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What treatments are there?

At the moment there's no cure for systemic sclerosis, although medications can help to control your symptoms and treat any complications. There's also a lot you can do for yourself, including exercise and skin care, which will help you manage your condition.

Treatments for Raynaud's phenomenon

Drugs can help with the symptoms of Raynaud's phenomenon by widening the blood vessels, improving circulation to your hands and feet. There are quite a few drugs available, including tablets such as nifedipine, and they’re sometimes more effective if more than one is used at the same time.

In more severe cases of Raynaud's, particularly if you have painful ulcers that won't heal, you may be given drugs such as iloprost into a vein through a drip (this is called an infusion). You'll usually be admitted to hospital for this treatment.

Drugs that relax your blood vessels and increase blood flow to your fingers and toes also have the same effect on blood vessels elsewhere in your body. This can cause side-effects such as:

  • flushing
  • headaches
  • swollen ankles.

Treatments for heartburn and swallowing difficulties

To prevent heartburn (reflux) and swallowing difficulties, your doctor may recommend you take antacids or a drug to lower acid production in your stomach. These are usually very effective, although you may need to continue treatment for a much longer period (months or years) than is usual with simple heartburn. You may also be prescribed a drug called a proton pump inhibitor (PPI), which will help to protect your stomach.

Treatments for other gastrointestinal problems

You may need to see a gastroenterologist if you have:

  • spells of constipation and diarrhoea
  • abdominal swelling
  • increased wind and discomfort.

Some people may also experience anal incontinence, meaning that they can't control their bowel motions properly so that small amounts of stool slip out and can soil their clothes. This can be uncomfortable or embarrassing, and people may not realise that it's anything to do with systemic sclerosis.

If this happens to you, you should also raise it with your doctor and ask for a referral to a gastroenterologist. Sometimes additional bacteria develop in the bowel, and this can be helped by medications such as antibiotics. However, it's important to have symptoms like diarrhoea and incontinence looked into to make sure that they don't have another cause.

Treatments for inflamed joints

Painkillers and non-steroidal anti-inflammatory drugs (NSAIDs) should help to relieve joint pain and inflammation. You can buy mild forms over the counter at pharmacies and supermarkets (for example paracetamol), but your doctor may prescribe stronger types if needed.

Like all drugs, NSAIDs can sometimes have side-effects, but your doctor will take precautions to reduce the risk of these – for example, by prescribing the lowest effective dose for the shortest possible period of time.

NSAIDs can cause digestive problems, including:

  • stomach upsets
  • indigestion
  • damage to the lining of the stomach.

Therefore, in most cases NSAIDs will be prescribed along with a PPI. Even with a PPI, you'll probably only be given NSAIDs for short periods because of the risk of making any existing gastrointestinal problems worse.

NSAIDs also carry an increased risk of heart attack or stroke. Although the increased risk is small, your doctor will be cautious about prescribing NSAIDs if there are other factors that may increase your overall risk – for example:

  • smoking
  • circulation problems
  • high blood pressure
  • high cholesterol
  • diabetes.

Treatments for high blood pressure and kidney complications

High blood pressure (hypertension) sometimes occurs in systemic sclerosis and in severe cases can lead to kidney damage and strain on your heart. This is a serious complication known as a systemic sclerosis renal crisis. It can be treated, or often prevented, with drugs that help to control the blood pressure, especially ACE inhibitors.

Treatments for lung and heart complications

Inflammation in the lungs can be treated with steroid tablets or disease-modifying anti-rheumatic drugs (DMARDs)

High blood pressure in the lungs (pulmonary hypertension) is a rare complication of systemic sclerosis, but you'll have regular tests to check how well your lungs and heart are working, which will pick up any problems. If necessary, pulmonary hypertension can be treated with specific drugs (including bosentan, ambrisentan, sildenafil or iloprost) that improve symptoms such as breathlessness.

Other drug treatments

Other drugs that may be used include:

  • steroid tablets
  • immunosuppressive drugs
  • drugs used to treat blood pressure and cholesterol.

Steroid tablets

Steroid tablets are synthetic forms of a hormone (cortisone) that occurs naturally in the body. They may be used either in the early stages of the condition when the skin is just starting to look puffy or later on if the muscles or lungs are affected. They're usually given in low doses because high doses can raise blood pressure and increase the risk of kidney problems.

Immunosuppressive drugs

Immunosuppressive drugs target the immune system, and they may be used in more severe cases of systemic sclerosis, especially where the skin or lung disease is more extensive.

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