Systemic sclerosis treatment response

Nifedipine also has a use in the treatment of Raynaud s disease. In Raynaud s disease, there is inappropriate vasoconstriction in the fingers and toes, usually in response to cold. The condition can be mild or severe leading to ulceration and possibly gangrene of the digits. Raynaud s disease can occur on its own, or as a consequence of systemic sclerosis or systemic lupus erythematosus, both chronic inflammatory diseases (see Chapter 7). 

Interferons—Family of immune system signal proteins that interfere with the ability of viruses to infect cells. Interferons have been genetically engineered to provide treatments by weakening immune response in autoimmune disease such as multiple sclerosis, or by strengthening immune response in diseases like hepatitis C. 

Floxuridine (FUdR) FUdR (fluorodeoxyuridine FUDR) is used primarily by continuous infusion into the hepatic artery for treatment of metastatic carcinoma of the colon or following resection of hepatic metastases, the response rate to such infusion is 40 to 50%, or double that observed with intravenous administration. Intrahepatic arterial infusion for 14 to 21 days may be used with minimal systemic toxicity. However, there is a significant risk of biliary sclerosis if this route is used for multiple cycles of therapy. Treatment should be discontinued at the earliest manifestation of toxicity (usually stomatitis or diarrhea) because the maximal effects of bone marrow suppression and gut toxicity will not be evident until days 7 to 14. 

The immunomodulatory properties of A -THC [48] are likely due to the interaction with CB2 receptors, highly expressed in cells of the immune system (T-cells, B-cells, macrophages). The effect on the immune system of cannabinoid administration appears to be hormesic, and related to the dosage. Indeed, high doses of caimabinoids suppress immune responses, while more physiologically relevant concentrations of cannabinoids result in metabolic stimulation of lymphocytes and in an increase in pro-inflammatory cytokine production rather than immunosuppression. It has been proposed that the immunosuppressive properties of cannabinoids can find application in the treatment of multiple sclerosis. 

Immunologic Two patients developed systemic immune responses 1-2 months after withdrawal of interferon beta, characterized by mouth ulcers, a photosensitivity rash, and transient formation of autoantibodies that required glucocorticoid therapy for resolution in an open baseline versus treatment phase II clinical trial of daclizumab in patients with multiple sclerosis and an inadequate response to interferon beta [211 ]. In rare cases severe hypersensitivity reactions after daclizumab have been reported. 

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