Artikel
Stellate blockade combined to iloprost as supportive treatment option improves pain and ischaemic symptoms in patients with systemic sclerosis
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Autoren
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Franziska Höcketstaller
- Rheumatology Department, Goethe-University Hospital Frankfurt; Fraunhofer IME, Translational Medicine & Pharmacology TMP
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Ulf Henkemeier
- Fraunhofer IME, Translational Medicine & Pharmacology TMP; Centre of Innovative Diagnostics and Therapeutics Rheumatology/Immunology CIRI
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Michael Zimmermann
- Clinic for anaesthesiology, intensive care and pain therapy, Goethe-University Frankfurt
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Harald Burkhardt
- Rheumatology Department, Goethe-University Hospital Frankfurt; Fraunhofer IME, Translational Medicine & Pharmacology TMP; Centre of Innovative Diagnostics and Therapeutics Rheumatology/Immunology CIRI; Fraunhofer Cluster of Excellence Immune-mediated Diseases CIMD
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Frank Behrens
- Rheumatology Department, Goethe-University Hospital Frankfurt; Fraunhofer IME, Translational Medicine & Pharmacology TMP; Centre of Innovative Diagnostics and Therapeutics Rheumatology/Immunology CIRI; Fraunhofer Cluster of Excellence Immune-mediated Diseases CIMD
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Ulrich Drott
- Rheumatology Department, Goethe-University Hospital Frankfurt
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Michaela Köhm
- Rheumatology Department, Goethe-University Hospital Frankfurt; Fraunhofer IME, Translational Medicine & Pharmacology TMP; Fraunhofer Cluster of Excellence Immune-mediated Diseases CIMD
| Veröffentlicht: | 9. September 2020 |
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Gliederung
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Introduction: Peripheral ischaemia is a common symptom in systemic sclerosis (SSc) patients with risk of development of ischaemic digital ulcers (DU) and limb loss. Since accompanying pain symptoms might worsen the ischaemic symptoms, a combination of intravenous Iloprost with anaesthetic procedures may improve perfusion and subjective sensations of raynaud’s phenomenon and pain. The aim of this study was to observe the impact of a combination of Iloprost with stellate blockade (ILOST) to improve ischaemic symptoms compared to Iloprost treatment only (ILO).
Methods: Twenty SSc-patients will be included in a prospective observational study. Beside documentation of disease activity (mRSS, number of DU, capillary microscopy), patients are assessed using fluorescence-optical imaging (FOI) and patient reported outcomes (DASH, VAS) at baseline, after treatment and at week 12.
Results: This interims analysis includes result of the first 11 patients treated. Iloprost treatment was initiated as prophylactic treatment to avoid DU in all patients. 100% of the patients in the ILOST-group were diagnosed as limited SSc compared to 60% in the ILO-group. All patients showed abnormalities in capillary microscopy with a scleroderma like pattern (ILOST group: 83,3% late pattern, 16.7% active pattern; ILO group: 80% late pattern, 20% early pattern). mRSS was low in both groups with 1.8, the disease duration was similar. Improvement in VAS pain was reported in 83% of the patients in the ILOST group and 60% in the ILO group. DASH was reported with a mean of 5.5 points in the ILOST group compared to 3 points in the ILO group. FOI was compared individually at both arms in the ILOST group only, detecting an increase of FOI signals of 5% in mean, whereas the opposite site showed a decrease of the signal shortly after ILO treatment, indicating an increase of vascularisation in the ILOST treated body site.
Conclusion: No new DU occurred at 12-week follow-up in both groups. ILOST was asked to repeat. Subjective sensation on pain and DASH improved in the combined group. FOI showed an increase in vascularisation in the blockade arm compared to the opposite site indicating a stronger effect of the combined treatment for improvement of vascularisation.
Disclosures: all authors: non declared
