rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2018-777-781rsp-2656Research ArticleОБЗОРЫТерапия дигитальных язв у больных системной склеродермиейTherapy for digital ulcers in patients with systemic sclerodermaСтаровойтоваМ. Н.StarovoitovaM. N.

115522 Москва, Каширское шоссе, 34А.

34A, Kashirskoe Shosse, Moscow 115522.

mayyastar@mail.ruДесиноваО. В.DesinovaO. V.

115522 Москва, Каширское шоссе, 34А.

34A, Kashirskoe Shosse, Moscow 115522.

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой».РоссияV.A. Nasonova Research Institute of Rheumatology.Russian Federation201821012019566777781Copyright © Старовойтова М.Н., Десинова О.В., 20192019Старовойтова М.Н., Десинова О.В.Starovoitova M.N., Desinova O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/2656

В настоящее время существует несколько фармакологических направлений в лечении и профилактике синдрома Рейно и дигитальных язв, включающих различные вазоактивные группы препаратов (блокаторы кальциевых каналов, внутривенные простаноиды, антагонисты эндотелиновых рецепторов, ингибиторы фосфодиэстеразы 5, антиагреганты и статины). Подход к терапии дигитальных язв, связанных с системной склеродермией, многофакторный: предотвращение факторов риска, локальное и системное лечение лекарственными препаратами, хирургическое лечение в случае необходимости.

As of now, there are several pharmacological directions in the treatment and prevention of Raynaud’s syndrome and digital ulcers, including various vasoactive drugs (calcium channel blockers, intravenous prostanoids, endothelin receptor antagonists, phosphodiesterase 5 inhibitors, antiplatelets, and statins). The approach to treating systemic sclerosis-related digital ulcers is multifactorial: prevention of risk factors, local and systemic drug treatment, and surgical treatment if necessary.

