Centre of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Switzerland.
Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Switzerland.
Clin Exp Rheumatol. 2020 May-Jun;38 Suppl 125(3):154-160. Epub 2020 Apr 15.
To evaluate the therapeutic benefit of botulinum toxin A (BTX-A) injections for digital ulcers (DU) in patients with systemic sclerosis (SSc).
A systematic literature review was performed and the identified articles were selected by two reviewers and analysed with respect to date of publication, inclusion and exclusion criteria, number and age of participants, volume of BTX-A, injection sites, outcomes, and adverse events. In addition, in the Zurich cohort, 7 SSc patients were eligible for the study and were assessed for the duration of DU to heal, duration of DU-free periods, changes in frequency and numbers of prescribed vasodilators, pain and blood flow.
In five articles from the systematic review, at least 48% of DU had healed and up to 100% reduction in VAS for pain was reported. Our 7 patients (median age of 53 (47-82) years) had in median 2.5 (2-4) DU and were injected with a median BTX-A volume of 90 (50-100) units per hand. Of the 31 DU in all patients, 77% (n=24) healed. Time to wound closure was in median 8 (4-12) weeks and the DU-free duration was in median 8 (3-10) months. In 80% of the cases, at least one vasodilator was stopped or could be administered less frequently. An improvement of blood flow and pain was reported in 60% of the cases.
BTX-A injections might be of benefit for the treatment of chronic, refractory DU in selected SSc patients, yet a sufficiently powered prospective study will be needed as ultimate proof.
评估肉毒毒素 A（BTX-A）注射治疗系统性硬化症（SSc）患者手指溃疡（DU）的疗效。
进行了系统的文献回顾，两名评审员选择了已识别的文章，并分析了其出版日期、纳入和排除标准、参与者的数量和年龄、BTX-A 量、注射部位、结果和不良事件。此外，在苏黎世队列中，7 名 SSc 患者符合研究条件，评估了 DU 愈合时间、无 DU 期持续时间、规定血管扩张剂的频率和数量变化、疼痛和血流变化。
在系统综述的五篇文章中，至少有 48%的 DU 已经愈合，疼痛的 VAS 评分降低了高达 100%。我们的 7 名患者（中位年龄为 53 岁[47-82 岁]）中位 DU 数量为 2.5 个[2-4 个]，每只手注射的 BTX-A 量中位数为 90 个单位[50-100 个单位]。所有患者的 31 个 DU 中，77%（n=24）愈合。伤口闭合时间中位数为 8 周[4-12 周]，无 DU 持续时间中位数为 8 个月[3-10 个月]。在 80%的情况下，至少一种血管扩张剂被停用或可以更频繁地使用。报告了 60%的情况下血流和疼痛改善。
BTX-A 注射可能对治疗选定的 SSc 患者的慢性、难治性 DU 有益，但需要进行足够的、前瞻性研究作为最终证据。
