2006;54:2243–9.

    Article  CAS  PubMed  Google Scholar 

  109. Drosos AA, Andonopoulos AP, Costopoulos JS, et al. Sjögren’s syndrome in progressive systemic sclerosis. J Rheumatol. 1988;15:965–8.

    CAS  PubMed  Google Scholar 

  110. Avouac J, Airo P, Dieude P, et al. Associated autoimmune diseases in systemic sclerosis define a subset of patients with milder disease: results from 2 large cohorts of European Caucasian patients. J Rheumatol. 2010;37:608–14.

    Article  PubMed  Google Scholar 

  111. Kobak S, Oksel F, Aksu K, et al. The frequency of sicca symptoms and Sjögren’s syndrome in patients with systemic sclerosis. Int J Rheum Dis. 2013;16:88–92.

    Article  PubMed  Google Scholar 

  112. Hebbar M, Janin A, Huglo D, et al. Xerostomia in systemic sclerosis: systematic evaluation by salivary scintigraphy and lip biopsy in thirty-four patients. Arthritis Rheum. 1994;37:439–41.

    Article  CAS  PubMed  Google Scholar 

  113. Janin A, Gosselin B, Gosset D, et al. Histological criteria of Sjögren’s syndrome in scleroderma. Clin Exp Rheumatol. 1989;7:167–9.

    CAS  PubMed  Google Scholar 

  114. Baron M, Hudson M, Tatibouet S, et al. The Canadian systemic sclerosis oral health study III: relationship between disease characteristics and oro-facial manifestations in systemic sclerosis. Arthritis Care Res (Hoboken). 2015;67(5):681–90. [Epub ahead of print].

    Google Scholar 

  115. Fischer DJ, Patton LL. Scleroderma-oral manifestations and treatment challenges. Spec Care Dentist. 2000;20:240–4.

    Article  CAS  PubMed  Google Scholar 

  116. Baron M, Hudson M, Tatibouet S, et al. The Canadian systemic sclerosis oral health study: orofacial manifestations and oral health-related quality of life in systemic sclerosis compared with the general population. Rheumatology. 2014;53:1386–94.

    Article  PubMed  PubMed Central  Google Scholar 

  117. Baron M, Hudson M, Tatibouet S, et al. The Canadian systemic sclerosis oral health study II: the relationship between oral and global health-related quality of life in systemic sclerosis. Rheumatology. 2015;54(4):692–6. [Epub ahead of print].

    Google Scholar 

  118. Rowell NR, Hopper FE. The periodontal membrane in systemic sclerosis. Br J Dermatol. 1977;96:15–20.

    Article  CAS  PubMed  Google Scholar 

  119. Alexandridis C, White SC. Periodontal ligament changes in patients with progressive systemic sclerosis. Oral Surg Oral Med Oral Pathol. 1984;58:113–8.

    Article  CAS  PubMed  Google Scholar 

  120. Gores RJ. Dental characteristics associated with acrosclerosis and diffuse scleroderma. J Am Dent Assoc. 1957;54:755–9.

    Article  CAS  PubMed  Google Scholar 

  121. Yuen HK, Weng Y, Reed SG, et al. Factors associated with gingival inflammation among adults with systemic sclerosis. Int J Dent Hygiene. 2014;12:55–61.

    Article  CAS  Google Scholar 

  122. Nauet PL. Scleroderma and dental health. Scleroderma Found. 1999;2:14–5.

    Google Scholar 

  123. Yuen HK, Hant FN, Hatfield C, et al. Factors associated with oral hygiene practices among adults with systemic sclerosis. Int J Dent Hygiene. 2014;12:180–6.

    Article  CAS  Google Scholar 

  124. Tűrk AG, Ulusoy M. A collapsible partial denture for a patient with limited mouth opening induced by scleroderma: a clinical report. J Prosthodont. 2015;24(4):334–8. [Epub ahead of print].

    Google Scholar 

  125. Nicholson D, White S, Lipson A, et al. Progressive systemic sclerosis and graves’ disease report of three cases. Arch Intern Med. 1986;146:2350–2.

    Article  CAS  PubMed  Google Scholar 

  126. Nakamura T, Higashi S, Tomoda K, et al. Primary biliary cirrhosis (PBC)-CREST overlap syndrome with coexistence of Sjögren’s syndrome and thyroid dysfunction. Clin Rheumatol. 2007;26:596–600.

