Treatment of systemic sclerosis

• Published in: Annals of the rheumatic diseases 1991-11, Vol.50 (Suppl 4), p.877-886
• Main Author: Medsger, T A
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Colchicine - therapeutic use; Humans; Immunosuppressive Agents - therapeutic use; Medical sciences; Penicillamine - therapeutic use; Pharmacology. Drug treatments; Scleroderma, Systemic - classification; Scleroderma, Systemic - drug therapy; Scleroderma, Systemic - therapy
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.50.Suppl_4.877

Proper classification of patients into diffuse cutaneous and limited cutaneous subsets and the anticipation of complications are the keys to the management of subjects with systemic sclerosis (scleroderma). Patients with early diffuse disease and rapidly progressive skin thickening are at highest risk of developing serious disease of the internal organs (intestine, lung, heart, kidney) and should be considered for disease modifying treatment. The targets of the disease and sites of possible intervention are vascular endothelium (vasoprotective agents), mononuclear cell subsets (immunosuppressive agents), and fibroblasts (colchicine, D-penicillamine). A number of new agents with sound scientific rationale are currently undergoing therapeutic trials. Much can be done to improve the lifestyle of those with scleroderma. The most dramatic recent development is the ability to reverse kidney disease by the prompt use of angiotensin converting enzyme inhibitors and modern methods of renal dialysis and transplantation. Scleroderma is not a hopeless disease.