Scleroderma

E. Lanciano, A. CHIALà, E. Praino, V. Grattagliano, M. Covelli, F. Iannone, G. Lapadula Reumatologia Universitaria, Policlinico, Bari, Italy
Ann Rheum Dis 2011;70(Suppl3):481

Background: Morphea is a skin disorder characterized by fibrosis. It affects more commonly females than males (ratio 3:1) with an year incidence of 27/million. Recently, some studies have shown that methotrexate and UVA-1 phototherapy may be effective in the treatment of Morphea. However, an index to monitor the disease activity and to evaluate the response to the therapy is not available. Aim of this study was to construct an index for Morphea by considering some parameters of objective evaluation of the skin lesions.

Methods: We enrolled 8 patients with morphea and for each of them the degree of infiltration of the lesions, the color of the margins and the size in cm2 were evaluated. In case of multiple lesions only the largest was considered. To each of these parameters a score from 0 (remission) to 3 (the highest activity) was assigned. The color of the margins indistinguishable from normal surrounding skin was considered as 0, as 1when the colour was dull beige, as 2 when it was pinkish, and as 3 when the colour was clearly red. With regard to the degree of infiltration the modified Rodnan Skin Score was used (0 for normal skin, 1 in case of mild infiltration, 2 in case of moderate infiltration and 3 for severe infiltration). As far as the size of lesions concerns, score 1 was assigned to lesions up to 50 cm2, score 2 to those between 50 and 100 cm2, score 3 to those larger than 100 cm2. The index of disease activity was indicated as high if between 6 and 9, moderate if between 4 and 6, low if between 1 and 3. While a complete resolution of lesions was considered as 0.The patients received methotrexate at a dose of 10-15 mg per week and methylprednisolone at a dose of 4 mg daily for 6 months. Clinical evaluation was performed at 3, 6, and 12months

Results: In all cases we had a good clinical response after 3 months of treatment,with almost complete resolution after 6 months. At baseline we evaluated an average index of 8, after 3 months it was equal to 4.25, at 6 months the index was estimated at 3, and after further 6 months free of therapy the index was unchanged.

Conclusions: This pilot study provided evidence that a combined therapy of methotrexate and low dose steroids may be effective to treat morphea. Further studies on larger cohort of patients are needed to validate this activity index.

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