How is scleroderma treated?
Currently, there is no cure for scleroderma. Instead, treatment is directed at controlling and managing the symptoms. Because scleroderma can have many symptoms, a combination of approaches is often needed to treat and manage the disease effectively.
- Skin treatments: For localized scleroderma, topical medications often are beneficial. Moisturizers are used to prevent the skin from drying out, as well as to treat hardened skin. To improve blood flow so that sores in the fingers can heal, nitrates such as nitroglycerin are prescribed. Nitrates work by relaxing the smooth muscles, causing the arteries to dilate (widen). Smooth muscles are those that generally form the support blood vessels and some internal organs. Nitrates can have side effects such as dizziness, nausea, rapid heartbeat and blurred vision, so it is important to discuss with your doctor whether or not they may be right for you.
- Digestive remedies: A variety of medications may be prescribed to help patients with heartburn and other digestive difficulties. These include over-the-counter and prescribed antacids, proton pump inhibitors (like Prevacid®, Protonix®, or Nexium®) and H 2 receptor blockers (like Zantac® or Pepcid®). Proton pump inhibitors work by preventing the proton or acid pump in the stomach from allowing stomach acid to be secreted. H 2 receptor blockers work by blocking histamine, a body chemical that promotes the production of acid in the stomach.
- Treatment of lung disease: For patients with scleroderma who have rapidly worsening pulmonary fibrosis (scarring of the lung tissue), the drug cyclophosphamide (Cytoxan®) - a form of chemotherapy - has been proven to be useful in a recent NIH study. This study showed the effectiveness of oral cyclophosphamide in improving lung function and the quality of life in scleroderma patients with interstitial lung disease.
For pulmonary hypertension, the most successful treatment is continuous intravenous infusion of epoprostenol (Flolan®), a prostaglandin, through a pump. Subcutaneous infusion of treprostinil (Remodulin®) – a related prostaglandin – is an acceptable alternative. Prostaglandins are hormone-like substances found in the body that, among other things, help relax the smooth muscle, and hence dilate blood vessels. Other forms of therapy that are currently FDA approved for pulmonary hypertension include oral bosentan (Tracleer ®), sildenafil (Revatio ®) and inhaled iloprost (Ventavis®).
Lung transplant is a viable option for both severe (drug refractory) interstitial lung disease and pulmonary hypertension.
- Joint difficulties: For patients with scleroderma who experience joint problems, anti-inflammatory drugs may be prescribed. These drugs work by reducing inflammation and hence the pain and swelling. Physical therapy to prevent joints from contracting can sometimes be helpful.
- Raynaud's phenomenon: Effective medications include vasodilators like calcium channel blockers (Procardia ® or Norvasc®), nitroglycerine patches/ointment, alpha blockers and sildenafil. Anti-platelet drugs such as aspirin are often added. For ischemic digital ulcers oral agents like sildenafil (Viagra®) or preventive use of bosentan (Tracleer®) can be useful. For fingers with severe ulceration or impending gangrene, hospitalization for a trial of intravenous epoprostenol (Flolan®) or alprostadil is appropriate. Infected ulcers need local wound care and a prolonged course of appropriate antibiotics.
- Sjögren's syndrome: Although it cannot be cured, the symptoms can be relieved. Dry eyes can be treated with artificial teardrops, and cyclosporine eye drops (Restasis®). Dry mouth can be alleviated by sipping liquids or chewing gum. In more severe cases of dry mouth, drugs that stimulate the production of saliva (Evoxac® or Salagen®) may be prescribed.
- Kidney problems: Depending on the severity of the disease, kidney problems related to scleroderma can be managed and treated using medications (especially Angiotensin Converting Enzyme (ACE) inhibitors) and dialysis.
Management of scleroderma
In addition to taking prescribed medications correctly and regularly, there are many steps a person with scleroderma can take to better manage the disease. These include:
Regular exercise will not only help improve your overall physical and spiritual well-being, but it will also help keep your joints flexible and improve circulation. Consult your doctor or physical therapist for appropriate exercises.
When your joints hurt, avoid lifting heavy objects or performing chores that may place a strain on them, thus risking further injury. A physical therapist can help you learn new ways to perform daily activities without placing undue strain on your joints.
Taking proper precautions and care of your skin can be beneficial not only for symptoms of Raynaud's phenomenon, but also in taking care of the dry, thick patches of skin that result from localized scleroderma. There are many ways to accomplish this, including:
- During the colder months, be sure to dress appropriately. Keeping your body warm and protected from the cold weather with boots, a hat, gloves and a scarf will help keep the blood vessels in your extremities open and your circulation flowing.
- Wear multiple thin layers. These will keep you warmer than wearing one thick layer.
- Wear loose-fitting boots or shoes to keep the blood supply moving to your feet.
- Put a humidifier in your house to help keep the air moist.
- Use soaps and creams that are designed especially for dry skin.
Aside from eating healthy foods to get the proper amounts of vitamins and nutrients, it is important to eat foods that do not aggravate existing stomach problems. Ways to do this include:
- Avoiding foods that cause heartburn.
- Drinking water or another liquid to soften food further.
- Eating high fiber foods to cut down on constipation.
- Eating more, smaller meals as opposed to three large meals. This enables the body to digest the food more easily. If you eat a large meal, wait at least four hours before lying down.
- Raising the head of your bed about six inches by placing blocks or bricks underneath it. This will prevent stomach acid from entering the esophagus while you are sleeping.
For those patients with scleroderma who also have Sjögren's syndrome, proper dental care is essential. Sjögren's syndrome increases the risk of developing cavities and tooth decay.
Because the effects of stress can play a part in reducing your blood flow, as well as affect many other aspects of your emotions and health, it is important to learn to manage or reduce stress. This can be done by taking the following steps:
- Getting proper sleep and rest.
- Avoiding stressful situations when possible.
- Eating a healthy diet.
- Learning methods to control anxieties and fears.
Although no cure has been found for scleroderma, the disease is very often slowly progressive and manageable, and people who have it may lead healthy and productive lives. Like many other conditions, education about scleroderma and local support groups can be the greatest tools for managing the disease and reducing the risk of further complications.