A 4-week comparison of capillaroscopy changes, healing effect, and cost-effectiveness of botulinum toxin-A vs prostaglandin analog infusion in refractory digital ulcers in systemic sclerosis
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In this paper, the clinical benefits, capillaroscopy changes, and cost-effectiveness of local injection of botulinum toxin-A (BTX-A) and intravenous prostaglandin analogs (iloprost/alprostadil) in patients with SSc with resistant DUs were studied.Abstract:
Systemic sclerosis (SSc) is a systemic multi-organ disease. Raynaud’s phenomenon (RP) and digital ulcers (DUs) in SSc patients can be resistant to usual treatments. We studied the clinical benefits, capillaroscopy changes, and cost-effectiveness of local injection of botulinum toxin-A (BTX-A) and intravenous prostaglandin analogs (iloprost/alprostadil) in patients with SSc with resistant DUs. In a clinical trial study, we evaluated 26 patients fulfilling the ACR/EULAR SSc criteria with resistant DUs. Visual analog scale of pain and RP, skin color and type of ulcers, and capillaroscopy were assessed before and 1 month after treatment. In the first group, 20 units of BTX-A was injected at the base of each involved fingers by a dermatologist. In the second group, 20 µg iloprost or 60 µg alprostadil was infused daily. The cost of these treatments was compared. In 26 patients (43 fingers), there were 16 patients (22 fingers) in the BTX-A and 10 patients (21 fingers) in the prostaglandin group. In 95.5% of the BTX-A and 90.5% of the prostaglandin group, the ulcers were healed. In both groups, a significant decrease in pain was seen (p < 0.0001). Capillaroscopy patterns in both groups were not changed although the microhemorrhages disappeared significantly (p value: BTX-A: 0.03 and prostaglandin: 0.002). The cost was significantly lower in the BTX-A injection group (p < 0.0001). Both BTX-A and prostaglandins helped in the healing and pain control of DUs. In capillaroscopy, microhemorrhages were significantly decreased in both groups. In the BTX-A group, the cost was significantly lower as an outpatient treatment and was more time-saving. • BTX-A and prostaglandin analogs both contributed to the healing of digital tip ulcers and improving the pain • In capillaroscopy, microhemorrhages were significantly decreased or disappeared after both treatments • There was no significant side effect in both groups • Comparing both groups, in the BTX-A group, the cost was significantly lower when performed on an outpatient treatment and more time-saving.read more
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Journal ArticleDOI
Treatment of digital ulcers in systemic sclerosis: recent developments and future perspectives
I. Sagonas,Dimitrios Daoussis +1 more
TL;DR: A literature search in Web of Science, PubMed and Directory of Open Access Journals was performed in December 2022 to identify articles published in the last decade regarding the management of digital ulcers (DUs) as mentioned in this paper .
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Copeptin as a Biomarker of Microcirculation Alterations in Systemic Sclerosis
TL;DR: In this paper , the concentration of copeptin in patients with systemic sclerosis and correlate it with specific clinical symptoms was found to be significantly higher in SSc patients with DUs (5.71 pmol/L [IQR 4.85-8.06]) than patients with "early" (2.17-4.63] (p<0.01).
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Treatment of Vascular Complications in Systemic Sclerosis: What Is the Best Approach to Diagnosis and Management of Renal Crisis and Digital Ulcers?
TL;DR: In this paper , the diagnosis and management of scleroderma renal crisis (SRC) and digital ulcers (DUs) in systemic sclerosis (SSc) is discussed.
Journal ArticleDOI
Botulinum Toxins for the Treatment of Raynaud Phenomenon
TL;DR: In this paper , a meta-analysis was conducted for the Shortened version of the Disabilities of the Arm, Shoulder, and Hand (Quick DASH) score and visual analog scale pain score using a random-effects model.
Journal ArticleDOI
Botulinum toxin injection for refractory Raynaud phenomenon and digital ulcers in systemic sclerosis
TL;DR: In this article , BTX injection protocol differed between clinical trials, and the results showed that local BTX injections did not significantly improve blood flow to the patients' hands, however, the improvement in Raynaud condition score was more remarkable in the intervention group with higher doses.
