Treatment of systemic sclerosis

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Abstract
The last few years have brought a resurgence in interest in managing systemic sclerosis. In the past year, there have been reports of small series of patients and several well-designed, double-blind, controlled trials. Treatment has been directed at a variety of potential pathogenic mechanisms. Stanazol, iloprost, plasmapheresis, thyroxine, and calcitonin were felt to have positive effects on vascular aspects of disease, ie, Raynaud's phenomenon. Immune-mediated treatment using antithymocyte and antilymphocyte globulin, cyclosporine, and methotrexate were encouraging in a small number of patients, but controlled studies of plasma exchange, extracorporeal phototherapy, and 5-fluorouracil were not very exciting. Changing fibroblast function was used with some success in some patients with D-penicillamine and interferon gamma, but not ketotifen. A very dramatic improvement in the survival of renal crisis occurred with the use of angiotensin-converting enzyme inhibitor. Hopefully, this improvement in survival will also occur in the other visceral abnormalities. All this activity in the therapy of systemic sclerosis will certainly lead to improvement in the overall management of disease.

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