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Heide M, von Figura A, Rademacher JG, Wincup C, Tampe B, Korsten P. Steroid-free flare management of a severe cutaneous lupus flare with anifrolumab. Lupus 2023; 32:1585-1587. [PMID: 37885415 DOI: 10.1177/09612033231210398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
- Marielle Heide
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Andrea von Figura
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Jan-Gerd Rademacher
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Chris Wincup
- Department of Rheumatology, King's College Hospital, London, UK
- Department of Rheumatology, Division of Medicine, Rayne Building, University College London, London, UK
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
- Department of Rheumatology and Clinical Immunology, St Josef-Stift Sendenhorst, Sendenhorst, Germany
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Rademacher JG, Korsten P. IRF6 mutation in systemic sclerosis: innocent bystander or contributing factor? Rheumatology (Oxford) 2022; 61:e383. [PMID: 35861558 DOI: 10.1093/rheumatology/keac414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Jan-Gerd Rademacher
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
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Rademacher JG, Tampe B, Borisch A, Buschfort RM, von Figura A, Asendorf T, Korsten P. Study Protocol: A Randomized Controlled Prospective Single-Center Feasibility Study of Rheopheresis for Raynaud’s Syndrome and Digital Ulcers in Systemic Sclerosis (RHEACT Study). Front Med (Lausanne) 2022; 9:871744. [PMID: 35492333 PMCID: PMC9046781 DOI: 10.3389/fmed.2022.871744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/11/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Raynaud’s phenomenon (RP) and digital ulcers (DU) are frequent manifestations of Systemic Sclerosis (SSc). Despite being very common in SSc patients, both conditions have proven to be notoriously difficult to study. There are very few available approved drugs with varying efficacy. It has been shown that the presence of DU is associated with increased whole blood viscosity (WBV). Rheopheresis (RheoP) is an extracorporeal apheresis technique used to treat microcirculatory disorders by improving blood viscosity. Improved blood flow and wound healing after RheoP treatments have been reported in single case reports. Methods and Analysis We report the clinical trial protocol of “A randomized controlled prospective single-center feasibility study of Rheopheresis for Raynaud’s syndrome and Digital Ulcers in Systemic Sclerosis (RHEACT).” RHEACT aims to investigate the efficacy of RheoP on the Raynaud Condition Score (RCS) as the primary efficacy outcome measure after 16 weeks from baseline. Thirty patients will be randomized in a 1:1:1 ratio to one of two RheoP treatment groups or assigned to the standard of care (SoC) control group (intravenous iloprost). Secondary endpoints include changes in DU, changes in nailfold video capillaroscopy and patient-reported-outcomes (Scleroderma Health Assessment Questionnaire, FACIT-Fatigue, and the Disability of Arm, Shoulder, and Hand, quick version). Discussion Apheresis techniques have been investigated in SSc but mainly in observational, retrospective studies, or single case reports. RheoP is a pathophysiologically driven potential new therapy for heavily burdened patients with SSc-associated secondary RP with or without DU. Ethics and Dissemination The study was registered at clinicaltrials.gov (Identifier: NCT05204784). Furthermore, the study is made publicly available on the website of the German network of Systemic Sclerosis “Deutsches Netzwerk Systemische Sklerodermie (DNSS).”
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Affiliation(s)
- Jan-Gerd Rademacher
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Angela Borisch
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Rosa Marie Buschfort
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Andrea von Figura
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
- *Correspondence: Peter Korsten,
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Rademacher JG, Glaubitz S, Zechel S, Oettler M, Tampe B, Schmidt J, Korsten P. Treatment and outcomes in anti-HMG-CoA reductase-associated immune-mediated necrotising myopathy. Comparative analysis of a single-centre cohort and published data. Clin Exp Rheumatol 2022; 40:320-328. [PMID: 35225222 DOI: 10.55563/clinexprheumatol/2ao5ze] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Anti-hydroxy-methyl-glutaryl-coenzyme A reductase (HMGCR) antibody-associated myopathy was recognised as a new form of immune-mediated necrotising myopathy (IMNM) a decade ago. Due to the rarity of the disease, only limited data on clinical manifestations and therapeutic outcomes are available. METHODS We retrospectively analysed a monocentric cohort of HMGCR-associated IMNM patients treated at the University Medical Centre Göttingen. Clinical, laboratory, and biopsy data, as well as treatment outcomes, were analysed. In addition, a literature search was performed on published HMGCR IMNM cohorts in Medline and Web of Science. RESULTS We identified nine patients; five were female. The median age was 68 years (47-77). Six were statin-exposed and older than statin-naive patients (71 years [65-77] vs. 51 years [47-67]). All had muscle weakness, seven myalgias. Strength (MRC sum score) was 53/65 (46-61) at baseline and increased to 63/65 (50-65) with therapy. Creatine kinase (CK) levels decreased from a median level of 12837 U/L (range 6346-25011) to 624 U/L (35-1564 U/L). All received glucocorticoids (GC) and at least one immunosuppressive therapy. The literature review identified 26 studies comprising 691 patients. 57.9% were female, 61.3% statin exposed. 95.2% had weakness, 39.1% myalgia. Dysphagia affected 28.8%. 84.9% received GC and a median of 1.5 additional immunosuppressants. Compared to published data, our patients had higher baseline CK values (12837 [6346-25011] vs. 6951 [2539-10500], p<0.001), and we used azathioprine and intravenous immunoglobulins (p<0.001) more frequently but methotrexate and rituximab less frequently (p<0.001). CONCLUSIONS HMGCR-associated IMNM is a rare subset of myositis. With systemic treatment, patients usually achieve partial or complete remission. Optimal treatment has not been established, but glucocorticoids, azathioprine, and methotrexate are generally effective with or without intravenous immunoglobulins.
