title: Safety and efficacy of extracorporeal shock wave therapy (ESWT) in calcinosis cutis associated with systemic sclerosis.
abstract: OBJECTIVE
  Calcinosis cutis is a frequent, difficult to treat manifestation of systemic sclerosis (SSc) associated with high morbidity. The aim of this prospective, controlled, monocentric study was to assess safety and efficacy of extracorporeal shock wave therapy (ESWT) for calcinosis cutis of the finger in SSc patients.
  
  
  METHODS
  A 12-week proof of concept study in which 4 SSc patients with calcinosis cutis were treated at one painful finger with high-energy, focused ESWT, in 3 sessions with one-week interval between each session. A second, untreated finger, served as control. The outcome parameters were: change in pain, change in size of calcification measured by ultrasound (US) and computed tomography (CT) and of the force by pressing the finger against a Dolorimeter.
  
  
  RESULTS
  Pain was reduced (by 91% and 60%) in the treated finger in two out of four patients. There was no change in the control fingers. The size of the calcinosis in the treated finger was reduced in three (US) and four patients (CT). Inter-assessor agreement was acceptable for US volume measures (ICC=0.863).
  
  
  CONCLUSIONS
  We could show promising evidence for safety and efficacy of ESWT for chronic, treatment resistant calcinosis cutis in SSc patients, thus justifying the initiation of larger multicentre controlled trials.
authors: Division of Rheumatology, University Hospital Zurich, Switzerland.
authors: Sandra
authors: S
authors: Blumhardt
authors: Division of Rheumatology, University Hospital Zurich, Switzerland.
authors: Diana P
authors: DP
authors: Frey
authors: Division of Rheumatology, University Hospital Zurich, Switzerland.
authors: Martin
authors: M
authors: Toniolo
authors: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Switzerland.
authors: Hatem
authors: H
authors: Alkadhi
authors: Horten Centre for Patient-Oriented Research and Knowledge Transfer, University of Zurich, Switzerland.
authors: Ulrike
authors: U
authors: Held
authors: Division of Rheumatology, University Hospital Zurich, Switzerland. oliver.distler@usz.ch.
authors: Oliver
authors: O
authors: Distler
mesh_terms: D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005260:Female; D019220:High-Energy Shock Waves / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012595:Scleroderma, Systemic / Q000150:complications* / Q000175:diagnosis; D013557:Switzerland; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography