Systemic sclerosis, otherwise known as scleroderma, is a rare but serious autoimmune disease that hardens and tightens the skin and connective tissue. It is associated with severe complications, including kidney disease, pulmonary arterial hypertension, lung inflammation or gastrointestinal problems.
Patients often develop Raynaud’s phenomenon, which can cause digital skin ulcers. The ulcers often require continuous therapy and can lead to severe symptoms such as gangrene, scarring, necrosis, even amputation, all of which cause pain and limit activities of daily living.
Treatments for the complication have limited effectiveness and are costly. At the 2017 annual meeting of the American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP), a research team proposed low-energy, extracorporeal shock-wave therapy (ESWT) to treat digital ulcers in association with systemic sclerosis. They presented results that show ESWT is effective at stimulating growth factors, forming new blood vessels and healing the skin wounds.
Tomonori Ishii, MD, of Tohoku University Hospital in Sendai, Japan, and co-authors studied 60 patients with systemic sclerosis and refractory digital ulcers that did not respond to intravenous prostaglandin E1 therapy for at least four weeks. They treated 30 patients with ESWT and 30 others with currently available therapies. Patients receiving ESWT were allowed to continue their pre-study treatments.
After eight weeks, the ESWT group experienced a significant decrease in the mean number of ulcers compared with those receiving conventional treatment (mean = 4.47 versus 0.83, respectively), and 70 percent of patients in the ESWT group saw a decrease in their total number of digital ulcers, compared to 26.7 percent of patients receiving conventional treatment. The patients in the ESWT group reported no serious adverse events.
The researchers encouraged consideration of ESWT because it is minimally invasive and well tolerated, does not require anesthesia, and can result in clinically meaningful improvement.
“It is a non-pharmacological treatment that may avoid the adverse effects that are inevitable with medication. It can be used in patients with severe disease, including renal, cardiac, and respiratory failure, as well as gastrointestinal tract disturbances,” Dr. Ishii said. “Moreover, its safety may enable treatment repetition with efficacy.”