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Affiliation(s)
- Jan-Gerd Rademacher
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany
| | - Stefanie Glaubitz
- Department of Neurology, University Medical Centre Göttingen, Germany
| | - Sabrina Zechel
- Institute of Neuropathology, University Medical Centre Göttingen, Germany
| | - Manuela Oettler
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany
| | - Jens Schmidt
- Department of Neurology, University Medical Centre Göttingen; Department of Neurology and Pain Treatment, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, and Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Germany.
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Rademacher JG, Korsten P. Anti-Jo-1 Syndrome Often Misdiagnosed as Rheumatoid Arthritis (for Many Years)-A Single-Center Experience Think of RA-ASyS Overlap! J Clin Rheumatol 2021; 27:S861-S862. [PMID: 34348367 DOI: 10.1097/rhu.0000000000001778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jan-Gerd Rademacher
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
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Rademacher JG, Tampe B, Korsten P. First Report of Two Cases of Löfgren's Syndrome after SARS-CoV-2 Vaccination-Coincidence or Causality? Vaccines (Basel) 2021; 9:vaccines9111313. [PMID: 34835244 PMCID: PMC8619392 DOI: 10.3390/vaccines9111313] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 02/06/2023] Open
Abstract
Sarcoidosis can present as an acute form or take a chronic course. One of the acute presentations is Löfgren’s syndrome (LS), consisting of the symptom triad of bilateral hilar lymphadenopathy, erythema nodosum, and ankle periarthritis. In addition, there are occasional reports of sarcoid-like reactions following drug exposures. Nevertheless, reports of sarcoidosis or LS after vaccination have not been published. Here, we report two cases of de novo LS in a temporal association with different vaccines against the new coronavirus SARS-CoV-2. One patient developed the first symptoms three days after the second vaccination (first vaccination ChadOx-1, Astra Zeneca; second vaccination CX-024414, Moderna); in the second patient, symptoms started 28 days after the first vaccination (ChadOx-1, Astra Zeneca). Both patients eventually required treatment with glucocorticoids. Both patients achieved clinical improvement with treatment. In conclusion, we report the first two cases of LS shortly after SARS-CoV-2 vaccination.
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Wurm-Kuczera RI, Buentzel J, Koenig JFL, Legler T, Valk JJ, Hasenkamp J, Jung W, Rademacher JG, Korsten P, Wulf GG. Sarcoidosis Following Hematopoietic Stem Cell Transplantation: Clinical Characteristics and HLA Associations. Front Immunol 2021; 12:746996. [PMID: 34691055 PMCID: PMC8529157 DOI: 10.3389/fimmu.2021.746996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose Extrinsic factors and genetic predisposition contribute to the etiology of sarcoidosis, converging in a phenotype of altered immune response associated with multisystemic inflammatory granulomatous tissue infiltration. Immunological reconstitution after hematopoietic stem cell transplantation (HSCT) may represent a unique window for the pathogenesis of the disease. We describe the incidence, clinicopathological features, and HLA associations of sarcoidosis after HSCT in a single-center cohort of patients, together with data from previously published cases. Methods We retrospectively analyzed clinical characteristics and HLA haplotypes from allogeneic (allo) or autologous (auto) HSCT patients from January 2001 through May 2021 at the University Medicine Goettingen (UMG), and data from previously published cases. Results A total number of 19 patients was identified. These included 4 patients from our center (3 allo HSCT and 1 auto HSCT) and 15 patients from the literature review. Thirteen patients had received an allo HSCT, and six patients had received an auto HSCT. Sarcoidosis occurred after a median interval of 20 (after allo HSCT) and 7 (after auto HSCT) months, respectively. The predominant HLA allele associated with sarcoidosis was HLA DRB1*03:01. Sarcoidosis involved the respiratory tract in 15 patients (three unknown, one without pulmonary involvement), and it was associated with graft-versus-host disease in 7 of 13 patients receiving allo HSCT. None of the donors or patients had a history of sarcoidosis before transplantation. Disease manifestations resolved with standard glucocorticoid treatment without long-term sequelae. Conclusion Sarcoidosis may occur at low frequency during reconstitution of the immune system after HSCT. HLA allele associations reflect the associations observed in the general population, particularly with DRB1*03:01. Further insights into the interplay between Tcell reconstitution and the development of sarcoidosis could also provide novel approaches to an improved understanding of the pathogenesis in sarcoidosis.
