Treatment of systemic sclerosis

The treatment of systemic sclerosis remains therapeutically challenging. Until just recently, no disease-modifying intervention was proved to be effective. Over the past year, much effort has gone into setting up proposals for outcome measures and response criteria in clinical trials. Several intervention studies were published. Aminobenzoate potassium was found to be ineffective in a double-blind, placebo-controlled trial. Possible efficacy for antithymocyte globulin was suggested in two small open studies, and the dispute about the use of extracorporeal photopheresis continues. The results of another open trial of methotrexate showed improvement of skin involvement in the majority of patients, and attention was drawn to the nephrotoxic side effects of cyclosporine. Combination therapy with cyclophosphamide and low-dose corticosteroids seems promising for improving pulmonary function in scleroderma patients with progressive lung involvement. Iloprost was shown to be superior to placebo in the treatment of Raynaud's phenomenon secondary to scleroderma. Anecdotal data indicate a possible beneficial effect of octreotide treatment in pseudoobstruction intestinalis due to scleroderma.