системная склеродермиясиндром Рейнодигитальные язвыsystemic sclerosisRaynaud’s phenomenondigital ulcersReferencesBolster MB, Silver RS. Clinical features of systemic sclerosis. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, editors. Rheumatology. 5th ed. Philadelphia: Mosby, Elsevier; 2011. P. 1373-86.Bolster MB, Silver RS. Clinical features of systemic sclerosis. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, editors. Rheumatology. 5th ed. Philadelphia: Mosby, Elsevier; 2011. P. 1373-86.Гусева НГ. Системная склеродермия и псевдосклеродермические синдромы. Москва: Медицина; 1993 [Guseva NG. Sistemnaya sklerodermiya i psevdosklerodermicheskie sindromy [Systemic scleroderma and pseudoscleroderma syndromes]. Moscow: Meditsina; 1993 (In Russ.)].Гусева НГ. Системная склеродермия и псевдосклеродермические синдромы. Москва: Медицина; 1993 [Guseva NG. Sistemnaya sklerodermiya i psevdosklerodermicheskie sindromy [Systemic scleroderma and pseudoscleroderma syndromes]. Moscow: Meditsina; 1993 (In Russ.)].Steen V, Deenton CP, Pope JE. Digital ulcer: over vascular disease in systemic sclerosis. Rheumatology (Oxford). 2009;48 Suppl 3:iii, 19-24.Steen V, Deenton CP, Pope JE. Digital ulcer: over vascular disease in systemic sclerosis. Rheumatology (Oxford). 2009;48 Suppl 3:iii, 19-24.Hachulla E, Clerson P, Launay D, et al. Natural history of ischemic digital ulcers in systemic sclerosis. J Rheumatol. 2007;34:2423-30.Hachulla E, Clerson P, Launay D, et al. Natural history of ischemic digital ulcers in systemic sclerosis. J Rheumatol. 2007;34:2423-30.Mouthon L, Carpenties P, Lok C, et al. Ischemic digital ulcers affect hand disability and pain in systemic sclerosis. J Rheumatol. 2014;41(7):1317-23. doi: 10.3899/jrheum.130900Mouthon L, Carpenties P, Lok C, et al. Ischemic digital ulcers affect hand disability and pain in systemic sclerosis. J Rheumatol. 2014;41(7):1317-23. doi: 10.3899/jrheum.130900Ingraham KM, Steen VD. Morbidity of digital tip ulcerations in scleroderma. Arthritis Rheum. 2006;54 Suppl 9:578.Ingraham KM, Steen VD. Morbidity of digital tip ulcerations in scleroderma. Arthritis Rheum. 2006;54 Suppl 9:578.Veale DJ, Collidge TA, Belch JJF. Increased prevalence of symptomatic macrovascular disease in systemic sclerosis. Ann Rhеum Dis. 1995;54:853-5. doi: 10.1136/ard.54.10.853Veale DJ, Collidge TA, Belch JJF. Increased prevalence of symptomatic macrovascular disease in systemic sclerosis. Ann Rhеum Dis. 1995;54:853-5. doi: 10.1136/ard.54.10.853Ho M, Veale D, Eastmond C, et al. Macrovascular disease and systemic sclerosis. Ann Rhеum Dis. 2000;59:39-43. doi: 10.1136/ard.59.1.39Ho M, Veale D, Eastmond C, et al. Macrovascular disease and systemic sclerosis. Ann Rhеum Dis. 2000;59:39-43. doi: 10.1136/ard.59.1.39Herrick AL. Management of Raynaud’s phenomenon and digital ischemia. Curr Rhеumatol Rep. 2013;15:303. doi: 10.1007/s11926-012-0303-1Herrick AL. Management of Raynaud’s phenomenon and digital ischemia. Curr Rhеumatol Rep. 2013;15:303. doi: 10.1007/s11926-012-0303-1Kowal-Bielecka O, Fransen J, Avouac J, et al. EUSTAR Coauthors. Update of EULAR recommendations for the treatment of systemic sclerosis. Ann Rheum Dis. 2017;0:1-12. doi: 10.1136/annrheumdis-2016-209909Kowal-Bielecka O, Fransen J, Avouac J, et al. EUSTAR Coauthors. Update of EULAR recommendations for the treatment of systemic sclerosis. Ann Rheum Dis. 2017;0:1-12. doi: 10.1136/annrheumdis-2016-209909Ананьева ЛП. Лечение системной склеродермии с учетом национальных рекомендаций и рекомендаций Европейской лиги по борьбе с ревматизмом (EULAR). Фарматека. 2014;10(283):79-86 [Anan'eva LP. Treatment of systemic scleroderma based on national recommendations and recommendations of the European League against Rheumatism (EULAR). Farmateka. 2014;10(283):79-86 (In Russ.)].Ананьева ЛП. Лечение системной склеродермии с учетом национальных рекомендаций и рекомендаций Европейской лиги по борьбе с ревматизмом (EULAR). Фарматека. 2014;10(283):79-86 [Anan'eva LP. Treatment of systemic scleroderma based on national recommendations and recommendations of the European League against Rheumatism (EULAR). Farmateka. 