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Affiliation(s)
| | - Judith Buentzel
- Department of Hematology and Medical Oncology, University Medical Center Goettingen, Goettingen, Germany
| | | | - Tobias Legler
- Department of Transfusion Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Jan-Jakob Valk
- Department of Transfusion Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Justin Hasenkamp
- Department of Hematology and Medical Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Wolfram Jung
- Department of Hematology and Medical Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Jan-Gerd Rademacher
- Department of Nephrology and Rheumatology, University Medical Center Goettingen, Goettingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Goettingen, Goettingen, Germany
| | - Gerald Georg Wulf
- Department of Hematology and Medical Oncology, University Medical Center Goettingen, Goettingen, Germany
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Korsten P, Rademacher JG, Riedel L, Schnitzler EM, Olgemöller U, Seitz CS, Schmidt J, Larsen J, Vasko R. Antisynthetase Syndrome-Associated Interstitial Lung Disease: Monitoring of Immunosuppressive Treatment Effects by Chest Computed Tomography. Front Med (Lausanne) 2021; 7:609595. [PMID: 33569387 PMCID: PMC7868424 DOI: 10.3389/fmed.2020.609595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/11/2020] [Indexed: 01/30/2023] Open
Abstract
Background: Antisynthetase syndrome (ASyS) is a rare autoimmune disease characterized by inflammatory myopathy, arthritis, fever, and interstitial lung disease (ILD). Pulmonary involvement in ASyS significantly increases morbidity and mortality and, therefore, requires prompt and effective immunosuppressive treatment. Owing to the rarity of ASyS, limited data exists on progression and prognosis of ILD under immunosuppression. Objectives: The objective of the study was to evaluate the radiological progression and outcome measures of ILD with immunosuppressive therapy in patients with ASyS. Methods: Twelve patients with ASyS-associated ILD (ASyS-ILD) were included. Demographic and clinical data, including organ involvement, pulmonary function tests (PFT), laboratory parameters, imaging studies, and treatment regimens were retrospectively analyzed from routinely collected data. The extent of ground glass opacities, fibrotic changes and honeycombing was analyzed and scored using high-resolution chest computed tomography (HRCT) scans. HRCT findings were compared between baseline and follow-up examinations. In addition, patients were stratified depending on whether they had received rituximab (RTX) or not. Results: Pulmonary function tests revealed stable lung function and follow-up HRCT scans showed an improvement of radiological alterations in the majority of ASyS patients under immunosuppressive therapy. We did not detect significant differences between the RTX- and non-RTX-treated groups, but the RTX-treated patients more frequently had myositis and relapsing disease. Conclusions: Radiographic alterations in ASyS-associated ILD respond to immunosuppressive treatment. RTX is a feasible treatment option with similar clinical and radiographic outcomes in patients with relapsing disease and clinically apparent myositis.
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Affiliation(s)
- Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Goettingen, Goettingen, Germany
| | - Jan-Gerd Rademacher
- Department of Nephrology and Rheumatology, University Medical Center Goettingen, Goettingen, Germany
| | - Linn Riedel
- Department of Nephrology and Rheumatology, University Medical Center Goettingen, Goettingen, Germany
| | - Eva-Maria Schnitzler
- Institute of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Ulrike Olgemöller
- Department of Cardiology and Pulmonology, University Medical Center Goettingen, Goettingen, Germany
| | - Cornelia Sabine Seitz
- Department of Dermatotology, Allergology, and Venereology, University Medical Center Goettingen, Goettingen, Germany
| | - Jens Schmidt
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Jörg Larsen
- Institute of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Radovan Vasko
- Department of Nephrology and Rheumatology, University Medical Center Goettingen, Goettingen, Germany
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Rademacher JG, Wulf G, Koziolek MJ, Zeisberg M, Wallbach M. Cytokine adsorption therapy in lymphoma-associated hemophagocytic lymphohistiocytosis and allogeneic stem cell transplantation. J Artif Organs 2021; 24:402-406. [PMID: 33459910 PMCID: PMC8380562 DOI: 10.1007/s10047-020-01244-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023]
Abstract
Lymphoma-associated Hemophagocytic lymphohistiocytosis (HLH) represents a severe complication of disease progression, mediated through cytokine release from the lymphoma cells. Cytokine adsorption may contribute as a supportive treatment to stabilize organ function by reduction of cytokine levels. So far, no experiences of cytokine adsorption and simultaneous stem cell transplantation were published. We report the case of a patient with aggressive lymphoma secondary to chronic lymphocytic leukemia with rapidly progressive HLH (Richter's transformation) upon conditioning chemotherapy prior to allogeneic stem cell transplantation (ASCT). Continuous hemodiafiltration was initiated in the treatment of shock with acute renal failure, lactacidosis and need for high-dose catecholamine therapy, integrating an additional cytokine-adsorbing filter (CytoSorb®) to reduce cytokine levels. This was followed by scheduled allogenic stem cell transplantation. We observed a marked decrease in interleukin-6 plasma levels, associated with a reduced need for vasopressor therapy and organ function stabilization. Hematopoietic engraftment was present at day 14 post-ASCT, leading to disease-free discharge at day 100 post-transplantation. Cytokine adsorption may serve as a safe adjunct to HLH/sepsis treatment during allogeneic stem cell transplantation. Clinical studies are required to make future treatment recommendations.
