[Iloprost for severe Raynaud's phenomenon and ischaemic ulcers related with systemic diseases].
OBJECTIVE
To evaluate the long term efficacy of treatment with intravenous iloprost for severe Raynaud's phenomenon (RP) and ischemic leg ulcers in patients with autoimmune systemic diseases.


METHODS
Prospective observational study over 2 years with iloprost (intravenous infusions, 0.5 to 2 ng/kg/min, initial cycle of 5 consecutive days and maintenance infusions during 24 h monthly, lengthened when it was needed) in patients with severe RP and ischemic leg ulcers whithout response to conventional therapy. Treatment was halted in patients with a good response after one year of treatment, with regular clinical controls.


RESULTS
We treated 23 patients. Iloprost reduced significantly the mean number (SD) of monthly episodes of RP (150.38 [102.04] initially and 40.05 [78.06] at the end; p < 0.0005), the mean highest duration of episodes of RP (21.86 [26.96] min initially and 7.14 [9.87] min at the end; p = 0.013), the associated pain (p = 0.005), and the mean number of ischemic digital (4.25 [2.86] initially and 0.63 [2.25] at the end; p = 0.003) and leg ulcers (1.67 [0.52] initially and 0.33 [0.52] at the end; p = 0.01). Articular symptoms and inflammatory markers did not improve. Treatment was stopped in 8 patients (in 5 for a very good evolution and in 3 for other causes), and only 1 of them needed to be treated again. Side effects were seen in all cases but always disappeared after slowing infusion.


CONCLUSIONS
Iloprost was effective in the long term treatment of severe RP and ischemic leg ulcers in patients with autoimmune systemic diseases.
García Hernández
Francisco José
FJ
Unidad de Colagenosis. Servicio de Medicina Interna. Hospital Universitario Virgen del Rocío. Sevilla. España.
Ocaña Medina
Celia
C
Mateos Romero
Luis
L
Molinillo López
Juan
J
Arias Zambrano
Andrés
A
González León
Rocío
R
Sánchez Román
Julio
J
D000328:Adult; D001327:Autoimmune Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D016285:Iloprost / Q000627:therapeutic use*; D007511:Ischemia / Q000150:complications / Q000188:drug therapy / Q000209:etiology; D007866:Leg / Q000098:blood supply; D007871:Leg Ulcer / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D011446:Prospective Studies; D011928:Raynaud Disease / Q000150:complications / Q000188:drug therapy*; D012720:Severity of Illness Index; D013997:Time Factors; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D016285:Iloprost