1. ‘RETROSPECTIVE STUDY OF EFFICACY OF I. V
‘RETROSPECTIVE STUDY OF EFFICACY OF I.V. DEXAMETHASONE- CYCLOPHOSPHAMIDE PULSE THERAPY IN ESTABLISHED SYSTEMIC SCLEROSIS’
BY DR.ANUP KUMAR TIWARY

2. THERAPY INTRODUCTION VASODILATORS AUTO-ANTIBODIES AUTO-IMMUNE,
SYSTEMIC SCLEROSIS
AUTO-IMMUNE,
MULTISYSTEM DISORDER
VASCULAR ABNORMALITIES
CONNECTIVE TISSUE SCLEROSIS
AUTO-ANTIBODIES
THERAPY
VASODILATORS
IMMUNO SUPPRESSIVE
ANTIFIBROTICS
&
ANALGESICS,PPI etc.
SYMPTOMATIC –
ANTIBIOTIC,

3. ObjeCTIVE TO INVESTIGATE THE EFFICACY OF I.V. DCP
THERAPY IN IMPROVEMENT OF SKIN
INDURATION
& PULMONARY FUNCTION IN
ESTABLISHED SYSTEMIC SCLEROSIS.

4. MATERIALS & METHODS 6 FEMALE CASES
ACCORDING TO ARA SCLERODERMA CRITERIA
WITH SKIN SCLEROSIS & ILD
CONFIRMED CLINICALLY
SYSTEMIC SCLEROSIS
(LcSS & DcSS)
3 minor criteria (a) sclerodactyly (b) digital pitted scarring
MAJOR- Scleroderma proximal to the digits
CRITERIA :
(c) b/l basal pulmonary fibrosis.
1 MAJOR + 2 MINOR IS REQUIRED.
&
DURATION OF DISEASE – 2-7Yrs.
Aug.2013 & Sept.2014
ADMITTED BETWEEN
AGE GROUP :
24 – 42 Yrs.
TREATED WITH I.V.
(PENTOXIFYLLINE)
MONTHLY FOR 12
DCP THERAPY
VASODILATOR
MONTHS
TO ALL PATIENTS
WERE GIVEN ORALLY

5. DEMOGRAPHIC AND CLINICAL DATA
PATIENT
GENDER
AGE IN
YRS.
DURATION
TYPE
DURATION OF SKIN INDURATION
IN YRS.
DURATION OF RESPI.
SYMPTOMS 1. F 38 5
LIMITED 3 1 2. 40
DIFFUSE 2 3. 24 6 4. 42 5. 39 7 6. 37

6. EXCLUSION CRITERIA IMPAIRED LIVER & KIDNEY FUNCTION ACTIVE INFECTION
TOTAL LYMPHOCYTE COUNT <1000/ml TOTAL WBC <4000/ml
PREGNANT OR LACTATING WOMEN & WOMEN PLANNING TO CONCIEVE
HISTORY OF OTHER CYTOTOXIC DRUGS IN LAST 1 YR.
ACTIVE INFECTION

7. MEASURES OF ASSESSMENT OF
IMPROVEMENT
MRSS (Modified RODNAN Skin Score) for skin induration by manual palpation.
PFT (FVC & FEV1)-based on ATS Guidelines
> 10% increment in %FVC & %FEV1 of normal values. (IMPROVEMENT)
< 10% increment in %FVC & %FEV1 of normal values. (STABLE)

8. MODIFIED RODNAN SKIN SCORE
TOTAL 17 SITES
0-NORMAL
1-MILD
2-MODERATE
3-SEVERE
MAX.SCORE = 51

9. RESULTS

12. STATISTICAL ANALYSIS P VALUE CALCULATED BY SPSS SOFTWARE.
for %FVC & for FEV1%
PAIRED STUDENT t-TEST
WILCOXAN RANK SUM TEST-
For MRSS
PAIRED STUDENT t-TEST
For %FVC & FEV1%
WILCOXAN RANK SUM TEST
DATA ARE COMPARED BETWEEN BASELINE & 12 MONTHS
P VALUE <0.05 WAS TAKEN AS SIGNIFICANT

13. DISCUSSION
Significant successive improvement at 3,6 & 12 months in pulmonary function in 5 cases.
In one case pulmonary function remained stable (<10% improvement in PFT).
Decrease in skin score in all cases.

14. Supported by convincing data from–
Scleroderma Lung Study Research Group, University of California,Los Angeles,USA.
Long term study by Barcelona University, Spain.
Systemic sclerosis study group of Italian Society of Rheumatology

15. CONCLUSION I.V. DCP Regime given for 12 months significantly decrease skin induration & improve the pulmonary function in established interstitial lung disease.

16. THANK YOU
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