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Affiliation(s)
- Jan-Gerd Rademacher
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Gerald Wulf
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Michael J Koziolek
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Michael Zeisberg
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Manuel Wallbach
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
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Rademacher JG, Wincup C, Tampe B, Korsten P. Combination therapy with bosentan and sildenafil for refractory digital ulcers and Raynaud's phenomenon in a 30-year-old woman with systemic sclerosis: Case report and literature review. J Scleroderma Relat Disord 2020; 5:159-164. [PMID: 35382024 PMCID: PMC8922606 DOI: 10.1177/2397198319876738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/20/2019] [Indexed: 01/14/2024]
Abstract
BACKGROUND Systemic sclerosis is a rare autoimmune disease characterized by skin and organ fibrosis, and vasculopathy. Raynaud's phenomenon is almost universally present in systemic sclerosis and can be the most debilitating symptom. Raynaud's phenomenon may lead to the development of digital ulcers, potentially complicated by infection, tissue necrosis, and auto-amputation. Recommended treatments have variable efficacy. METHODS We report the case of a 30-year-old woman with diffuse systemic sclerosis suffering from severe Raynaud's phenomenon and digital ulcers with digital tissue necrosis who was treated with combination therapy of an endothelin receptor antagonist and phosphodiesterase 5 inhibitor. In addition, we reviewed the literature on the topic. RESULTS Previous therapy with calcium-channel blockers, intravenous iloprost, and bosentan had all failed to control symptoms. We added sildenafil in combination with bosentan and observed a rapid and sustained treatment effect. Raynaud's phenomenon severity, number of attacks, and attack duration decreased within 2 weeks of initiating treatment. Furthermore, this resulted in the healing of established digital ulcers. CONCLUSION Our case report suggests that combination therapy may be a feasible treatment for the most severely affected and refractory patients. In our literature review, we found one retrospective study and three additional cases with similarly encouraging results.
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Affiliation(s)
- Jan-Gerd Rademacher
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Chris Wincup
- Department of Rheumatology, University College London, London, UK
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
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Korsten P, Müller GA, Rademacher JG, Zeisberg M, Tampe B. Rheopheresis for Digital Ulcers and Raynaud's Phenomenon in Systemic Sclerosis Refractory to Conventional Treatments. Front Med (Lausanne) 2019; 6:208. [PMID: 31620442 PMCID: PMC6759692 DOI: 10.3389/fmed.2019.00208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/05/2019] [Indexed: 01/03/2023] Open
Abstract
Raynaud's phenomenon (RP) is almost universally present in patients with Systemic Sclerosis (SSc). RP represents a generalized vasculopathy and potentially lead to digital ulcers (DU), which may be complicated by superinfection, tissue necrosis, and limb loss. We report the analysis of an extracorporeal procedure in a 36-year-old female patient with diffuse SSc with refractory RP and DU despite treatment with diltiazem, candesartan, sildenafil, and intravenous iloprost. We performed rheopheresis (RheoP), a variant of double-filtration plasmapheresis, as a potential new treatment option for refractory patients despite optimal medical therapy. We performed two RheoP per week every 4 weeks for a total of 3 months. Clinical improvement in DU healing occurred with no adverse events directly related to the treatment. While there was no reduction in the number of Raynaud attacks with RheoP, a significant reduction of the duration of attacks from a median of 15 (5-45, 95% CI 10-15) to 7 (3-30, 95% CI 6-10) minutes with an improvement of the Raynaud Condition Score (RCS) improved from 4 to 2. In conclusion, RheoP is a feasible and potentially beneficial treatment modality in patients with refractory RP and DU. We propose that RheoP should be investigated in a larger number of patients in a clinical trial setting.
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Affiliation(s)
- Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
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