2014;10(283):79-86 (In Russ.)].Matucci-Cerenic M, Denton CP, Furst DE, et al. Bosentan treatment of digital ulsers related to systemic sclerosis: results from the RAPIDS-2 randomised, double-blind, placebo-controlled trial. Ann Rhеum Dis. 2011;70:32-8. doi: 10.1136/ard.2010.130658Matucci-Cerenic M, Denton CP, Furst DE, et al. Bosentan treatment of digital ulsers related to systemic sclerosis: results from the RAPIDS-2 randomised, double-blind, placebo-controlled trial. Ann Rhеum Dis. 2011;70:32-8. doi: 10.1136/ard.2010.130658Allanore Y, Borderie D, Lemorechol H, et al. Acute and sustained effect of dihidropyridine-type calcium channel antagonists on oxidative stress in systemic sclerosis. Am J Med. 2004;116:595-600. doi: 10.1016/j.amjmed.2003.11.022Allanore Y, Borderie D, Lemorechol H, et al. Acute and sustained effect of dihidropyridine-type calcium channel antagonists on oxidative stress in systemic sclerosis. Am J Med. 2004;116:595-600. doi: 10.1016/j.amjmed.2003.11.022Thompson AE, Pope JE. Calcium-channel blockers for primary Raynaud’s phenomenon: a meta-analysis. Rheumatology. 2005;44:145-50. doi: 10.1093/rheumatology/keh390Thompson AE, Pope JE. Calcium-channel blockers for primary Raynaud’s phenomenon: a meta-analysis. Rheumatology. 2005;44:145-50. doi: 10.1093/rheumatology/keh390Rademaker M, Cooke ED, Almond NE, et al. Comparison of intravenous infusions of iloprost and oral nifedipine in treatment of Raynaud’s phenomenon in patients with systemic sclerosis: a double blind randomized study. Brit Med J. 1989;298:561-4. doi: 10.1136/bmj.298.6673.561Rademaker M, Cooke ED, Almond NE, et al. Comparison of intravenous infusions of iloprost and oral nifedipine in treatment of Raynaud’s phenomenon in patients with systemic sclerosis: a double blind randomized study. Brit Med J. 1989;298:561-4. doi: 10.1136/bmj.298.6673.561Wigley FM, Korn JH, Csuka ME, et al. Oral iloprost treatment in patients with Raynaud’s phenomenon secondary to systemic sclerosis: a multi-center, placebo-controlled, double-blind study. Arthritis Rhеum. 1998;41:670-7. doi: 10.1002/1529-0131(199804)41:4<670::AID-ART14>3.0.CO;2-IWigley FM, Korn JH, Csuka ME, et al. Oral iloprost treatment in patients with Raynaud’s phenomenon secondary to systemic sclerosis: a multi-center, placebo-controlled, double-blind study. Arthritis Rhеum. 1998;41:670-7. doi: 10.1002/1529-0131(199804)41:4<670::AID-ART14>3.0.CO;2-IChung L, Fiorentino D. Digital ulcers in patients with systemic sclerosis. Autoimmun Rev. 2006;5:125-8. doi: 10.1016/j.autrev.2005.08.004Chung L, Fiorentino D. Digital ulcers in patients with systemic sclerosis. Autoimmun Rev. 2006;5:125-8. doi: 10.1016/j.autrev.2005.08.004Chung L, Fiorentino D. A pilot trial of treprostinil for the treatment and prevention of digital ulcers in patients with systemic sclerosis. J Am Acad Dermatol. 2006;54:880-2. doi: 10.1016/j.jaad.2006.02.004Chung L, Fiorentino D. A pilot trial of treprostinil for the treatment and prevention of digital ulcers in patients with systemic sclerosis. J Am Acad Dermatol. 2006;54:880-2. doi: 10.1016/j.jaad.2006.02.004Wigley FM, Wise RA, Seibold JR, et al. Intravenous iloprost infusion in patients with Raynaud’s phenomenon secondary to systemic sclerosis. A multicenter, placebo-controlled, double-blind study. Ann Intern Med. 1994;120:199-206. doi: 10.7326/0003-4819-120-3-199402010-00004Wigley FM, Wise RA, Seibold JR, et al. Intravenous iloprost infusion in patients with Raynaud’s phenomenon secondary to systemic sclerosis. A multicenter, placebo-controlled, double-blind study. Ann Intern Med. 1994;120:199-206. doi: 10.7326/0003-4819-120-3-199402010-00004Насонов ЕЛ, редактор. Российские клинические рекомендации. Ревматология. Москва: ГЭОТАР-Медиа; 2017. 464 с. [Nasonov EL, editor. Rossiyskie klinicheskie rekomendatsii. Revmatologiya [Russian clinical guidelines. Rheumatology.]. Moscow: GEOTAR-Media; 2017. 464 p. (In Russ.)].Насонов ЕЛ, редактор. Российские клинические рекомендации. Ревматология. Москва: ГЭОТАР-Медиа; 2017. 464 с. [Nasonov EL, editor. Rossiyskie klinicheskie rekomendatsii. Revmatologiya [Russian clinical guidelines. Rheumatology.]. Moscow: GEOTAR-Media; 2017. 464 p. (In Russ.)].Korn JH, Mayes M, Matucci-Cerenic M. for the RAPIDS-1 study group. Digital ulcers in systemic sclerosis. Prevention by treatment with bosentan, an oral endothelin receptor antagonist. Arthritis Rhеum. 