Treatment of systemic sclerosis-associated calcinosis: a case report of rituximab-induced regression of CREST-related calcinosis and review of the literature.

Abstract

OBJECTIVES:

Calcinosis is frequently encountered in patients with systemic sclerosis (SSc) and may be associated with significant morbidity. No treatment has shown so far an unequivocal beneficial effect.

METHODS:

We performed an extensive internet search (MEDLINE) using the keywords calcinosis, calcification, scleroderma, systemic sclerosis, and treatment.

RESULTS:

Our patient had extensive Calcinosis, Raynaud, Esophagitis, Sclerodactyly, telangiectasia (CREST)-related calcinosis, frequently ulcerating and painful. Following 2 rituximab courses (consisting of 4 weekly infusions, 375 mg/m(2) each), calcinosis significantly improved and pain disappeared. Pharmacologic agents used in the treatment of SSc-associated calcinosis include diltiazem, minocycline, warfarin, biphosphonates, and intravenous immunoglobulin. Other therapeutic approaches include surgical excision, laser vaporization, and extracorporeal shock wave lithotripsy.

CONCLUSIONS:

Evidence for all existing therapies is weak and therefore larger scale controlled studies are needed. Rituximab appears as a promising treatment especially in view of recent evidence that this therapy may be also effective in the underlying disease.

• Authors: Dimitrios Daoussis, Ioannis Antonopoulos, Stamatis-Nick C Liossis, Georgios Yiannopoulos, Andrew P Andonopoulos
• Journal: Seminars in arthritis and rheumatism (Semin Arthritis Rheum) Vol. 41 Issue 6 Pg. 822-9 (Jun 2012) ISSN: 1532-866X [Electronic] United States
• PMID: 22221908 (Publication Type: Case Reports, Journal Article, Review)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• Antirheumatic Agents
• Rituximab

Topics

• Antibodies, Monoclonal, Murine-Derived (therapeutic use)
• Antirheumatic Agents (therapeutic use)
• CREST Syndrome (complications, drug therapy)
• Calcinosis (complications, drug therapy)
• Female
• Humans
• Middle Aged
• Pain Measurement
• Rituximab
• Scleroderma, Systemic (complications)
• Treatment Outcome