Abstract
Thirty-five patients with diffuse systemic sclerosis were studied in a randomized, placebo-controlled, double-blind study. Seventeen patients received intravenous dexamethasone “pulse” therapy, while 18 patients received placebo. Each “pulse” consisted of 100 mg dexamethasone in 250 ml 5% dextrose infused intravenously over 1 h. Pulse therapy was repeated every month for 6 months. Assessment of disease status with various parameters was done at entry and at completion of trial, i.e. after 6 months. Significant improvement in skin involvement was seen in the study group, with the total skin score (TSS) decreasing from 28.5±12.2 to 25.8±12.8, while in the control group, TSS increased from 30.6±13.2 to 34.7±10. Similarly, significant improvement was noted in the flexion index. Other parametres that included extension index, maximum oral opening, range of movement of joints, functional disability score, Raynaud's phenomenon (frequency and duration), ESR, proteinuria, chest X-ray, ECG, lung function tests, barium swallow and antinuclear antibody were unchanged. Adverse effects of therapy were limited to an increased incidence of minor chest infections. It is concluded that intravenous pulse dexamethasone may be useful in the treatment of diffuse systemic sclerosis.
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References
Black CM (1990) Systemic sclerosis: is there a treatment yet? Ann Rheum Dis 49:735–737
Medsger TA Jr (1991) Treatment of systemic sclerosis. Ann Rheum Dis 50:877–886
Kallenberg CGM, Jansen HM, Elema JD et al (1984) Steroid responsive interstitial pulmonary disease in systemic sclerosis. Monitoring by bronchoalveolar lavage. Chest 86:489–492
Baylis EM, William IA, English J et al (1982) High dose intravenous methyl prednisolone pulse therapy in patients with rheumatoid arthritis. Eur J Clin Pharmacol 2:385–388.
Ponticelli C, Fogazzi GB (1989) Methylprednisolone pulse therapy for primary glomerulonephritis. Am J Nephrol 9 [Suppl 1]: 41–46
Vineyard GC, Faden SJ, Dmochowski L (1974) Evaluation of corticosteroid therapy for acute renal allograft rejection. Surg Gynecol Obstet 138:225–231
Gray D, Shepherd H, Daar A et al (1978) Oral versus intravenous high dose steroid treatment of renal allograft rejection. The big shot or not? Lancet I:117–118
Malaviya AN, Singh RR, Kumar A et al (1988) SLE in Northern India. A review of 329 cases. J Assoc Physician India 36:476–480
Pasricha JS, Thanzama J, Khan UK (1988) Intermittent high dose dexamethasone-cyclophosphamide pulse therapy for pemphigus. Br J Rheumatol 119:73–77
Masi AT, Rodnan GP, Medsger TA et al (1980) Preliminary criteria for the classification of systemic sclerosis (scleroderma). Arthritis Rheum 23:581–590
Le Roy EC, Black C, Fleishmajer R et al (1988) Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol 15:202–205
Medsger TA Jr (1983) Clinical trials in progressive systemic sclerosis. Clin Rheum Dis 9:655–670
Kahaleh MP, Sultany GL, Smith EA et al (1986) A modified scleroderma skin scoring method. Clin Exp Rheum 4:367–368
Helfrich DJ, Banner B, Steen VD et al (1989) Renal failure in normotensive patients with systemic sclerosis. Arthritis Rheum 32:1128–1134
Medsger TA Jr (1983) Progressive systemic sclerosis. Clin Rheum Dis 9:655–664
Steen V (1991) D-penicillamine treatment in systemic sclerosis. J Rheumatol 18:1435–1437
Jimenez SA, Sigal SH (1991) A fifteen year prospective study of treatment of rapidly progressive systemic sclerosis with D-penicillamine J Rheumatol 18:1496–1503
Steen VD, Medsger TA, Rodnan GP (1982) D-penicillamine therapy in progressive systemic sclerosis (scleroderma). Ann Intern Med 97:652–658
Jansen GT, Barraza DF, Ballard JF et al (1968) Generalised scleroderma. Treatment with an immunosuppressive agent. Arch Dermatol 97:690–698
Furst DE, Clements PJ, Hillis S et al (1989) Immunosuppression with chlorambucil, versus placebo, for scleroderma: results of a three-year, parallel randomized, double-blind study. Arthritis Rheum 32:584–593
Steigerwald JC (1974) Chlorambucil therapy in progressive systemic sclerosis. J Rheumatol 1 [Suppl 1]:74
Russell ML, Schachter RK (1988) Cyclosporin treatment in scleroderma. Arthritis Rheum 31:51
Van den Hoogen FMJ, Boeroom AM Th, van de Putte LBA (1989) Methotrexate treatment in scleroderma. Am J Med 87:116–117
Casas JA, Subauste CE, Alarcon GS et al (1990) 5-FU in the treatment of scleroderma: a randomised, double-blind placebo-controlled international collaborative study. Ann Rheum Dis 49:926–928
Rosenbloom J, Feldman G, Freundlich B et al (1986) Inhibition of scleroderma fibroblast collagen production by recombinant g-interferon. Arthritis Rheum 29:851–856
Kahan A, Amor B, Menkes CJ et al (1989) Recombinant interferon-g in the treatment of systemic sclerosis. Am J Med 87:273–277
Alarcon-Segovia D, Ramos-Niembro F, Ibanez de Kasp G et al (1979) Long-term evaluation of colchicine in the treatment of scleroderma. J Rheumatol 6:705–712
Guttadauria M, Diamond H, Kaplan S (1977) Colchicine in the treatment of scleroderma. J Rheumatol 4:272–275
Steigerwald JC, Lynch D (1977) Colchicine therapy versus placebo. A double-blind study in progressive systemic sclerosis. Abstracts of the XIV International Congress of Rheumatology, San Francisco, p 163
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Sharada, B., Kumar, A., Kakker, R. et al. Intravenous dexamethasone pulse therapy in diffuse systemic sclerosis. Rheumatol Int 14, 91–94 (1994). https://doi.org/10.1007/BF00300808
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DOI: https://doi.org/10.1007/BF00300808