Scleroderma medicine

NYTimes reports cytoxan has modest effect on scleroderma.

Now, most family docs have no patients with scleroderman, partly because it is rare, and partly because usually they are cared for by specialists.

However , collagen disease are very common among Native Americans. So most Indian clinics and hospitals have Rheumatology clinics.

I once did a geneology on one of my patients and found half of her family had one disease or another...and when her uncle came in with strange symptoms, I sent him to the universary, and warned them about the family history...turns out he had Lupus.

In scleroderma, the skin becomes thick and hard, like scar tissue. Their esophagus gets stiff, so they need medicine for acid reflux. Often they have joint pain. But what kills them is either kidney disease or pulmonary fibrosis.

The main treatment was prednisone. But I had a patient who had severe pulmonary disease, so bad that she was on a transplant list. But they started cytoxan, and gradually weaned her off the Prednisone, and she lost weight...and improved.

She still required lots of pain medicine (we had her on a narcotic contract to cover both us and her because she used large amounts of percocet) and still had to carry oxygen with her, but she was at least able to go shopping and care for her family.