Treatment of Systemic Sclerosis-Associated Calcinosis: A Case Report of Rituximab-Induced Regression of CREST-Related Calcinosis and Review of the Literature

被引:51
|
作者
Daoussis, Dimitrios [1 ]
Antonopoulos, Ioannis [1 ]
Liossis, Stamatis-Nick C. [1 ]
Yiannopoulos, Georgios [1 ]
Andonopoulos, Andrew P. [1 ]
机构
[1] Univ Patras, Sch Med, Patras Univ Hosp, Dept Internal Med,Div Rheumatol, Patras 26504, Greece
关键词
Rituximab; B cells; systemic sclerosis; scleroderma; limited; CREST; calcinosis; calcification; treatment; warfarin; diltiazem; IVIG; minocycline; biphosphonates; laser; lithotripsy; MATRIX GLA PROTEIN; B-CELL DEPLETION; TIGHT-SKIN MOUSE; INTERSTITIAL LUNG-DISEASE; CARBON-DIOXIDE LASER; LOW-DOSE WARFARIN; JUVENILE DERMATOMYOSITIS; CUTANEOUS CALCINOSIS; INTRAVENOUS IMMUNOGLOBULIN; ECTOPIC CALCIFICATION;
D O I
10.1016/j.semarthrit.2011.11.007
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives: Calcinosis is frequently encountered in patients with systemic sclerosis (SSc) and may be associated with significant morbidity. No treatment has shown so far an unequivocal beneficial effect. Methods: We performed an extensive internet search (MEDLINE) using the keywords calcinosis, calcification, scleroderma, systemic sclerosis, and treatment. Results: Our patient had extensive Calcinosis, Raynaud, Esophagitis, Sclerodactyly, telangiectasia (CREST)-related calcinosis, frequently ulcerating and painful. Following 2 rituximab courses (consisting of 4 weekly infusions, 375 mg/m(2) each), calcinosis significantly improved and pain disappeared. Pharmacologic agents used in the treatment of SSc-associated calcinosis include diltiazem, minocycline, warfarin, biphosphonates, and intravenous immunoglobulin. Other therapeutic approaches include surgical excision, laser vaporization, and extracorporeal shock wave lithotripsy. Conclusions: Evidence for all existing therapies is weak and therefore larger scale controlled studies are needed. Rituximab appears as a promising treatment especially in view of recent evidence that this therapy may be also effective in the underlying disease. (C) 2012 Elsevier Inc. All rights reserved. Semin Arthritis Rheum 41:822-829
引用
收藏
页码:822 / 829
页数:8
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