4.5 Review

Clinical Treatment Options in Scleroderma: Recommendations and Comprehensive Review

期刊

CLINICAL REVIEWS IN ALLERGY & IMMUNOLOGY
卷 62, 期 2, 页码 273-291

出版社

HUMANA PRESS INC
DOI: 10.1007/s12016-020-08831-4

关键词

Systemic sclerosis; Localized scleroderma; Immunomodulators; Antifibrotic agents; AHSCT; Vasoactive drugs

资金

  1. Key project for international and regional cooperation in science and technology innovation of Hunan province [2019WK2081]
  2. Project for leading talents in science and technology in Hunan province [2019RS3003]
  3. CAMS Innovation Fund for Medical Sciences [2019-I2M-5-033]

向作者/读者索取更多资源

Scleroderma consists of two major clinical subsets: systemic sclerosis and localized scleroderma, each with distinct characteristics and clinical manifestations. Systemic sclerosis can lead to organ complications, while localized scleroderma is primarily confined to the skin and subcutaneous tissues.
There are two major clinical subsets of scleroderma: (i) systemic sclerosis (SSc) is a complex systemic autoimmune disorder characterized by inflammation, vasculopathy, and excessive fibrosis of the skin and multiple internal organs and (ii) localized scleroderma (LoS), also known as morphea, is confined to the skin and/or subcutaneous tissues resulting in collagen deposition and subsequent fibrosis. SSc is rare but is associated with significant morbidity and mortality compared with other rheumatic diseases. Fatal outcomes in SSc often originate from organ complications of the disease, such as lung fibrosis, pulmonary artery hypertension (PAH), and scleroderma renal crisis (SRC). Current treatment modalities in SSc have focused on targeting vascular damage, fibrosis, and regulation of inflammation as well as autoimmune responses. Some drugs previously used in an attempt to suppress fibrosis, like D-penicillamine (D-Pen) or colchicine, have been disappointing in clinical practice despite anecdotal evidence of their advantages. Some canonical medications, including glucocorticoids, immunosuppressants, and vasodilators, have had some success in treating various manifestations in SSc patients. Increasing evidence suggests that some biologic agents targeting collagen, cytokines, and cell surface molecules might have promising therapeutic effects in SSc. In recent years, hematopoietic stem cell transplantation (HSCT), mostly autologous, has made great progress as a promising treatment option in severe and refractory SSc. Due to the complexity and heterogeneity of SSc, there are currently no optimal treatments for all aspects of the disease. As for LoS, local skin-targeted therapy is generally used, including topical application of glucocorticoids or other immunomodulatory ointments and ultraviolet (UV) irradiation. In addition, systemic immunosuppressants are also utilized in several forms of LoS. Here, we comprehensively discuss current treatment options for scleroderma, encompassing old, new, and future potential treatment options. In addition, we summarize data from new clinical trials that have the potential to modify the disease process and improve long-term outcomes in SSc.

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