    Article  PubMed  Google Scholar 

  127. Horita M, Takahashi N, Seike M, et al. A case of primary biliary cirrhosis associated with hashimoto’s thyroiditis, scleroderma and Sjögren’s syndrome. Intern Med. 1992;31:418–21.

    Article  CAS  PubMed  Google Scholar 

  128. D’Angelo WA, Fries JF, Masi AT, et al. Pathologic observations in systemic sclerosis (scleroderma). A study of fifty-eight autopsy cases and fifty-eight matched controls. Am J Med. 1969;46:428–40.

    Article  PubMed  Google Scholar 

  129. Gordon MB, Klein I, Dekker A, et al. Thyroid disease in progressive systemic sclerosis: increased frequency of glandular fibrosis and hypothyroidism. Ann Intern Med. 1981;95:431–5.

    Article  CAS  PubMed  Google Scholar 

  130. Hudson M, Rojas-Villarraga A, Coral-Alverado P, et al. Polyautoimmunity and familial autoimmunity in systemic sclerosis. J Autoimmun. 2008;31:156–9.

    Article  CAS  PubMed  Google Scholar 

  131. Biro E, Szekanecz Z, Czirjak L, et al. Association of systemic and thyroid autoimmune diseases. Clin Rheumatol. 2006;25:240–5.

    Article  PubMed  Google Scholar 

  132. Marasini B, Ferrari PA, Solaro N, et al. Thyroid dysfunction in women with systemic sclerosis. Ann N Y Acad Sci. 2007;1108:305–11.

    Article  CAS  PubMed  Google Scholar 

  133. Antonelli A, Ferri C, Fallahi P, et al. Clinical and subclinical autoimmune thyroid disorders in systemic sclerosis. Eur J Endocrinol. 2007;156:431–7.

    Article  CAS  PubMed  Google Scholar 

  134. Lippi G, Caramaschi P, Montagnana M, et al. Thyroid status in patients with systemic sclerosis. J Clin Rheumatol. 2006;12:322–4.

    Article  PubMed  Google Scholar 

  135. Innocencio RM, Romaldini JH, Ward LS. Thyroid autoantibodies in autoimmune diseases. Medicina (B Aires). 2004;64:227–30.

    CAS  Google Scholar 

  136. Kahl LE, Medsger Jr TA, Klein I. Prospective evaluation of thyroid function in patients with systemic sclerosis (scleroderma). J Rheumatol. 1986;13:103–7.

    CAS  PubMed  Google Scholar 

  137. De Keyser L, Narhi DC, Furst DE, et al. Thyroid dysfunction in a prospectively followed series of patients with progressive systemic sclerosis. J Endocrinol Invest. 1990;13:161–9.

    Article  PubMed  Google Scholar 

  138. Antonelli A, Fallahi P, Ferrari SM, et al. Incidence of thyroid disorders in systemic sclerosis: results from a longitudinal follow-up. J Clin Endocrinol Metab. 2013;98:E1198–202.

    Article  CAS  PubMed  Google Scholar 

  139. Danielides S, Mavragani CP, Katsakoulas I, et al. Increased prevalence of anti-thyroid antibodies in patients with limited scleroderma. Scand J Rheumatol. 2011;40:299–303.

    Article  CAS  PubMed  Google Scholar 

  140. Robinson Jr D, Eisenberg D, Nietert PJ, et al. Systemic sclerosis prevalence and comorbidities in the US, 2001–2002. Curr Med Res Opin. 2008;24:1157–66.

    Article  PubMed  Google Scholar 

  141. McMahon RF, Babbs C, Warnes TW. Nodular regenerative hyperplasia of the liver, CREST syndrome and primary biliary cirrhosis: an overlap syndrome? Gut. 1989;30:1430–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  142. Efe C, Ozasian E, Nasiroglu N, et al. The development of autoimmune hepatitis and primary biliary cirrhosis overlap syndrome during the course of connective tissue diseases: report of three cases and review of the literature. Dig Dis Sci. 2010;55:2417–21.

    Article  PubMed  Google Scholar 

  143. Skare TL, Nisihara RM, Haideer O, et al. Liver autoantibodies in patients with scleroderma. Clin Rheumatol. 2011;30:129–32.

