Embedded Files
those who continued with the survey (median 5 patients). Treatment of different LS subtypes. PR were asked if they thought all patients with a specific LS subtype should be treated with systemic medications at some point during their disease course. The queried subtypes were circumscribed deep morphea, linear scleroderma of face or scalp, linear scleroderma of trunk or limb, generalized morphea, mixed morphea, pansclerotic morphea, and bullous morphea. Most PR thought patients with any of these subtypes should be treated with systemic medications, with a high level of agreement for linear scleroderma of face or scalp (92%), pansclerotic morphea (87%), linear scleroderma of trunk or limb (83%), and generalized morphea (77%). There was a lower level of agreement for treating mixed morphea, circumscribed deep morphea, and bullous morphea with systemic medications (68%, 66%, and 56%, respectively), with 176 The Journal of Rheumatology 2010; 37:1; doi:10.3899/jrheum.090708 Personal non-commercial use only. The Journal of Rheumatology Copyright © 2010. All rights reserved. Downloaded on November 15, 2021 from www.jrheum.org 15% and 29% of respondents choosing “do not know” for mixed morphea and bullous morphea treatment, respectively. LS treatment medications. When asked which systemic medications they use to treat LS, nearly all respondents use MTX administered subcutaneously (93.5%, 115/123 respondents) or orally (88.6%, 109/123). The majority of respondents also use oral corticosteroids (prednisone, 76.4%, 94/123) and intravenous methylprednisolone (IV MP, 68.3%, 84/123). A minority of respondents use oral cyclosporine (17.1%), oral tacrolimus (7.3%), hydroxychloroquine (7.3%), or mycophenolate mofetil (4.9%). Calcitriol, etanercept, intravenous gamma-globulin, D-penicillamine, azathioprine, imatinib, and pimecrolimus were each mentioned by no more than 2 respondents. Most respondents use topical medications (64.5%, 78/121), with one-third willing to use topical therapy alone (33.1%, 40/121), and the others using them in conjunction with systemic therapy (31.4%, 38/121). The majority of those who were willing to use topical therapy alone specified that this treatment should be reserved for minimal disease, such as small, flat, and/or shallow lesions that were considered inactive or minimally active. Lesions on the face, head, near a joint, or in a cosmetically significant region were considered inappropriate sites for isolated topical treatment. The most commonly used topical treatments were corticosteroids (60.3%, 47/78), calcipotriene (42.3%, 33/78), tacrolimus 0.1% (41.0%, 32/78), pimecrolimus 1% (21.8%, 17/78), tacrolimus 0.03% (14%, 17/78), and imiquimod (9.1%, 7/78). Pimecrolimus 0.3% and sirolimus were infrequently used. Factors that influence treatment. PR were asked whether specific disease characteristics altered their treatment strategy. Most respondents would treat lesions on the face (85.5%, 106/124) or near a limb joint (83%, 103/124) more aggressively (i.e., larger medication dose, longer duration of treatment, adding intravenous corticosteroids). About half the respondents treated scalp (51%, 63/124) and genital (44%, 55/124) lesions more aggressively. Few thought lesions on other body areas warranted more treatment. About half the respondents (47%, 58/124) varied treatment according to disease duration, treating patients with recent onset (< 1 month 24%; 1–3 months 29%; 3–6 months 23%) more aggressively than those with longstanding disease. Most respondents did not modify treatment based on patient age (75%, 93/124). Those who did tended to treat younger patients
Report abuse