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Shock-wave Therapy Improves Finger Ulcers in Patients With Scleroderma
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SAN DIEGO — Low-level extracorporeal shock-wave therapy demonstrated clinically meaningful improvement in patients with systemic scleroderma and finger ulcers, according to findings presented at the American College of Rheumatology Annual Meeting.
“Digital ulcers are a severe complication of [systemic scleroderma] SSc caused by microvascular impairment and persistent vasospasm associated with Raynaud’s phenomenon,” Tomonori Ishii, MD, researcher at Tohoku University Hospital in Japan, said in a press release. He added, “In some cases, digital ulcers cause severe scarring and lead to amputation. Although most of the small ulcers are localized to the fingertips, some large ulcers spread throughout the finger and lead to necrosis or progressive digital shortening. Even a small fingertip ulcer causes severe pain and restricts activities of daily living.”
Prior study has shown that extracorporeal shock-wave therapy (ESWT) at low energy effectively stimulates growth factors and the formation of new blood vessels, and heals skin wounds. In this study, Ishii and colleagues evaluated the safety and efficacy of ESWT for treatment of refractory skin ulcers caused by SSc after 8 weeks of therapy. They enrolled 60 patients with SSc and refractory digital ulcers that had no response to intravenous prostaglandin E1 therapy for at least 4 weeks. They allocated 30 patients to treatment with ESWT and 30 patients to conventional treatment. Patients who received ESWT could continue their pre-study treatments.
Results showed a significant decrease in the mean number of ulcers in the ESWT group compared with the conventional treatment group after 8 weeks of treatment (4.47 vs. 0.83). Patients who received ESWT experienced a significant decrease in the total number of their digital ulcers during the follow-up period compared with patients who received conventional therapy (70% vs. 26.7%). After 8 weeks of therapy, the average number of new ulcers was 1.57 in the conventional treatment group compared with 0.23 in the ESWT group. There were no serious adverse events associated with ESWT during the study period.
“Low-energy ESWT may be a new approach to managing digital ulcers associated with SSc,” Ishii said. “It is a non-pharmacological treatment that may avoid the adverse effects that are inevitable with medication. It can be used in patients with severe disease, including renal, cardiac and respiratory failure, as well as gastrointestinal tract disturbances. Moreover, its safety may enable treatment repetition with efficacy. In addition to treating ulcers, ESWT may help eliminate pain, which is the most severe and persistent complaint of these patients.” – by Savannah Demko
References:
Ishii T, et al. Abstract 1704. Presented at: American College of Rheumatology Annual Meeting; Nov. 4-8,2017; San Diego.
Disclosures: Ishii reports disclosures from Chugai, Ono, Pfizer, Mitsubishi-Tanabe and Astellas. No other authors report relevant financial disclosures.