title: Photochemotherapy for systemic sclerosis: effect on clinical and molecular markers.
abstract: BACKGROUND
  The cutaneous changes seen in systemic sclerosis (SSc) can result in considerable patient morbidity.
  
  
  OBJECTIVE
  We previously reported on the beneficial effect of psoralen ultraviolet A (PUVA) phototherapy in 13 patients with morphoea. We now report the findings of a study in which patients with SSc were treated with PUVA.
  
  
  METHODS
  Twelve patients with SSc were treated with PUVA phototherapy. The effect on cutaneous disease activity was assessed using the modified Rodnan score, and the effect on serological and immunohistochemical growth factors and adhesion molecules was also measured.
  
  
  RESULTS
  The median Rodnan score at baseline was 24.5 [interquartile range (IQR) 18.5-26.0]. The median number of treatments with PUVA was 24 exposures (IQR 20-26) with a median cumulative exposure of 68.3 J/cm(2) (IQR 28.6-139.8). Of the 12 patients, 11 responded well to phototherapy with a mean change in Rodnan score of 6.58 (36.98%) (P < 0.01, Wilcoxon signed ranks test). After treatment with PUVA there was a significant increase in circulating tumour necrosis factor-alpha levels in 8/12 patients (P = 0.03). In 7/12 patients there was an increase in E-selectin and vascular cell adhesion molecule, although this was not significant.
  
  
  CONCLUSIONS
  PUVA treatment is associated with a significant improvement in cutaneous symptoms in patients with SSc as measured by the Rodnan score (P < 0.01). Specific lymphocyte markers, adhesion molecules and cytokines are also affected by this treatment, helping to clarify further the mechanism of action of PUVA treatment and our understanding of the primary pathological process.
authors.affiliation: Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK. nailausmani@hotmail.com
authors.forename: N
authors.initials: N
authors.lastname: Usmani
authors.forename: A
authors.initials: A
authors.lastname: Murphy
authors.forename: D
authors.initials: D
authors.lastname: Veale
authors.forename: V
authors.initials: V
authors.lastname: Goulden
authors.forename: M
authors.initials: M
authors.lastname: Goodfield
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015815:Cell Adhesion Molecules / Q000097:blood; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011701:PUVA Therapy / Q000379:methods*; D012595:Scleroderma, Systemic / Q000097:blood / Q000188:drug therapy*; D012720:Severity of Illness Index; D013223:Statistics as Topic; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D015815:Cell Adhesion Molecules; D016207:Cytokines