| Treatment of Systemic Sclerosis Complications: What to Use When First-Line Treatment Fails-A Consensus of Systemic Sclerosis Experts. | |
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MedLine Citation:
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PMID: 22464314 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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OBJECTIVES: There is a need for standardization in systemic sclerosis (SSc) management. METHODS: SSc experts (n = 117) were sent 3 surveys to gain consensus for SSc management. RESULTS: First-line therapy for scleroderma renal crisis (SRC) was an angiotensin-converting enzyme inhibitor (ACEi). For SRC there were not many differences between treating mild or severe SRC. In general, Second-line was to add either a calcium channel blocker (CCB) or angiotensin receptor blocker (ARB) and then an alpha-blocker (66% agreed). Endothelin receptor agonists (ERAs) were the first treatment in mild pulmonary arterial hypertension (PAH) (72%), followed by adding a phosphodiesterase-5 inhibitor (PDE5i) (77%) and then a prostanoid (73%). For severe PAH, initial treatment was 1 of the following: a prostanoid (49%), combination of a ERA and a PDE5i (18%), or combination of a ERA and a prostanoid (16%) (71% agreed). For mild Raynaud's phenomenon (RF), after a CCB and adding a PDE5i (35%), trying an ARB (32%) and finally a prostanoid (23%) was suggested. For more severe RF, 54% agreed on adding a PDE5i (45%) or prostanoid (32%) to a CCB. In the prevention of digital ulcers (DU), initial treatment was a CCB (73%), then adding a PDE5i, then use of a ERA, and then a prostanoid (44% agreed). In interstitial lung disease/pulmonary fibrosis, for induction, usually intravenous cyclophosphamide and mycophenolate mofetil (MMF) or azathioprine were chosen. For maintenance, MMF was chosen by three-fourths (56% agreed). For gastroesophageal reflux disease, >50% would exceed the maximum recommended proton pump inhibitor dose if required (72% agreed). For skin involvement after methotrexate, MMF was usually chosen (37% agreement). For SSC-related inflammatory arthritis, methotrexate therapy (60%) was followed by adding corticosteroids (37%) or hydroxychloroquine (31%) (62% agreed). CONCLUSIONS: Discrepancies in drug choices occurred in treatment after first line in SSc. Not all algorithms had good agreement. This study provides some guidance for SSc management. |
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Authors:
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Kyle M Walker; Janet Pope; ; |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-3-29 |
Journal Detail:
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Title: Seminars in arthritis and rheumatism Volume: - ISSN: 1532-866X ISO Abbreviation: - Publication Date: 2012 Mar |
Date Detail:
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Created Date: 2012-4-2 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 1306053 Medline TA: Semin Arthritis Rheum Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2012 Elsevier Inc. All rights reserved. |
Affiliation:
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Trinity College, Dublin, Dublin, Ireland. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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