Treatment of systemic sclerosis.
A new awareness of the challenges and pitfalls of clinical research in patients with systemic sclerosis has recently arisen. Several editorials discussed concern about the design of therapeutic trials and the need to use established scientific standards to find better markers of disease activity and better ways to measure improvement or deterioration of organ involvement, including the heart, lung, and gastrointestinal tract. This year, an uncontrolled experience in the use of D-penicillamine in the treatment of patients with rapidly progressive skin involvement was reported. In addition, a multicenter study of photopheresis demonstrated benefit compared with D-penicillamine. Several new prokinetic drugs demonstrated promise for the treatment of gastrointestinal disease in patients with systemic sclerosis. Although studies continue to demonstrate the benefit of intravenous prostaglandins in the treatment of Raynaud's phenomenon and digital ulcers in scleroderma, an initial report of oral prostaglandins was disappointing. Clinical researchers are now working together to design multicenter studies and to define new uniform standards of disease activity so that the appropriate treatment for systemic sclerosis can be determined.
Wigley
F M
FM
Johns Hopkins University School of Medicine, Baltimore, Maryland.
D016572:Cyclosporine / Q000627:therapeutic use; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D010396:Penicillamine / Q000627:therapeutic use; D010778:Photochemotherapy; D011928:Raynaud Disease / Q000150:complications / Q000188:drug therapy; D012595:Scleroderma, Systemic / Q000150:complications / Q000188:drug therapy*
D016572:Cyclosporine; D010396:Penicillamine; D008727:Methotrexate