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World J Rheumatol. Oct 3, 2012; 2(2): 12-20
Published online Oct 3, 2012. doi: 10.5499/wjr.v2.i2.12
Pulmonary arterial hypertension associated with systemic sclerosis: Current diagnostic approach and therapeutic strategies
Olga Vera-Lastra, Mateo Porres-Aguilar
Olga Vera-Lastra, Department of Internal Medicine, Hospital de Especialidades, Centro Médico Nacional la Raza, IMSS, Universidad Nacional Autónoma de México, 02990 Mexico City, México
Mateo Porres-Aguilar, Division of Hospital Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center/Paul L. Foster School of Medicine, El Paso, TX 79905, United States
Author contributions: Vera-Lastra O and Porres-Aguilar M contributed equally in the design and writting of this work.
Correspondence to: Olga Vera-Lastra, MD, Department of Internal Medicine, Hospital de Especialidades, Centro Médico Nacional la Raza, IMSS, Universidad Nacional Autónoma de México, Seris y Saachila s/n, colonia La Raza, 02990 Mexico City, México. olgavera62@yahoo.com.mx
Telephone: +52-55-57245900 Fax: +52-55-57245900
Received: September 28, 2011
Revised: December 23, 2011
Accepted: July 5, 2012
Published online: October 3, 2012
Abstract

Pulmonary arterial hypertension (PAH) represents a devastating vascular complication of systemic sclerosis (SSc) and is found in 10%-15% of cases carrying a severe prognosis. PAH has a dramatic impact on the clinical course and overall survival, being the single most common cause of death in patients with this entity. The clinical course and aggressive progression of PAH has led clinicians to perform annual screening for it, since early detection and diagnosis are the cornerstone of a prompt therapeutic intervention. The diagnosis of PAH can be challenging to clinicians, particularly in its early stages, since in the context of SSc, the multiple causes of dyspnea need to be assessed. Doppler echocardiography represents the best initial screening tool, however, right heart catheterization remains the gold standard and definitive diagnostic means. Remarkable advances have been achieved in elucidating the pathogenesis of PAH in the past two decades, leading to the development of disease-specific targeted therapies: prostacyclin analogues, endothelin receptor antagonists and inhibitors of five phosphodiesterase pathways. However, the clinical response to these therapies in SSc-associated PAH has not been as great as the one seen with idiopathic PAH. This review also focuses on the diagnosis and novel therapies that are currently available for PAH, as well as potential future therapeutic developments based on newly acquired knowledge of diverse pathogenic mechanisms.

Keywords: Pulmonary arterial hypertension; Systemic sclerosis; Diagnosis; Therapy; Prognosis