What is the treatment for scleroderma?
Scleroderma has no known cure - there is no treatment to stop the overproduction of collagen. Your doctor may recommend a number of medications to make it easier for you to live with scleroderma by treating its symptoms. Your doctor may also suggest treatments to deal with complications of scleroderma that may affect various organs.
Doctors often treat localized scleroderma with therapies such as moisturizers or corticosteroid medications that you apply to your skin. Corticosteroid medications impede your body's ability to make substances that can cause inflammation.
If the condition involves a lot of body area or an arm or a leg, your doctor may prescribe systemic drugs to try to halt the progression of the disease. Treatment of systemic scleroderma may be with drugs that improve blood flow, promote esophagus and bowel function, preserve kidney function and control high blood pressure.
Mild Raynaud's phenomenon may require only hand warming and protection. Low dose aspirin is often added to prevent tiny blood clots in the fingers, especially in patients with a history of fingertip ulcerations. Moderate Raynaud's phenomenon can be helped by medications that open up the arteries, such as nifedipine (Procardia, Adalat) and nicardipine (Cardizem), or with topical nitroglycerin applied to the most affected digit. Gently applied finger splinting can protect tender tissues. A class of medications that is typically used for depression, called serotonin reuptake inhibitors, such as fluoxetine (Prozac), can sometimes improve the circulation of the affected digit. Severe Raynaud's phenomenon can require surgical procedures, such as those to interrupt the nerves of the finger that stimulate constriction of the blood vessels (digital sympathectomy). Ulcerations of the fingers can require topical or oral antibiotics.
Non-steroidal anti-inflammatory drugs (NSAIDs - pronounced en-seds) are often used to treat scleroderma. These are a type of medication that helps reduce pain and swelling and decrease stiffness. However, they do not prevent further damage. NSAIDs reduce pain when taken at a low dose, and relieve inflammation when taken at a higher dose. NSAIDs such as ASA (Aspirin, Anacin, etc.) and ibuprofen (Motrin IB, Advil, etc.) can be purchased without a prescription. Examples of NSAIDs that require a prescription include Naprosyn, Relafen, Indocid, Voltaren, Feldene, and Clinoril. The various NSAIDs and Aspirin? if taken in full doses, usually have the same levels of anti-inflammatory effect. However, different individuals may experience greater relief from one medication than another. Taking more than one NSAID at a time increases the possibility of side effects, particularly stomach problems such as heartburn, ulcers and bleeding. People taking these medications should consider taking something to protect the stomach, such as misoprostol (Cytotec).
Cortisone is a steroid that reduces inflammation and swelling and that can influence regulation of the immune system. It is a hormone naturally produced by the body. Corticosteroids are man-made drugs that closely resemble cortisone.
The most common form of corticosteroid is called prednisone, taken in pill form. Prednisone use needs to be carefully monitored because of its many side effects, and the drug must never be stopped abruptly. Some of the side effects from long-term use include cataracts, high blood pressure, sleep problems, muscle loss, bruising, thinning of the bones (osteoporosis), weight gain and increased risk of infections. The goal with this and most drugs is to find the lowest effective dose that will avoid as many of the side effects as possible.
DMARDs target the processes causing the inflammation, but do not reverse permanent damage. The most common of them are gold salts, methotrexate, sulfasalazine, hydroxychloroquinine, chloroquinine and azathioprine. Methotrexate is often used to treat scleroderma. DMARDs are usually given in addition to other medications such as NSAIDs. They usually take a few months to make a difference in the inflammation. Side effects may include mouth sores, diarrhea and nausea. More serious side effects, monitored through regular blood and urine tests, include liver damage, and excessive lowering of the white blood cell count (increasing susceptibility to certain infections) and platelet count (affecting blood clotting).
Penicillamine is a medication that is also sometimes used in the treatment of rheumatoid arthritis. Researchers have recently been investigating its possibility of treating skin thickening and preventing abnormal cell growth in the lungs.
A variety of other agents may be used depending upon the particular organs involved. Medications that control small blood vessel spasms are used in individuals with marked Raynaud's phenomenon. In cases where kidney involvement has lead to high blood pressure, certain medications need to be used to deal with this potentially serious problem. Medications are available to reduce acid production in the stomach and control heartburn. Other drugs may improve bowel problems.
Regular exercise helps improve overall health and fitness. For people who have scleroderma, it also helps keep the skin and joints flexible, maintain better blood flow, and prevent contractures. General exercise, such as swimming, cycling, or walking keeps you fit and flexible. Special range of motions exercises help keep skin and specific joints flexible. These should be practiced twice daily.
No diet will cure scleroderma, but you should eat balanced meals and stay at a sensible weight. If you have trouble swallowing, eat slowly and chew thoroughly. Also drink water or another beverage to soften food. Eat high fiber foods to help cut down on constipation. Try eating six small meals a day rather than three large ones, so food digests better.