ABANO TERME, ITALY — The unexpected finding of increased rates of diabetes in patients with morphea suggests that metabolic factors may be involved in triggering the condition, Dr. Christiane Pfeiffer reported in a poster session at a congress on skin, rheumatism, and autoimmunity.
Several etiologic factors have been reported, though inconsistently, for morphea. Infection, particularly with Borrelia burgdorferi, has been suggested as a trigger, as have vaccination and trauma. But a questionnaire survey of 113 patients seeking care at a university-based dermatology department in Saxony, Germany, found twice the prevalence of diabetes in patients with morphea, compared with the normal population in the district. (See box.) This finding has not previously been reported for morphea, or cutaneous scleroderma, and the association may involve the effects of nonenzymatic glycosylation of extracellular matrix components in diabetes, she said.
Moreover, obesity was not implicated, because the increase in diabetes was seen even though body mass index was not significantly different in morphea patients than in age- and sex-matched controls, said Dr. Pfeiffer of the department of dermatology, University Hospital, Dresden, Germany.
Analysis of responses to questionnaires filled out by patients also revealed that the number of plaques correlated with the severity of disease and extracutaneous involvement.
In patients with five or more lesions, arthralgias were reported by 23.9% of the patients, myalgias by 15.2%, contractures by 10.9%, and esophageal dysmotility by 6.5%. In those with fewer than five lesions, the same complications were reported by 7.1%, 9.5%, 2.4%, and 2.4% of patients, respectively, she said. High numbers of lesions also correlated with increases in erythrocyte sedimentation rate and C-reactive protein levels.
A total of 78% of patients had the plaque variant of morphea, with the rest having the guttate variant, idiopathic atrophoderma of Pasini and Pierini, linear scleroderma, and profound scleroderma. In patients with all variants of morphea, lesions were found on the trunk in 81%, whereas only 8 patients had facial lesions. Overlap syndromes also were reported; 8 patients had morphea and lichen sclerosus et atrophicus; and two had morphea with eosinophilic fasciitis.
“Our data also suggest the existence of variant-specific organ involvement in morphea,” Dr. Pfeiffer said. Arthralgias were reported by 40% of patients with atrophoderma Pasini and Pierini, while linear scleroderma was associated with the presence of antinuclear antibodies, muscular atrophy, and contractures.
In patients with profound scleroderma, 45% had myalgias and myopathy. There were no increases in Raynaud symptoms, carpal tunnel syndrome, or lung disorders in patients with any of the variants, she said.