title: Treatment of calcinosis universalis with low-dose warfarin.
abstract: Patients with calcinosis universalis secondary to dermatomyositis or systemic sclerosis have increased levels of the calcium-binding amino acid, gamma-carboxyglutamic acid. The enzyme that effects gamma carboxylation of glutamic acid is warfarin-sensitive. Four patients with calcinosis universalis were treated with 1 mg per day of warfarin for 18 months in a non-blind initial study. Two patients had both decreased gamma-carboxyglutamic acid urinary concentration and decreased extra-skeletal uptake on technetium 99m-diphosphonate whole-body nuclear scanning. In a subsequent double-blind placebo study, two thirds of the patients receiving 1 mg per day of warfarin had decreases in extra-skeletal nuclear tracer uptake after 18 months, compared with none of the four patients receiving placebo. No patient had a change in clinical assessment, bleeding complication, or baseline normal prothrombin time. This low-dose warfarin regimen appears to have no demonstrable adverse effects, and these results suggest a beneficial effect on the progression of calcinosis in these rheumatic diseases.
mesh_terms: D001842:Bone and Bones / Q000000981:diagnostic imaging; D002114:Calcinosis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D003882:Dermatomyositis / Q000150:complications; D004311:Double-Blind Method; D004341:Drug Evaluation; D006801:Humans; D011859:Radiography; D011877:Radionuclide Imaging; D011897:Random Allocation; D012595:Scleroderma, Systemic / Q000150:complications; D012871:Skin Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D013997:Time Factors; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D014859:Warfarin