■约50%的系统性硬化症(SSc)患者发生数字溃疡(DU)。DU是痛苦和毁容的,对手部功能和生活质量有重大影响。尽管一些药物治疗已被证明具有益处,迫切需要新的治疗方法:与SSc相关的DUs是一个主要的未满足的临床需求领域。这篇综述集中在药理学管理方面的进展。
■DU定义,DU的类型,简要描述了临床负担,并介绍了多学科管理的一般方法,接下来是更详细的药理学管理描述,特别是关于阻断内皮素途径,补充一氧化氮和前列环素途径。药理学管理的其他方面,还讨论了包括镇痛和肉毒杆菌毒素注射。通知审查,在MEDLINE数据库中搜索了1946年至2022年12月期间发表的英文论文,使用以下搜索词:\'系统性硬化症(硬皮病)\'和\'数字溃疡\'或\'手指溃疡\'或\'数字血管病变.\'
■预防和治疗DU的关键挑战是开发和验证可靠的,敏感的结果措施,以促进临床试验,然后进行新的治疗方法的试验,包括局部治疗和(在疾病早期)血管重塑治疗。
UNASSIGNED: Digital ulcers (DUs) develop in approximately 50% of patients with systemic sclerosis (SSc). DUs are painful and disfiguring, with a major impact on hand function and quality of life. Although some pharmacological treatments have been shown to confer benefit, new treatments are badly needed: SSc-related DUs are an area of major unmet clinical need. This review focuses on advances in pharmacological management.
UNASSIGNED: DU definition, types of DU, and clinical burden are briefly described and the general approach to multidisciplinary management, followed by a more detailed description of pharmacological management, with particular reference to blocking the endothelin pathway, and supplementing the nitric oxide and prostacyclin pathways. Other aspects of pharmacological management, including analgesia and botulinum toxin injections are also discussed. To inform the review, the MEDLINE database was searched for English-language papers published between 1946 and December 2022 using search terms: \'systemic sclerosis (scleroderma)\' and \'digital ulcer\' or \'finger ulcer\' or \'digital vasculopathy.\'
UNASSIGNED: The key challenges to preventing and treating DUs are to develop and validate reliable, sensitive outcome measures to facilitate clinical trials, and then to undertake trials of emerging new approaches to treatment, including topical therapies and (in early disease) vascular remodeling therapies.