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Prostaglandin E1 — salvage therapy in the treatment of difficult-to-heal ulcers in systemic sclerosis
Affiliations- Department of Rheumatology, Małopolska Centre for Rheumatology Immunology and Rehabilitation, Józef Dietl Hospital in Kraków, al. Focha 33, 30-119 Kraków, Poland
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Abstract
Involvement of blood vessels in the form of Raynaud’s phenomenon and microcirculatory dysfunction as well as accompanying skin lesions of the fingers in patients with systemic sclerosis lead to easy skin damage and difficult-to-heal ulcers. Patient education regarding, among other things, the avoidance of injuries, exposure to cold or smoking and pharmacological treatment are becoming important. The choice of drugs listed in current recommendations depends on the clinical manifestation, i.e. the presence and severity of Raynaud’s phenomenon, the treatment or prevention of ulceration and the response to previous treatment. The paper presents a case of a 79-year-old woman with advanced necrotic lesions of the fingers in the course of systemic sclerosis diagnosed late in life. Due to the advancement of the lesions and the lack of improvement after first-line oral medications, the patient required intravenous prostaglandin. Six months of effective therapy and additional surgical treatment led to complete healing and inhibition of new ulcer formation. Intravenous prostaglandin is an effective alternative for the treatment of difficult-toheal ulcers in the course of systemic sclerosis while preventing the formation of new lesions.
Abstract
Involvement of blood vessels in the form of Raynaud’s phenomenon and microcirculatory dysfunction as well as accompanying skin lesions of the fingers in patients with systemic sclerosis lead to easy skin damage and difficult-to-heal ulcers. Patient education regarding, among other things, the avoidance of injuries, exposure to cold or smoking and pharmacological treatment are becoming important. The choice of drugs listed in current recommendations depends on the clinical manifestation, i.e. the presence and severity of Raynaud’s phenomenon, the treatment or prevention of ulceration and the response to previous treatment. The paper presents a case of a 79-year-old woman with advanced necrotic lesions of the fingers in the course of systemic sclerosis diagnosed late in life. Due to the advancement of the lesions and the lack of improvement after first-line oral medications, the patient required intravenous prostaglandin. Six months of effective therapy and additional surgical treatment led to complete healing and inhibition of new ulcer formation. Intravenous prostaglandin is an effective alternative for the treatment of difficult-toheal ulcers in the course of systemic sclerosis while preventing the formation of new lesions.
Keywords
Raynaud’s phenomenon; ulcers; systemic sclerosis; prostaglandin
About this articleTitle
Prostaglandin E1 — salvage therapy in the treatment of difficult-to-heal ulcers in systemic sclerosis
Journal
Issue
Article type
Case report
Pages
31-36
Published online
2022-06-17
Page views
4734
Article views/downloads
284
DOI
Bibliographic record
Rheumatology Forum 2022;8(1):31-36.
Keywords
Raynaud’s phenomenon
ulcers
systemic sclerosis
prostaglandin
Authors
Joanna Musiał
Jolanta Bucka
References (11)- Hoogen Fv, Khanna D, Fransen J, et al. 2013 Classification Criteria for Systemic Sclerosis: An American College of Rheumatology/European League Against Rheumatism Collaborative Initiative. Arthritis & Rheumatism. 2013; 65(11): 2737–2747.
- Sierakowski S, Sierakowska M. Twardzina układowa. In: Zimmermann-Górska I, Tuchocka-Kaczmarek A, Goncerz G. ed. Interna Szczeklika 2020. Medycyna Praktyczna, Kraków 2020: 2060–2069.
- Horimoto AM, de Souza AS, Rodrigues SH, et al. Risk of digital ulcers occurrence in systemic sclerosis: a cross-sectional study. Adv Rheumatol. 2019; 59(1): 14.
- Kowal-Bielecka O, Fransen J, Avouac J, et al. EUSTAR Coauthors. Update of EULAR recommendations for the treatment of systemic sclerosis. Ann Rheum Dis. 2017; 76(8): 1327–1339.
- Khanna D, Denton CP, Merkel PA, et al. DUAL-1 Investigators, DUAL-2 Investigators. Effect of Macitentan on the Development of New Ischemic Digital Ulcers in Patients With Systemic Sclerosis: DUAL-1 and DUAL-2 Randomized Clinical Trials. JAMA. 2016; 315(18): 1975–1988.
- Kowal-Bielecka O, Kuryliszyn-Moskal A. Zalecenia postępowania diagnostyczno-terapeutycznego, Twardzina układowa. Reumatologia. 2016; suppl. 1: 51–55.
- Chiou G, Crowe C, Suarez P, et al. Digital Sympathectomy in Patients With Scleroderma: An Overview of the Practice and Referral Patterns and Perceptions of Rheumatologists. Ann Plast Surg. 2015; 75(6): 637–643.
- Kowal-Bielecka O, Kowal K. Twardzina układowa. In: Zimmermann-Górska I. ed. Terapia w chorobach reumatycznych. Vol. I. PZWL Wydawnictwo Lekarskie, Warszawa 2018: 323–324.
- Charakterystyka Produktu Leczniczego – Alprostadyl.
- Mihai C, Landewé R, van der Heijde D, et al. EUSTAR co-authors. Digital ulcers predict a worse disease course in patients with systemic sclerosis. Ann Rheum Dis. 2016; 75(4): 681–686.
- Morrisroe K, Stevens W, Sahhar J, et al. Digital ulcers in systemic sclerosis: their epidemiology, clinical characteristics, and associated clinical and economic burden. Arthritis Res Ther. 2019; 21(1): 299.
