Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Extracorporeal shock wave therapy (ESWT) at low energy has been shown to be effective for digital ulcers in systemic sclerosis (SSc) in our study reported at ACR last year. However, studies to confirm treatment protocols with the most therapeutic effect have not been satisfactorily performed. We aimed to determine the optimal treatment period by comparing the number of cutaneous ulcers before and after treatment.
Methods: The study enrolled 60 patients with SSc and refractory digital ulcers. Of these, 30 were treated with ESWT and 30 received conventional treatment. ESWT treatment was performed once a week for 8 weeks and the results were observed for 4 additional weeks. The total number of ulcers and the number of large ulcers (defined as having a diameter ≥5 mm) were evaluated. During the treatment period, outcomes were assessed every week for 8 weeks and then evaluated during a 4-week observation period, after treatment completion. The visual analog scale (VAS) for pain as a patient-reported outcome (PRO) was also evaluated.
Results: The ulcers decreased by 78.34% in the ESWT group and 20.94% in the conventional treatment group at 8 weeks, and the difference was significant (p=0.0001). However, the ulcers decreased by 71.85% in the ESWT group and 53.75% in the conventional treatment group at 12 weeks (observation period). No further improvement was seen following the treatment period in the ESWT group, and the difference in efficacy from the conventional treatment group decreased during the observation period. Large ulcers alone decreased by 84.21% in the ESWT group and 52.78% in the conventional treatment group at 8 weeks, and the difference was not significant. However, the improvement in VAS pain scores at 8 weeks was 43.96% in the ESWT group and -16.60% in the conventional treatment group (p=0.0817). The pain VAS scores did not decrease significantly probably because of insufficient improvement in large ulcers.
Conclusion: ESWT treatment was discontinued at 8 weeks, but some ulcers remained. Persistence of large ulcers had a significant influence on VAS pain scores. Treatment protocols may require continued ESWT until ulcer disappearance, especially for large ulcers.
To cite this abstract in AMA style:Ishii T, Kawaguchi Y, Ishikawa O, Takemori H, Takasawa N, Kobayashi H, Takahashi Y, Yasuoka H, Kodera T, Takai O, Nakaya I, Izumiyama T, Fujii H, Kamogawa Y, Shirota Y, Shirai T, Fujita Y, saito S, Shimokawa H, Harigae H. Optimized Protocol for Extracorporeal Shock Wave Therapy on Digital Ulcers in Systemic Sclerosis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/optimized-protocol-for-extracorporeal-shock-wave-therapy-on-digital-ulcers-in-systemic-sclerosis/. Accessed August 14, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/optimized-protocol-for-extracorporeal-shock-wave-therapy-on-digital-ulcers-in-systemic-sclerosis/