    Article  PubMed  Google Scholar 

  144. Reynolds TB, Denison EK, Frankl HD, et al. Primary biliary cirrhosis with scleroderma, Raynaud’s phenomenon and telangiectasia, new syndrome. Am J Med. 1971;50:302–12.

    Article  CAS  PubMed  Google Scholar 

  145. Assassi S, Fritzler MJ, Arnett FC, et al. Primary biliary cirrhosis (PBC), PBC autoantibodies, and hepatic parameter abnormalities in a large population of systemic sclerosis patients. J Rheumatol. 2009;36:2250–6.

    Article  PubMed  PubMed Central  Google Scholar 

  146. Jacobsen S, Halberg P, Ullman S, et al. Clinical features and serum antinuclear antibodies in 230 Danish patients with systemic sclerosis. Br J Rheumatol. 1998;37:39–45.

    Article  CAS  PubMed  Google Scholar 

  147. Rigamonti C, Shand LM, Feudjo M, et al. Clinical features and prognosis of primary biliary cirrhosis associated with systemic sclerosis. Gut. 2006;55:388–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  148. Powell FC, Schroeter AL, Dickson ER. Primary biliary cirrhosis and the CREST syndrome: a report of 22 cases. Q J Med. 1987;62:75–82.

    CAS  PubMed  Google Scholar 

  149. Watt FE, James OF, Jones DE. Patterns of autoimmunity in primary biliary cirrhosis patients and their families: a population-based cohort study. QJM. 2004;97:397–406.

    Article  CAS  PubMed  Google Scholar 

  150. Abraham S, Begum S, Isenberg D. Hepatic manifestations of autoimmune rheumatic diseases. Ann Rheum Dis. 2004;63:123–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  151. Akimoto S, Ishikawa O, Takagi H, et al. Immunological features of patients with primary biliary cirrhosis (PBC) overlapping systemic sclerosis: a comparison with patients with PBC alone. J Gastroenterol Hepatol. 1998;13:897–901.

    Article  CAS  PubMed  Google Scholar 

  152. Akimoto S, Ishikawa O, Muro Y, et al. Clinical and immunological characterization of patients with systemic sclerosis overlapping primary biliary cirrhosis: a comparison with patients with systemic sclerosis alone. J Dermatol. 1999;26:18–22.

    Article  CAS  PubMed  Google Scholar 

  153. Agmon-Levin N, Shapira Y, Selmi C, et al. A comprehensive evaluation of serum autoantibodies in primary biliary cirrhosis. J Autoimmun. 2010;34:55–8.

    Article  CAS  PubMed  Google Scholar 

  154. Nakamura M, Kondo H, Bori T, et al. Anti-gp210 and anti-centromere antibodies are different risk factors for the progression of primary biliary cirrhosis. Hepatology. 2007;45:118–27.

    Article  CAS  PubMed  Google Scholar 

  155. Gao L, Tian X, Liu B, et al. The value of antinuclear antibodies in primary biliary cirrhosis. Clin Exp Med. 2008;8:9–15.

    Article  CAS  PubMed  Google Scholar 

  156. Liberal R, Grant CR, Sakkas L, et al. Diagnostic and clinical significance of anti-centromere antibodies in primary biliary cirrhosis. Clin Res Hepatol Gastroenterol. 2013;37:572–85.

    Article  CAS  PubMed  Google Scholar 

  157. Gupta RC, Seibold JR, Krishnan MR, et al. Precipitating autoantibodies to mitochondrial proteins in progressive systemic sclerosis. Clin Exp Immunol. 1984;58:68–76.

    CAS  PubMed  PubMed Central  Google Scholar 

  158. Norman GL, Bialek A, Encabo S, et al. Is prevalence of PBC underestimated in patients with systemic sclerosis? Dig Liver Dis. 2009;41:762–4.

    Article  CAS  PubMed  Google Scholar 

  159. Pope JE, Thompson A. Antimitochondrial antibodies and their significance in diffuse and limited scleroderma. J Clin Rheumatol. 1999;5:206–9.

    Article  CAS  PubMed  Google Scholar 

  160. Sakauchi F, Mori M, Zeniya M, et al. Antimitochondrial antibody negative primary biliary cirrhosis in Japan: utilization of clinical data when patients applied to receive public financial aid. J Epidemiol. 2006;16:30–4.

