Low-Dose Naltrexone for Pruritus in Systemic Sclerosis PDF Print E-mail
Thursday, 01 March 2012 16:43
Tracy Frech, Kirsten Novak, Monica P. Revelo, Maureen Murtaugh, Boaz Markewitz, Nathan Hatton, Mary Beth Scholand, Edward Frech, David Markewitz, and Allen D. Sawitzke
Received 31 May 2011; Accepted 14 July 2011


Systemic sclerosis (SSc; scleroderma) is an autoimmune disease characterized by vasculopathy and fibrosis of multiple organs including the skin, lungs, and gastrointestinal tract (GIT). This chronic disease process results in pain and pruritus, two distinct, but interacting phenomena. Pruritus is most common in the early stages of disease and may subside as the disease progresses. SSc patients that complain of pruritus have more significant skin involvement, more severe finger ulcers, worse respiratory symptoms, and a greater number of GIT complaints. Of interest, pruritus is independently associated with GIT symptoms in SSc. Although pruritus is associated with significant disability, management guidelines for pruritus in SSc do not exist.

Pruritus is also a feature of primary biliary cirrhosis (PBC), which occurs more commonly in SSc than the normal population. There is a known association with PBC and oxidative stress as well as endothelial dysfunction. Pharmaceutical management suggestions for treatment of pruritus in PBC include cholestyramine, rifampin, sertraline, and naloxone. More recently, pilot trials of low-dose naltrexone hydrochloride (LDN), which is a pharmaceutical similar to naloxone, have recently gained increasing recognition for treating chronic pain associated with fibromyalgia, multiple sclerosis, and Crohn’s disease.

Evidence supporting the hypotheses that increased opioid-mediated neurotransmission in the brain is a mechanism of pruritus and that central opioidergic tone is increased in cholestasis provides a rationale for treating the pruritus of cholestasis with opiate antagonists in PBC. Another potential mechanism of action of LDN is through attenuation of the production of proinflammatory cytokines and superoxides potentially mediated by activity of toll-like receptor. Modulation of mitochondrial apoptosis has also been proposed as a mechanism of LDN. In SSc, oxidative stress may be important in disease pathogenesis. Thus, an agent that potentially modulates oxidative stress is attractive as an emerging therapeutic in SSc. Given the putative mechanisms of action of LDN and the roles of these various pathways in SSc, our hypothesis is that LDN may be a reasonable agent to treat pruritus in SSc.

Continue reading the full review article, by downloading it from the link provided below.

 
More articles :

» Managing Your Digical Ulcer

Around 40% of patients with develop open sores on their fingertips called digital ulcers. In some patients, this is the major ongoing difficulty whereas in others, digital ulcers are an uncommon and short term complication.Digital ulcers occur...

» Insights on Autoimmune Diseases and their Impact on Women

In a recent press release by the , Dr. Vivian Pinn discussed the latest research on autoimmune diseases in two podcasts with Dr. Robert Carter. Your body's immune system protects you from disease and infection. But if you have an autoimmune disease,...

» Scleroderma Drug In Development

According to , has partnered with , the health care investment arm of Morgan Keegan and Co. Inc., to jump-start a capital campaign to raise $12 million to $15 million. ArGentis shelved the campaign last year when the economy soured.The money will...

» Scleroderma Foundation Medical Advisory Board Offers Consensus On Gleevec

® (imatinib mesylate, Novartis) is approved in the United States for the treatment of certain forms leukemias and solid tumors. The recent discovery that Gleevec® inhibits important cellular enzymes that control fibrosis led to studies to evaluate...

» Sildenafil Reduces Raynaud's Frequency in Systemic Sclerosis Patients

Researchers in Europe reported that treatment with modified-release sildenafil significantly reduced the frequency of attacks of in patients with limited cutaneous systemic sclerosis (lcSSc), also known as . The double-blind, placebo-controlled...

» Unite Against Scleroderma

On May 1st 2011, the would be holding its first annual "Unite Against Scleroderma" Walk around the Queen's Park Savannah, Port Of Spain. It is our aim to help raise awareness of this rare autoimmune disease and the funding needed to aid those who...