ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 682

Effects Of Extracoporeal Shock Wave Therapy To The Digital Ulcers Of Scleroderma:a Pilot Study

Shinichiro Saito1, Yukiko Kamogawa2, Kyohei Nakamura3, Ryu Watanabe3, Tsuyoshi Shirai2, Yoko Fujita4, Hiroshi Fujii3, Yuko Shirota5, Tomonori Ishii3, Hideo Harigae3, Katsuko Kikuchi6 and Yasushi Kawaguchi7, 1Department of hematology and rheumatology, Tohoku University, Sendai, Japan, 2Tohoku University, Sendai, Japan, 3Department of Hematology and Rheumatology, Tohoku University, Sendai, Japan, 4Department of Hematolgy and rheumatolgy, Tohoku University, Sendai, Japan, 5Department of Hematology and Rheumatolgy, Tohoku University, Sendai, Japan, 6Department of Dermatology, Tohoku University, Sendai, Japan, 7Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: , , ,

Session Information

Title: Systemic Sclerosis, Fibrosing Syndromes, and Raynaud’s - Clinical Aspects and Therapeutics I

Session Type: Abstract Submissions (ACR)

Background/Purpose: Vasculopathy, immunological abnormalities and excessive tissue fibrosis are key elements in the pathogenesis of Scleroderma (SSc). In winter,  patients often display Raynaud syndrome, which sometimes causes digital skin ulcers. As these ulcers do not depend on autoimmune or abnormal coagulation, conventional immunosuppressive therapies and anticoagulants are often ineffective. Extracorporeal shock waves (ESW) have been induced primarily in urology for lithotripsy, as its low energy application has yielded evidence for the successful treatment of myocardial ischemia and skin ulcers caused by diabetes. The rationale of this effectiveness is that, new angiogenesis induced by VEGF produced at arteries in the applied area. We tried to introduce ESWT to skin with Raynaud and digital ulcers of SSc.

Methods: We enrolled 9 SSc patients with newly observed digital ulcers: 8 females and 1 male. All 9 patients had been treated with currently available anti-coagulant therapies, especially 6 patients had received intravenous administration of prostaglandin E1. One ESW therapies (ESWT) sitting consisted of 100 impulses at 0.08~0.25 mJ/mm2 per area, 20 areas in both hands and 15 in both feet, totaling 7000 impulses. Sitting were done once a week for 9 weeks. We examined the patients, counting the number of skin ulcers, and checking the Rodnan Skin Score (RSS) as well as patient disability index (HAQ, EQ-5D), pain VAS and objective pain index using PainVisionTM, before and after ESWT. Additionally, the surface skin temperature of all fingers was measured by thermography.

Results: Numbers of skin ulcers were reduced from 5.4 per person to 1.1 by the last treatment of ESWT. Totally, 18 large ulcers (>5mm) were observed from 9 patients before ESWT, 10 disappeared and average size was diminished from 10.8mm into 3.7mm after ESWT. Average HAQ score of 9 patients was improved from 0.57 to 0.43 and other index as EQ5D and PainVisionTM scores also showed improvement. Fingers with the lowest temperatures displayed a rise in temperature. This treatment was minimally invasive and could be repeated without any side effects.

Conclusion: ESWT may be a safe and efficacious treatment that can be used as a type of therapy for indolent digital ulcers caused by SSc.

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Disclosure:

S. Saito,
None;

Y. Kamogawa,
None;

K. Nakamura,
None;

R. Watanabe,
None;

T. Shirai,
None;

Y. Fujita,
None;

H. Fujii,
None;

Y. Shirota,
None;

T. Ishii,
None;

H. Harigae,
None;

K. Kikuchi,
None;

Y. Kawaguchi,
None.

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