    Article  PubMed  Google Scholar 

  161. Zuchner D, Sternsdorf T, Szostecki C, et al. Prevalence, kinetics, and therapeutic modulation of autoantibodies against Sp100 and promyelocytic leukemia protein in a large cohort of patients with primary biliary cirrhosis. Hepatology. 1997;26:1123–30.

    CAS  PubMed  Google Scholar 

  162. Goulis J, Leandro G, Burroughs AK. Randomised controlled trials of ursodeoxycholic-acid therapy for primary biliary cirrhosis: a meta-analysis. Lancet. 1999;354:1053–60.

    Article  CAS  PubMed  Google Scholar 

  163. Floreani A, Caroli D, Variola A, et al. A 35-year follow-up of a large cohort of patients with primary biliary cirrhosis seen at a single centre. Liver Int. 2011;31:361–8.

    Article  PubMed  Google Scholar 

  164. Jones DE, Al-Rifai A, Frith J, et al. The independent effects of fatigue and UDCA therapy on mortality in primary biliary cirrhosis: results of a 9 year follow-up. J Hepatol. 2010;53:911–7.

    Article  CAS  PubMed  Google Scholar 

  165. Nishio A, Neuberger J, Gershwin ME. Management of patients with primary biliary cirrhosis: a practical guide. BioDrugs. 1999;12:159–73.

    Article  CAS  PubMed  Google Scholar 

  166. Kojima H, Uemura M, Sakurai S, et al. Clinical features of liver disturbance in rheumatoid diseases: clinicopathological study with special reference to the cause of liver disturbance. J Gastroenterol. 2002;37:617–25.

    Article  PubMed  Google Scholar 

  167. Shah AA, Wigley FM. Often forgotten manifestations of systemic sclerosis. Rheum Dis Clin North Am. 2008;34:221–38.

    Article  PubMed  Google Scholar 

  168. Ishikawa M, Okada J, Shibuya A, et al. CREST syndrome (calcinosis cutis, raynaud’s phenomenon, sclerodactyly, and telangiectasia) associated with autoimmune hepatitis. Intern Med. 1995;34:6–9.

    Article  CAS  PubMed  Google Scholar 

  169. Marie I, Levesque H, Tranvouez JL, et al. Autoimmune hepatitis and systemic sclerosis: a new overlap syndrome? Rheumatology (Oxford). 2001;40:102–6.

    Article  CAS  Google Scholar 

  170. Yabe H, Noma K, Tada N, et al. A case of CREST syndrome with rapidly progressive liver damage. Intern Med. 1992;31:69–73.

    Article  CAS  PubMed  Google Scholar 

  171. West M, Jasin HE, Medhekar S. The development of connective tissue diseases in patients with autoimmune hepatitis: a case series. Semin Arthritis Rheum. 2006;35:344–8.

    Article  CAS  PubMed  Google Scholar 

  172. Friedman LS, Gee MS, Misdraji J. Case records of the Massachusetts General Hospital, case 39-2010. A 19-year-old woman with nausea, jaundice, and pruritus. N Engl J Med. 2010;23:2548–57.

    Google Scholar 

  173. Perez Ruiz F, Orte Martinez FJ, Zea Mendoza AC, et al. A nodular regenerative hyperplasia of the liver in rheumatic diseases: report of seven cases and review of the literature. Semin Arthritis Rheum. 1991;21:47–54.

    Article  CAS  PubMed  Google Scholar 

  174. Kaburaki J, Kuramochi S, Fujii T, et al. Nodular regenerative hyperplasia of the liver in a patient with systemic sclerosis. Clin Rheumatol. 1996;15:613–6.

    Article  CAS  PubMed  Google Scholar 

  175. Fraile G, Rodriguez-Garcia JL, Moreno A. Primary sclerosing cholangitis associated with systemic sclerosis. Postgrand Med J. 1991;67:189–92.

    Article  CAS  Google Scholar 

  176. Moschos J, Leontiadis GI, Kelly C, et al. Idiopathic portal hypertension complicating systemic sclerosis: a case report. BMC Gastroenterol. 2005;26:5–16.

    Google Scholar 

  177. Kogawa H, Migita K, Ito M, et al. Idiopathic portal hypertension associated with systemic sclerosis and Sjögren’s syndrome. Clin Rheumatol. 2005;24:544–7.

