RECOMMENDATIONS

EULAR recommendations for the treatment of systemic sclerosis: a report from the EULAR Scleroderma Trials and Research group (EUSTAR)

O Kowal-Bielecka¹, R Landewé², J Avouac³, S Chwiesko¹, I Miniati⁴, L Czirjak⁵, P Clements⁶, C Denton⁷, D Farge⁸, K Fligelstone⁹, I Földvari¹⁰, D E Furst⁶, U Müller-Ladner¹¹, J Seibold¹², R M Silver¹³, K Takehara¹⁴, B Garay Toth¹⁵, A Tyndall¹⁶, G Valentini¹⁷, F van den Hoogen¹⁸, F Wigley¹⁹, F Zulian²⁰, Marco Matucci-Cerinic⁴, and the EUSTAR co-authors

¹ Department of Rheumatology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
² Department of Internal Medicine/Rheumatology, University Hospital Maastricht, Maastricht, The Netherlands
³ Rheumatology A Department, RDU, Paris, France
⁴ Department BioMedicine, Division of Rheumatology, University of Florence, Florence, Italy
⁵ Rheumatology Department, UP, Pecs, Hungary
⁶ Rheumatology Department, UCLA, Los Angeles, California, USA
⁷ Rheumatology Department, RFH, London, UK
⁸ Internal Medicine Department, HSL, Paris, France
⁹ Scleroderma Association, FESCA, Harlesden, UK
¹⁰ Department of Pediatric Rheumatology, Klin Eilbek, Hamburg, Germany
¹¹ Rheumatology Department, JLU, Bad Nauheim, Germany
¹² Rheumatology Department, UMI, Ann Arbor, Michigan, USA
¹³ Rheumatology Department, MUSC, Charleston, Sorth Carolina, USA
¹⁴ Dermatology Department, USM, Kanazawa, Japan
¹⁵ Scleroderma Association, FESCA, Budapest, Hungary
¹⁶ Rheumatology Department, UH, Basel, Switzerland
¹⁷ Rheumatology Department, SU, Naples, Italy
¹⁸ Rheumatology Centre Sint Maartenskliniek, Nijmegen, The Netherlands
¹⁹ Rheumatology Department, JHU, Baltimore, Maryland, USA
²⁰ Department of Pediatrics, University of Padua, Padua, Italy

Dr M Matucci-Cerinic, Department of BioMedicine and Surgery, Division of Rheumatology, University of Florence, Villa Monna Tessa, viale G Pieraccini 18, 50134 Florence, Italy; cerinic{at}unifi.it

Purpose: The optimal treatment of systemic sclerosis (SSc) is a challenge because the pathogenesis of SSc is unclear and it is an uncommon and clinically heterogeneous disease affecting multiple organ systems. The aim of the European League Against Rheumatism (EULAR) Scleroderma Trials and Research group (EUSTAR) was to develop evidence-based, consensus-derived recommendations for the treatment of SSc.

Methods: To obtain and maintain a high level of intrinsic quality and comparability of this approach, EULAR standard operating procedures were followed. The task force comprised 18 SSc experts from Europe, the USA and Japan, two SSc patients and three fellows for literature research. The preliminary set of research questions concerning SSc treatment was provided by 74 EUSTAR centres.

Results: Based on discussion of the clinical research evidence from published literature, and combining this with current expert opinion and clinical experience, 14 recommendations for the treatment of SSc were formulated. The final set includes the following recommendations: three on SSc-related digital vasculopathy (Raynaud’s phenomenon and ulcers); four on SSc-related pulmonary arterial hypertension; three on SSc-related gastrointestinal involvement; two on scleroderma renal crisis; one on SSc-related interstitial lung disease and one on skin involvement. Experts also formulated several questions for a future research agenda.

Conclusions: Evidence-based, consensus-derived recommendations are useful for rheumatologists to help guide treatment for patients with SSc. These recommendations may also help to define directions for future clinical research in SSc.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Matucci-Cerinic, M, Allanore, Y, Czirjak, L, Tyndall, A, Muller-Ladner, U, Denton, C, Valentini, G, Distler, O, Fligelstone, K, Tyrrel-Kennedy, A, Farge, D, Kowal-Bielecka, O, van den Hoogen, F, Cutolo, M, Sampaio-Barros, P D, Nash, P, Takehara, K, Furst, D E (2009). The challenge of early systemic sclerosis for the EULAR Scleroderma Trial and Research group (EUSTAR) community. It is time to cut the Gordian knot and develop a prevention or rescue strategy. Ann Rheum Dis 68: 1377-1380 [Abstract] [Full Text]