Shock-Waves Reduce Finger Ulcers in Scleroderma

November 22, 2017

Compared with conventional treatment, extracorporeal shock-wave therapy resulted in a significant decrease in finger ulcers.

Extracorporeal shock-wave therapy resulted in a significant decrease in the number of finger ulcers in patients with systemic sclerosis compared with conventional treatment.

This therapy is minimally invasive, does not require anesthesia, and is well tolerated by patients who have scleroderma with refractory digital ulcers, researchers noted.

When systemic sclerosis is complicated by Raynaud phenomenon, painful and debilitating skin ulcers may develop on patients’ digits that are difficult to treat in a cost-effective way, they added.

Dr Tomonori Ishii and fellow researchers in Sendai, Japan, pointed out in a press release that “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.”

The researchers sought to determine whether low energy extracorporeal shock-wave treatment through stimulation of growth factors and formation of new blood vessels could be used to treat skin ulcers in patients with scleroderma. They presented their findings at the ACR/ARHP Annual Meeting in San Diego.

The study
The authors included 60 patients with systemic sclerosis who had refractory digital ulcers and no prior response to conventional prostaglandin treatment. Half were treated with continued conventional therapy, and the other half were treated with extracorporeal shock-wave therapy.

The results
• The shock-wave therapy group saw a mean reduction in ulcers of 4.47 versus 0.83 fewer with conventional therapy. The difference was significant.

• Among the shock-wave patients, 70% experienced a decrease in the number of digital ulcers at 8 weeks, compared with 26.7% of the conventional patients.

• On average, 1.57 new ulcers formed in the conventional patients, compared with 0.23 in the shock-wave group.

• No serious adverse events occurred in the shock-wave group.

Implications for physicians
• Low-energy extracorporeal shock-wave therapy represents a minimally invasive, low-risk alternative to conventional vasodilator therapy in patients with scleroderma-related digital ulcers.

• The cost and adverse effects of conventional digital ulcer therapy alone should prompt physicians to investigate whether shock-wave therapy is right for their patients.

• Neovascularization may promote healing and help eliminate pain and has promise at least as an adjunct to conventional therapy in patients who have systemic sclerosis and digital ulcers.

References:

American College of Rheumatology Press Release. “Shock-Wave Therapy Successfully Treats Finger Ulcers in Scleroderma Patients.” November 4, 2017.