    Article  PubMed  Google Scholar 

  178. Kucharz EJ, Jonderko G, Rubisz-Brzezinska J, et al. Premictional volume and contractility of the urinary bladder in patients with systemic sclerosis. Clin Rheumatol. 1996;15:118–20.

    Article  CAS  PubMed  Google Scholar 

  179. Minervini R, Morelli G, Minervini A, et al. Bladder involvement in systemic sclerosis: urodynamic and histological evaluation in 23 patients. Eur Urol. 1998;34:47–52.

    Article  CAS  PubMed  Google Scholar 

  180. Lazzeri M, Beneforti P, Benaim G, et al. Vesical dysfunction in systemic sclerosis (scleroderma). J Urol. 1995;153:1184–7.

    Article  CAS  PubMed  Google Scholar 

  181. Raz S, Boxer R, Waisman J, et al. Scleroderma of lower urinary tract. Urology. 1977;9:682–3.

    Article  CAS  PubMed  Google Scholar 

  182. Lally EV, Kaplan SR, Susset JG, et al. Pathologic involvement of the urinary bladder in progressive systemic sclerosis. J Rheumatol. 1985;12:778–81.

    CAS  PubMed  Google Scholar 

  183. La Civita L, Fiorentini L, Tognetti A, et al. Severe urinary bladder involvement in systemic sclerosis: case report and review of the literature. Clin Exp Rheumatol. 1998;16:591–3.

    PubMed  Google Scholar 

  184. De Luca A, Terrone C, Tirri E, et al. Vesical telangiectasias as a cause of macroscopic hematuria in systemic sclerosis. Clin Exp Rheumatol. 2001;19:93–4.

    PubMed  Google Scholar 

  185. Rennie C, Britton J, Rouse P. Bilateral avascular necrosis of the lunate in a patient with server Raynaud’s phenomenon and scleroderma. J Clin Rheumatol. 1999;5:165–8.

    Article  CAS  PubMed  Google Scholar 

  186. Matsumoto AK, Moore R, Alli P, et al. Three cases of osteonecrosis of the lunate bone of the wrist in scleroderma. Clin Exp Rheumatol. 1999;17:730–2.

    CAS  PubMed  Google Scholar 

  187. Agus B. Bilateral aseptic necrosis of the lunate in systemic sclerosis. Clin Exp Rheumatol. 1987;5:155–7.

    CAS  PubMed  Google Scholar 

  188. Kawai H, Tsuyuguchi Y, Yonenobu K, et al. Avascular necrosis of the carpal scaphoid associated with progressive systemic sclerosis. Hand. 1983;15:270–3.

    CAS  PubMed  Google Scholar 

  189. Nowlin NS, Brick JE, Weaver DJ, et al. Impotence in scleroderma. Ann Intern Med. 1986;104:794–8.

    Article  CAS  PubMed  Google Scholar 

  190. Klein LE, Posner MS. Progressive systemic sclerosis and impotence. Letter to the Editor. Ann Intern Med. 1981;95:658.

    Article  CAS  PubMed  Google Scholar 

  191. Lally EV, Jimenez SA. Impotence in progressive systemic sclerosis. Letter to the Editor. Ann Intern Med. 1982;96:125.

    Google Scholar 

  192. Nowlin NS, Brick JE, Weaver DJ, et al. Impotence in scleroderma. Letter to the Editor. Ann Intern Med. 1987;106:910.

    Google Scholar 

  193. Nowlin NS, Brick JE, Weaver DJ, et al. Impotence in scleroderma. Letter to the Editor. Ann Intern Med. 1988;109:148.

    Google Scholar 

  194. Sukenik S, Abarbanel JM, Buskila D, et al. Impotence, carpal tunnel syndrome and peripheral neuropathy as presenting symptoms in progressive systemic sclerosis. Letter to the Editor. J Rheumatol. 1987;14(3):641–3.

    CAS  PubMed  Google Scholar 

  195. Rossman B, Zorgniotti AW. Progressive systemic sclerosis (scleroderma) and impotence. Urology. 1989;33:189–92.

    Article  CAS  PubMed  Google Scholar 

  196. Hong P, Pope JE, Ouimet JM, et al. Erectile dysfunction associated with scleroderma: a case-control study of men with scleroderma and rheumatoid arthritis. J Rheumatol. 2004;31:508–13.

