How is scleroderma treated?

There is currently no cure for the distinctive symptom of scleroderma – thickening and tightening of the skin. In fact, there is no cure for autoimmune disease at all, but different therapies exist to treat various conditions associated with scleroderma. Known as palliative therapies, these treatments help to manage the wide range of diseases of the disease and its related symptoms, and thus maintain the quality of life of a patient.

Voltaren from $0.27

The following are a number of these conditions, and their respective therapies.

Therapies for the Raynaud phenomenon

The Raynaud phenomenon is usually treated with the same therapies used for Raynaud’s disease, which work to improve blood flow and blood pressure.

Calcium channel blockers affect the movement of calcium in heart and blood cells. Common medicines include:

  • Nifedipine (Procardia, Adalat)
  • Amlodipine (Norvasc)
  • Diltiazem (Dilacor XR, Cardizem, Tiazac)
  • Verapamil (Calan, Verelan, Isoptin)
  • Felodipine (Plendil)
  • Nisoldipine (Sular)
  • Bepridil (Vascor)
  • Isradipine (DynaCirc)
  • Nicardipine (Cardene)
  • Nisoldipine (Sular)
  • Prazosin (Minipress)

The disease can also be treated by using angiotensin II receptor antagonists, which block a certain chemical that leads to narrow blood vessels. Common therapies include:

  • Losatan (Cozaar)
  • Valsartan (Diovan)

Angiotensin-converting enzyme (ACE) inhibitors offer another treatment option for Raynaud’s because they block an enzyme from contributing to narrow vessels. Common treatments include:

  • Captopril (Capoten)
  • Benazepril (Lotensin)
  • Lisinopril (Prinivil, Zestril)
  • Ramipril (Altace)
  • Enalapril (Vasotec)

PDE-5 inhibitors may be prescribed to improve blood circulation by opening narrowed blood vessels. This action reduces high blood pressure, which reduces the workload of the heart. Common therapies include:

  • Sildenafil Citrate (Viagra)
  • Tadalafil (Cialis)

An important non-pharmacological approach to the Raynaud phenomenon is to keep the body warm, especially the fingers and toes, and to avoid stress triggers. Calm and peaceful exercises and meditation can help reduce stress.

Therapies for heartburn

Acidity (acid reflux) can be treated with antacids. Many are sold without a prescription. Common brand names include:

  • Maalox
  • Mylanta
  • Phillips (Milk of Magnesia)
  • Gaviscon
  • Rolaids
  • Tums

Antacids relieve heartburn and acid indigestion by neutralizing excess stomach acid.

Proton pump inhibitors and H2 blockers decrease acid production that minimizes reflux and helps prevent esophageal ulcers.

Common inhibitors of the proton pump include:

  • Omeprazole (Prilosec, Prilosec OTC is available without a prescription, while Zegerid is an immediate release form of omeprazole)
  • Lansoprazole (Prevacid)
  • Esomeprazole (Nexium)
  • Rabeprazole (Aciphex)
  • Pantoprazole (Protonix)

Common H2 blockers include:

  • Nizatidine (Axid)
  • Famotidine (Pepcid)
  • Cimetidine (Tagamet)
  • Ranitidine (Zantac)

Therapies for kidney disease

Renal disease in scleroderma is treated with angiotensin converting enzyme (ACE) inhibitors because they block the formation of an enzyme that narrows blood vessels. The desired effect is relaxed blood vessels and low blood pressure. Common therapies are:

  • Captopril (Capoten)
  • Benazepril (Lotensin)
  • Lisinopril (Prinivil, Zestril)
  • Ramipril (Altace)
  • Enalapril (Vasotec)

Therapies for muscle weakness, joint pain

Muscle weakness and joint pain are usually treated with non-steroidal anti-inflammatory drugs (NSAIDs). Anti-inflammatory therapies help relieve inflammation, swelling, stiffness and joint pain caused by arthritis. Common medicines include:

  • Aspirin (Bayer, San Jose)
  • Ibuprofen (Advil, Motrin)
  • Naproxen (Naprosyn, Aleve)
  • Nabumeton (Relafen)
  • Flurbiprofen (Ansaid)
  • Fenoprofen (Nalfon)
  • Diclofenac (Voltaren, Cataflam)
  • Meloxicam (Mobic)
  • Diclofenac and misoprostol (Arthrotec)
  • Diclofenac Sodium (Voltaren)
  • Etodolac (Lodina)
  • Indomethacin (Indocin)
  • Ketoprofen (Orudis)
  • Ketorolac (Toradol)
  • Oxaprozin (Daypro)
  • Piroxicam (Feldene)
  • Suldinac (Clinoril)

Low-dose glucocorticoids (prednisone) are also used to treat inflammation because they reduce swelling, redness, itching, and allergic reactions. Intravenous immunoglobulin or immunosuppressive drugs may also be used for muscle weakness and joint pain. Joint and cutaneous flexibility can be maintained with both physical and occupational therapy.

Therapies for pulmonary arterial hypertension in scleroderma

Pulmonary arterial hypertension (PAH) is characterized by high blood pressure in the main artery that carries blood from the right side of the heart to the lungs. When the smaller arteries of the lung become resistant to blood flow, the right ventricle is forced to work harder to pump blood through the lungs. PAH can be treated with prostaglandin derivatives. Common therapies include:

Epoprostenol (Flolan) and Treprostinil (Remodulin) relax blood vessels and increase blood flow to the lungs
Iloprost (Ventavis), an inhalable form of prostacyclin, is introduced directly into the lungs which reduces side effects to the rest of the body

Endothelin receptor antagonists may also be prescribed to prevent the small endothelin-1 protein from binding to its receptors. This blockage leads to increased blood supply to the lungs and less need for the heart to work overtime. Common therapies are:

  • Bosentan (Tracleer)Ambrisentan (Letairis)
  • Macitent (Opsumit)
  • Riociguat (Adempas)

PDE5 inhibitors accumulate a signaling molecule called cGMP that relaxes muscles, increasing blood flow in the lungs and decreasing hypertension. Common inhibitors of PDE5 include:

  • Sildenafil Citrate (Viagra, Revatio)
  • Tadalafil (Cialis, Adcirca)

Therapies for interstitial lung disease in scleroderma

People with scleroderma may also develop interstitial lung disease, a group of lung disorders in which the lung tissues become inflamed and damaged, such as pulmonary fibrosis. There are different kinds of medicines to address the treatment of these diseases.

The anti-fibrotic agent pirfenidone (Esbriet) inhibits the synthesis of TGF-beta (a chemical mediator with a key role in fibrosis) and TNF-alpha (an active cytokine in inflammation).

Nintedanib (OFEV), a tyrosine kinase inhibitor, targets growth factor receptors that are involved in the mechanisms of fibrosis.

Finally, immunosuppressants work by weakening the body’s immune system so they do not attack the body in the event of an autoimmune disease, and alkylating agents slow or stop cancer growth. Common therapies include:

  • Cyclosporine (Neoral, Sandimmune)
  • Mycophenolate mofetil (CellCept)
  • Azathioprine (Imuran)
  • Methotrexate (Rheumatrex, Trexall)
  • D-penicillamine (Cuprimine, Depen)
  • Cyclophosphamide (Cytoxan, Neosar)

Scleroderma News is strictly a news and information page about the disease. It does not provide medical advice, diagnosis or treatment.