References
More filters
Journal ArticleDOI
2013 classification criteria for systemic sclerosis: An american college of rheumatology/European league against rheumatism collaborative initiative
Frank H J van den Hoogen,Dinesh Khanna,Jaap Fransen,Sindhu R Johnson,Murray Baron,Alan Tyndall,Marco Matucci-Cerinic,Raymond P. Naden,Thomas A. Medsger,Patricia Carreira,Gabriela Riemekasten,Philip J. Clements,Christopher P. Denton,Oliver Distler,Yannick Allanore,Daniel E. Furst,Armando Gabrielli,Maureen D. Mayes,Jacob M van Laar,James R. Seibold,László Czirják,Virginia D. Steen,Murat Inanc,Otylia Kowal-Bielecka,Ulf Müller-Ladner,Gabriele Valentini,Douglas J. Veale,Madelon C. Vonk,Ulrich A Walker,Lorinda Chung,David H. Collier,David H. Collier,Mary Ellen Csuka,Barri J. Fessler,Serena Guiducci,Ariane L. Herrick,Vivien Hsu,Sergio A. Jimenez,Bashar Kahaleh,Bashar Kahaleh,Peter A. Merkel,Stanislav Sierakowski,Richard M. Silver,Robert W. Simms,Robert W. Simms,John Varga,Janet E. Pope +46 more
TL;DR: The ACR/EULAR classification criteria for SSc performed better than the 1980 ACR criteria and should allow for more patients to be classified correctly as having the disease.
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Nailfold videocapillaroscopy assessment of microvascular damage in systemic sclerosis.
TL;DR: In this article, the authors used NVC to correlate microvascular abnormalities, evaluated by nailfold videocapillaroscopy (NVC), with the duration of both Raynaud's phenomenon (RP) and systemic sclerosis (SSc) from the date of diagnosis, in a large number of patients with SSc.
Journal ArticleDOI
Intravenous Iloprost Infusion in Patients with Raynaud Phenomenon Secondary to Systemic Sclerosis: A Multicenter, Placebo-controlled, Double-Blind Study
Fredrick M. Wigley,Robert A. Wise,James R. Seibold,Deborah A. McCloskey,Gregory Kujala,Thomas A. Medsger,Virginia Steen,John Varga,Sergio A. Jimenez,Maureen D. Mayes,Philip J. Clements,Steven R. Weiner,John Porter,Michael H. Ellman,Christopher Wise,Lee D. Kaufman,John Williams,William Dole +17 more
TL;DR: This is the first double-blind, placebo-controlled, parallel-group, multicenter study designed to investigate the efficacy of iloprost in treating patients with Raynaud phenomenon secondary to systemic sclerosis.
Journal ArticleDOI
Standardisation of nailfold capillaroscopy for the assessment of patients with Raynaud's phenomenon and systemic sclerosis
Vanessa Smith,Vanessa Smith,Ariane L. Herrick,Francesca Ingegnoli,Nemanja Damjanov,Rossella De Angelis,Christopher P. Denton,Christopher P. Denton,Oliver Distler,Karinna Espejo,Ivan Foeldvari,Tracy M. Frech,Boris Garro,Marwin Gutierrez,Geneviève Gyger,Geneviève Gyger,Eric Hachulla,Roger Hesselstrand,Annamaria Iagnocco,Cristiane Kayser,Karin Melsens,Karin Melsens,Ulf Müller-Ladner,Sabrina Paolino,Carmen Pizzorni,Mislav Radić,Valeria Riccieri,Marcus H Snow,Wendy Stevens,Alberto Sulli,Jacob M van Laar,Madelon C. Vonk,Amber Vanhaecke,Amber Vanhaecke,Maurizio Cutolo +34 more
TL;DR: Experts in the field of capillaroscopy/microcirculation provide in this very consensus paper their view on image acquisition and analysis, different capillsaroscopic techniques, normal and abnormal capillARoscopic characteristics and their meaning, scoring systems and reliability of image acquisitionand interpretation.