    PubMed  Google Scholar 

  197. Foocharoen C, Tyndall A, Hachulla E, et al. Erectile dysfunction is frequent in systemic sclerosis and associated with severe disease: a study of EULAR Scleroderma Trial and Research group. Arthritis Res Therapy. 2012;14:R37.

    Article  Google Scholar 

  198. Rosato E, Aversa A, Molinaro I, et al. Erectile dysfunction of sclerodermic patients correlates with digital vascular damage. Eur J Intern Med. 2011;22:318–21.

    Article  PubMed  Google Scholar 

  199. Rosato E, Barbano B, Gigante A, et al. Erectile dysfunction, endothelium dysfunction and microvascular damage in patients with systemic sclerosis. J Sex Med. 2013;10:1380–8.

    Article  PubMed  Google Scholar 

  200. Keck A, Foocharoen C, Rosato E, et al. Nailfold capillary abnormalities in erectile dysfunction of systemic sclerosis. A EUSTAR group analysis. Rheumatology. 2014;53:639–43.

    Article  PubMed  Google Scholar 

  201. Bivalacqua TJ, Usta MF, Champion HC, et al. Endothelial dysfunction in erectile dysfunction: role of the endothelium in erectile physiology and disease. J Androl. 2003;24:S17–37.

    Article  CAS  PubMed  Google Scholar 

  202. Burnett AL. Metabolic syndrome, endothelial dysfunction, and erectile dysfunction: association and management. Curr Urol Rep. 2005;6:470–5.

    Article  PubMed  Google Scholar 

  203. Nehra A, Hall SJ, Basile G, et al. Systemic sclerosis and impotence: a clinicopathological correlation. J Urol. 1995;53:1140–6.

    Google Scholar 

  204. Aversa A, Proietti M, Bruzziches R, et al. The penile vasculature in systemic sclerosis: a duplex ultrasound study. J Sex Med. 2006;3:554–8.

    Article  PubMed  Google Scholar 

  205. Granchi S, Vannelli GB, Vignozzi L, et al. Expression and regulation of endothelin-1 and its receptors in human penile smooth muscle cells. Mol Hum Reprod. 2002;8:1053–64.

    Article  CAS  PubMed  Google Scholar 

  206. Varga J, Lally E, Jimenez S. Endocrinopathy and other visceral organ involvement in progressive systemic sclerosis. Systemic sclerosis: scleroderma, New York; Wiley. 1988. p. 267–78.

    Google Scholar 

  207. Aversa A, Basciani S, Visca P, et al. Platelet-derived growth factor (PDGF) and PDGF receptors in rat corpus cavernosum: changes in expression after transient in vivo hypoxia. J Endocrinol. 2001;170:395–402.

    Article  CAS  PubMed  Google Scholar 

  208. Faller DV. Endothelial cell responses to hypoxic stress. Clin Exp Pharmacol Physiol. 1999;26:74–84.

    Article  CAS  PubMed  Google Scholar 

  209. Walker UA, Tyndall A, Ruszat R. Erectile dysfunction in systemic sclerosis. Ann Rheum Dis. 2009;68:1083–5.

    Article  CAS  PubMed  Google Scholar 

  210. Aversa A, Bruzziches R, Francomano D, et al. Penile involvement in systemic sclerosis: new diagnostic and therapeutic aspects. Int J Rheum. 2010;2010:708067.

    Google Scholar 

  211. Proietti M, Aversa A, Letizia C, et al. Erectile dysfunction in systemic sclerosis: effects of long term inhibition of phosphodiesterase type-5 on erectile function and plasma endothelin-1 levels. J Rheumatol. 2007;34:1712–7.

    CAS  PubMed  Google Scholar 

  212. Aversa A, Caprio M, Rosano GM, et al. Endothelial effects of drugs designed to treat erectile dysfunction. Curr Pharm Des. 2008;14:3768–78.

    Article  CAS  PubMed  Google Scholar 

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Lally, E.V., Shah, A.A., Wigley, F.M. (2017). Overlooked Manifestations. In: Varga, J., Denton, C., Wigley, F., Allanore, Y., Kuwana, M. (eds) Scleroderma. Springer, Cham. https://doi.org/10.1007/978-3-319-31407-5_38

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