There is no effective treatment for scleroderma so far. However, after intervention, some cases are stable without progression of illness or even relieved
1. General management includes quitting smoking, strengthening nutrition, keeping warm and avoiding mental stimulation.
2. Vasoactive drugs are used to dilate the vessels, reduce blood viscosity and improve microcirculation.
(1) Danshen Injection
Each milliliter of Danshen injection is equilavent to 2 grams of the crude drug in the amount of active ingredient. Add 8-16 milliliter of the injection into 500 ml of low Molecular Dextran and give the solution by intravenous drip infusion once daily, 10 times as a treatment course. And the therapy can be used either continuously or intermittently. Studies prove that Danshen demonstrates a significant inhibition on fibroblasts and its collagen synthesis in the skin. Clinically, Danshen shows some effect on dermatosclerosis, difficulty in opening mouth and swallowing, joint stiffness and Raynaud’s phenomenon. Patients with bleeding tendency and kidney dysfunction should not use this therapy.
Nifedipine controlled-release tablet, 20 mg bid;
Amlodipine, effect similar to nifedipine but longer half-life, 5-10mg per day, administered at draught;
Prazosin, added to amlodipine in severe cases with necrotic tendency, 0.5 mg initially, tid or qid, adding up to 1-2mg if necessary, tid or qid;
Guanethidine, 12.5 mg/d at the beginning and gradually adding up to 25 mg/d, then 37.5mg/d three weeks later, effective to 50% of Raynaud’s phenomenon.
(3) Methyldopa, 250mg, tid, capable of inhibiting Raynaud’s syndrome.
(4) Dipyridamole and low dose of aspirin, both having the ability of anti-platelet aggregation and capable of being taken orally.
3. antifibrotic agents
Glucocorticoid is effective for inflammation, edema and joint discomfort in early stage of SSc. Patients are usually recommended to orally take prednisone 30-40 mg per day for several weeks and then slowly reduce to the maintenance dose of 5-10mg per day. But it is contradicted to patients of advanced stage, especially those with nitremia, for glucocorticoid may contribute to renovascular obliteration in those patients.
(2) Other Immuno-suppressive agents
Choices of this kind of drugs include azathioprine, chlorambucil, cyclophosphamide, etc., which have curative effect on joint, skin and kidney lesions. When in combined therapy with glucocorticoid (GC), their effect is improved and the dose of GC can be decreased.
3. Other Symptomatic Treatments
Patients who suffer from reflux esophagitis should have more meals a day but less food at each and stay in an erect or semi-reclining position after meals. Ranitidine, famotidine and proton pump inhibitors like omeprazole are used to reduce the acid. As for dysphagia, domperidone is recommended to improve gastric dynamics.
4. Physical Therapies
Physical therapies include audio frequency electrotherapy, massage and heating bath, etc. Audio frequency electrotherapy is helpful in softening the skin, improving the nutrition of tissue, and promoting healing of the ulcers. Phototherapy can improve the symptoms caused by thickening of the skin.
5. Other treatments include vein block therapy, vitamin E, phosphoesterases complex and propionate testerone, etc., which can be used cooperatively with the drugs mentioned before. These years, endothelin receptor antagonist (EDRA) and transforming growth factorβ1(TGFβ1) per os have been observed effective to treat pulmonary arterial hypertension abroad. Transplantation of CD34+ sorted peripheral hemopoietic stem cells has been put into clinical practice.
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