ARTICLE remission of tinnitus was also reported , with no episodes occurring in the four weeks between consultations . Her overall mood and QOL had improved . She was feeling hopeful and positive about treatment moving forward .
Discussion
The patient ’ s presentation of UCTD had several contributing and perpetuating factors associated with an autoimmune disease and resulting in continual flares , such as a genetic predisposition evident from positive SCL70 , a biomarker for scleroderma , early menopause , silicone breast implants , poor diet , vitamin D deficiency , high levels of stress and a history of EBV . Female endocrinological transitions , such as menopause , elicit hormonal changes that exert significant effects on the innate and adaptive immune systems , increasing susceptibility to autoimmunity , with research demonstrating early onset menopause is significantly associated with autoimmune conditions . 2 Silicone can spread throughout the body , inducing a chronic inflammatory response in tissues ; ASIA and immune dysregulation are common in patients with silicone breast implants , with research showing a direct correlation with SADs . Studies show that 60-80 % of patients demonstrate an amelioration of symptoms after explantation . 11 The patient ’ s diet was inflammatory and lacking in nutrients , consisting of saturated fats , dairy , sugar , caffeine and alcohol , which studies have shown to increase systemic inflammation in the body and risk autoimmunity and symptom flares . 12 Vitamin D exerts an immunomodulatory action in the body , with deficiency significantly associated with autoimmunity ; UCTD patients with deficient vitamin D levels have demonstrated higher rates of progression to defined CTD . 13 Psychosocial stress as a result of high demands in work and family alongside poor diet and alcohol consumption can affect the microbiome and are significant risk factors for autoimmunity . 12 Studies also show significant associations between EBV and SADs due to viral weakening of immune defences and increased inflammation . 14 EBV is also associated with breast cancer , chronic fatigue syndrome , vitamin D deficiency and thyroid disorders , indicating a multifaceted role in the patient ’ s health issues . 15
The patient presented with several concomitant health issues , with tinnitus significantly reducing her QOL . Audiovestibular symptoms , such as tinnitus , are present in 20-70 % of SAD cases due to local immune complex deposition , cytotoxic actions or direct autobodyantigen reactions causing oxidative damage . 16 Currently tinnitus cannot be cured and conventional management targets measures to minimise stress and reduce caffeine and alcohol intake . 17 Tinnitus is commonly treated with antioxidants , indicating a role for antioxidant treatment in alleviating tinnitus naturally . 18
N-acetyl-L-cysteine ( NAC ) is a potent antioxidant that supports bodily reduction-oxidation ( REDOX ) regulatory systems via glutathione synthesis , significantly reducing leucocyte infiltration in inflamed tissues , ameliorating inflammation and slowing pathology progression . Studies support NAC use in alleviating chronic inflammatory pathologies . 19 NAC is used clinically for autoimmunity , liver insufficiency , toxicity , mood disorders , dry eyes , intestinal healing , post-cancer treatment , reducing muscle fatigue and Alzheimer ’ s prevention . 20 Studies also demonstrate amelioration of EBV-induced chronic inflammation with NAC supplementation . 19 Despite conflicting research data as to NAC efficacy in treating tinnitus , case reports demonstrate significant results in tinnitus remittance with 2g daily NAC treatment . 21
Conclusion
UCTD is a complex and debilitating systemic autoimmune disease with potential to progress to a more severe , defined CTD without appropriate management . UCTD can present with comorbidities such as tinnitus that significantly compromise a patient ’ s quality of life . UCTD is currently a poorly understood condition and clinical treatment guidelines are lacking . This case report demonstrates the importance of a quality diet and adequate nutrition in the treatment of UCTD-related symptoms following an autoimmune protocol , and warrants further research into NAC supplementation as a therapeutic tool to manage symptoms and prevent disease progression .
REFERENCES
1 . Mosca M , Tani C , Talarico R , Bombardieri S . Undifferentiated connective tissue diseases ( UCTD ): simplified systemic autoimmune diseases . Autoimmunity reviews . 2011 ; 10 ( 5 ): 256-8 .
2 . Desai MK , Brinton RD . Autoimmune disease in women : endocrine transition and risk across the lifespan . Frontiers in endocrinology . 2019 ; 10:265 .
3 . Rosenblum MD , Remedios KA , Abbas AK . Mechanisms of human autoimmunity . The Journal of clinical investigation . 2015 ; 125 ( 6 ): 2228-33 .
4 . Shi G , Zhang J , Zhang ZJ , Zhang X . Systemic autoimmune diseases 2014 . Journal of immunology research . 2015 .
5 . Spinillo A , Beneventi F , Caporali R , Ramoni V , Montecucco C . Undifferentiated connective tissue diseases and adverse pregnancy outcomes . An undervalued association ? American Journal of Reproductive Immunology . 2017 ; 78 ( 6 ): e12762 .
6 . Antunes M , Scirè CA , Talarico R , Alexander T , Avcin T , Belocchi C , Doria A , Franceschini F , Galetti I , Govoni M , Hachulla E . Undifferentiated connective tissue disease : state of the art on clinical practice guidelines . RMD open . 2019 ; 4 ( Suppl 1 ): e000786 .
7 . Mosca M , Tani C , Vagnani S , Carli L , Bombardieri S . The diagnosis and classification of undifferentiated connective tissue diseases . Journal of Autoimmunity . 2014 ; 48:50-2 .
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