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Long-term treatment of scleroderma-related digital ulcers with iloprost: a cohort study


1, 2, 3, 4, 5, 6, 7, 8

 

  1. Rheumatology Unit, Scleroderma Unit, University of Modena and Reggio Emilia, Modena, Italy. michelecolaci@virgilio.it
  2. Rheumatology Unit, Scleroderma Unit, University of Modena and Reggio Emilia, Modena, Italy.
  3. Rheumatology Unit, Scleroderma Unit, University of Modena and Reggio Emilia, Modena, Italy.
  4. Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit AOUC, Florence, Italy.
  5. Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit AOUC, Florence, Italy.
  6. Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit AOUC, Florence, Italy.
  7. Department of Experimental and Clinical Medicine, University of Florence, and Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit AOUC, Florence, Italy.
  8. Rheumatology Unit, Scleroderma Unit, University of Modena and Reggio Emilia, Modena, Italy.

CER10476
2017 Vol.35, N°4 ,Suppl.106
PI 0179, PF 0183
Treatment

purchase article

PMID: 28980901 [PubMed]

Received: 04/04/2017
Accepted : 11/07/2017
In Press: 18/09/2017
Published: 12/10/2017

Abstract

OBJECTIVES:
Raynaud’s phenomenon and chronic/recurrent digital ulcers (DU) are main features of systemic sclerosis (SSc). Their treatment includes both systemic (i.e., iloprost) and local therapies. We report the therapeutic effects of iloprost in a cohort of SSc patients during a long-lasting follow-up period.
METHODS:
Fifty consecutive SSc patients (M/F 7/43, age at SSc diagnosis 43.5±12.7SD years) received iloprost infusions for 10±4.2SD years. Iloprost schedule consisted in monthly infusion at 0.8-1 ng/kg body weight/min (average cumulative dose 25 μg), according to patients’ tolerance. For recalcitrant cases, continuous infusion of iloprost (3 days, average 0.2 mg) was administered.
RESULTS:
31/50 (62%) patients showed DU at the beginning of iloprost therapy: among them, 22 (71%) resolved during the follow-up, while the other 9 presented recurrent or chronic DU, despite the treatment. With regards the 19/50 patients without DU at baseline, only one developed skin lesions at the end of 10-year follow-up, when severe pulmonary hypertension developed, which lead to exitus. Considering the 31 patients with DU at baseline, a diffuse skin subset was present in 3/22 patients with healed DU, and in 5/9 who did not (13.6% vs. 55.5%; p=0.027).
CONCLUSIONS:
Iloprost is a long-term effective treatment to achieve healing and prevention in SSc-related DU. Besides the possible problems concerning patients’ tolerability or clinical management, iloprost therapy may be considered of great help in the therapeutic strategy of SSc-related ischaemic manifestations.

Rheumatology Article