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Intravenous immunoglobulins (IVIG) improve the function and ameliorate joint involvement in systemic sclerosis: a pilot study
  1. F Nacci (nacci_francesca{at}libero.it)
  1. dept medicine surgery, Italy
    1. A Righi (blesie{at}tin.it)
    1. dept medicine surgery, Italy
      1. M L Conforti (iuppi{at}hotmail.com)
      1. dept medicine surgery, Italy
        1. O Miniati
        1. dept medicine surgery, Italy
          1. G Fiori (ginevrafiori{at}hotmail.com)
          1. dept medicine surgery, Italy
            1. D Martinovic
            1. dept medicine surgery florence italy, Department of Internal Clinic-Clinical Hospital of Split, Jordan
              1. D Melchiorre
              1. dept medicine surgery florence italy, Department of Internal Clinic-, Italy
                1. T Sapir
                1. Center for Autoimmune Disease and Department of Medicine ‘B, Israel
                  1. M Blank
                  1. Center for Autoimmune Disease and Department of Medicine ‘B, Israel
                    1. Y Shoenfeld (shoenfel{at}post.tau.ac.il)
                    1. Center for Autoimmune Disease and Department of Medicine ‘B, Israel
                      1. A Moggi Pignone (pignone{at}unifi.it)
                      1. dept medicine surgery, Jordan
                        1. M Matucci Cerinic (cerinic{at}unifi.it)
                        1. dept medicine surgery, Italy

                          Abstract

                          In systemic sclerosis (SSc), joint involvement may reduce the functional capacity of the hands. Intravenous immunoglobulins (IVIg) previously have shown to benefit patients with SSc. Our aim was to verify the efficacy of IVIg on joint involvement and function in SSc.

                          Patient and methods: Seven female SSc, 5 limited and 2 diffuse SSc, with a severe and refractory joint involvement were enrolled in the study. Methotrexate and cyclophosphamide pulse therapy did not ameliorate joint symptoms. For this reason, IVIg therapy was prescribed at a dosage of 2g / Kg body weight during 4 days / month for 6 consecutive courses. The presence of joint tenderness and swelling, and articular deformities (due to primary joint involvement and not to skin and subcutaneous changes) were evaluated. Before and after 6 months of therapy, patients were subjected to 1) Ritchie Index (RI), evaluation of joint involvement; 2) Dreiser algo-functional index (IAFD), evaluation of hand joint function; 3) Pain visual analogic scale (VAS) to measure joint pain; 4) Health Assessment Questionnaire (HAQ) to evaluate the limitations in the every day living and physical disability; 5) Modified Rodnan skin score for skin involvement.

                          Results: After 6 months of IVIg therapy, joint pain and tenderness measured with the VAS scale, decreased significantly (p< 0,03), and hand function (IAFD) improved significantly (p < 0,02) together with the quality of life (HAQ) (p < 0,03). All patients significantly improved except one. The skin score after 6 months of IVIg therapy was significantly reduced (p < 0,003) (Figure 1).

                          Conclusion: This pilot study suggests that IVIg may reduce joint pain and tenderness with a significant recovery of joint function in SSc patients with severe and refractory joint involvement. IVIg cost might limit their use only to patients that failed DMARDs .

                          • arthritis
                          • intravenous immune globulins
                          • systemic sclerosis

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