Treating systemic sclerosis in 2001.
Systemic sclerosis (SS) is characterized by sclerosis of the dermis and internal organs and by vascular abnormalities. Although the pathophysiology of the disease has been partly elucidated, the efficacy of long-term treatments remains limited, with no significant increase in survival in prospective studies. Conventional drug treatments are disappointing in clinical practice, and in a recent prospective randomized study standard-dose D-penicillamine was not more effective than mini-dose D-penicillamine. New long-term treatments are emerging for diffuse SS, including cyclophosphamide for patients with progressive interstitial lung disease or stem cell transplantation for those with early organ involvement. The most effective treatments remain symptomatic, such as angiotensin-converting enzyme inhibitors for acute renal crisis, calcium channel antagonists for Raynaud's phenomenon, and proton pump inhibitors for the complications of gastroesophageal reflux. This review article focuses on long-term treatments that are most likely to be effective and suggests symptomatic treatment strategies tailored to specific organ involvements.
Mouthon
L
L
Internal Medicine Department, Hôpital Avicenne, Université Paris-Nord, Bobigny France. luc.mouthon@avc.ap-hop-paris.fr
Agard
C
C
D000970:Antineoplastic Agents / Q000008:administration & dosage; D018501:Antirheumatic Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D010396:Penicillamine / Q000008:administration & dosage; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000534:rehabilitation / Q000628:therapy*; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D010396:Penicillamine