Doctors know that there are no similar or identical cases of scleroderma. Each case of the disease is different, making it necessary for your doctors to identify your disease subtype, stage, as well as the number of organs involved. This will help your doctor customize a specific scleroderma treatment that will help cure your disease The treatment must address 4 key features of the disease which are the stages of inflammation, severity of autoimmunity, presence of vascular disease, and degree of tissue fibrosis.
Anti-inflammatory medications for scleroderma treatment address two types of inflammation. The first type is inflammation of the joints (arthritis), muscles (myositis), lining of the heart (pericarditis), or lining of the lung (pleuritis). Sesositis is a collective term used if both pericarditis and pleuritis are present. Commonly used drugs for this stage of the disease are NSAID’s such as ibuprofen. Corticosteroids such as prednisone are also used if NSAID’s are not effective. Unfortunately, not all inflammatory phases of scleraderma respond to this therapy. Skin inflammation and other tissue injury caused by scleroderma are not relieved by anti-inflammatory medications.
Immunosuppressive therapy is employed to limit the progression of the inflammatory phase of scleroderma. You immune system must be suppressed as its hyperactivity is causing the damaging inflammatory process. Methotrexate, antithymocyte globulin, cyclosporine, mycophenolate mofetil have been studied as scleroderma treatment. So far, studies have showed that methotrexate did not produce any significant changes in skin inflammation. Cyclosporine studies are limited due to the presence of renal toxicity. Mycophenolate mofetil or cyclophosphamide are the only drugs that show promising results.
Vascular changes of scleroderma are also treated with several drugs. Calcium channel blockers such as nefedipine help dilate the blood vessels to prevent or cure Raynaud’s phenomenon, as well as reduce the incidence of digital ulcers. These drugs also help improve blood flow to the skin and heart. ACE (angiotensin converting enzyme) inhibitors also help fix vasospasm in renal crisis of scleroderma. Blood circulation to the lungs is improved with the use of bosentan (endothelin-1 receptor inhibitor or epoprostenol (prostacyclin).
Anti-fibrotic agents are used to address the presence of excess collagen production in the skin and other organs affected by scleroderma. This scleroderma treatment acts by reducing the collagen production or destabilize tissue collagen. These medications include colchicines, dimethyl sulfoxide, para-aminobenzoic acid (PABA). Not all medical experts advocate the use of these drugs as they give very little change in the collagen production. Some doctors prescribe D-penicillamine as an alternative.
Research is still being conducted to find the right medication for scleroderma treatment. So far, no universal drug is known to treat all signs and symptoms of scleroderma.