2004;50:3985-93. doi: 10.1002/art.20676Korn JH, Mayes M, Matucci-Cerenic M. for the RAPIDS-1 study group. Digital ulcers in systemic sclerosis. Prevention by treatment with bosentan, an oral endothelin receptor antagonist. Arthritis Rhеum. 2004;50:3985-93. doi: 10.1002/art.20676Caglayan E, Axmann S, Hellmich M, et al. Vardenafil for the treatment of Raynaud’s phenomenon; a randomized, doubleblind, placebo-controlled crossover study. Arch Intern Med. 2012;172;1182-4. doi: 10.1001/archinternmed.2012.2271Caglayan E, Axmann S, Hellmich M, et al. Vardenafil for the treatment of Raynaud’s phenomenon; a randomized, doubleblind, placebo-controlled crossover study. Arch Intern Med. 2012;172;1182-4. doi: 10.1001/archinternmed.2012.2271Tingey T, Shu J, Smuczek J, et al. A meta-analysis of healing and prevention of digital ulsers (DU) in systemic sclerosis (SSc). Arthritis Care Res (Hoboken). 2013 April 1. doi: 10.1002/acr.22018Tingey T, Shu J, Smuczek J, et al. A meta-analysis of healing and prevention of digital ulsers (DU) in systemic sclerosis (SSc). Arthritis Care Res (Hoboken). 2013 April 1. doi: 10.1002/acr.22018Denton CP, Howell K, Stratton RJ, et al. Long-term low molecular weight heparin therapy for severe Raynaud’s phenomenon: a pilot study. Clin Exp Rheumatol. 2000;18:499-502.Denton CP, Howell K, Stratton RJ, et al. Long-term low molecular weight heparin therapy for severe Raynaud’s phenomenon: a pilot study. Clin Exp Rheumatol. 2000;18:499-502.Abou-Raya A, Abou-Raya S, Helmii M Statins: potentially useful in therapy of systemic sclerosis-related Raynaud’s phenomenon and digital ulcers. J Rheumatol. 2008;35:1801-8.Abou-Raya A, Abou-Raya S, Helmii M Statins: potentially useful in therapy of systemic sclerosis-related Raynaud’s phenomenon and digital ulcers. J Rheumatol. 2008;35:1801-8.Chung L, Shapiro L, Fiorentino D, et al. MQX-503, a novel formulation of nitroglycerin, improves the severity of Raynaud’s phenomenon. Arthritis Rhеum. 2009;60:870-7. doi: 10.1002/art.24351Chung L, Shapiro L, Fiorentino D, et al. MQX-503, a novel formulation of nitroglycerin, improves the severity of Raynaud’s phenomenon. Arthritis Rhеum. 2009;60:870-7. doi: 10.1002/art.24351Amanzi L, Braschi F, Fiori G. Digital ulcers in scleroderma: staging, characteristics and sub-setting through observation 0f 1614 digital lesions. Rheumatology (Oxford). 2010;49:1374-82. doi: 10.1093/rheumatology/keq097Amanzi L, Braschi F, Fiori G. Digital ulcers in scleroderma: staging, characteristics and sub-setting through observation 0f 1614 digital lesions. Rheumatology (Oxford). 2010;49:1374-82. doi: 10.1093/rheumatology/keq097Fiori G, Galluccio F, Braschi F, et al. Vitamin E gel reduces time of healing of digital ulcers in patients with systemic sclerosis. Clin Exper Rheumatol. 2009;27 Suppl:51-4.Fiori G, Galluccio F, Braschi F, et al. Vitamin E gel reduces time of healing of digital ulcers in patients with systemic sclerosis. Clin Exper Rheumatol. 2009;27 Suppl:51-4.Bogoch ER, Gross DK. Surgery of the hand in patients with systemic sclerosis: outcomes and considerations. J Rheumatol. 2005;32:642-8.Bogoch ER, Gross DK. Surgery of the hand in patients with systemic sclerosis: outcomes and considerations. J Rheumatol. 2005;32:642-8.Herrick A, Muir L. Raynaud’s phenomenon (secondary). Clinical evidence. London: BMJ Publishing Group Ltd; 2015.Herrick A, Muir L. Raynaud’s phenomenon (secondary). Clinical evidence. London: BMJ Publishing Group Ltd; 2015.Fregene A, Ditmars D, Saddiqvi A. Botulinum toxin type A: a treatment option for digital ischemia in patients with Raynaud’s phenomenon. J Hand Surg. 2009;34:446-52. doi: 10.1016/j.jhsa.2008.11.026Fregene A, Ditmars D, Saddiqvi A. Botulinum toxin type A: a treatment option for digital ischemia in patients with Raynaud’s phenomenon. J Hand Surg. 2009;34:446-52. doi: 10.1016/j.jhsa.2008.11.026Iorio ML, Masden DL, Higgins JP. Botulinum toxin A treatment Raynaud’s phenomenon: a review. Semin Arthritis Rheum. 2012;41:599-603. doi: 10.1016/j.semarthrit.2011.07.006Iorio ML, Masden DL, Higgins JP. Botulinum toxin A treatment Raynaud’s phenomenon: a review. Semin Arthritis Rheum. 2012;41:599-603. doi: 10.1016/j.semarthrit.2011.07.006Rajendram R, Hayward A. Ultrasound-guided digital sympathectomy using botulinum toxin. Anaestesia. 2013;68(10):1077. doi: 10.1111/anae.12416Rajendram R, Hayward A. Ultrasound-guided digital sympathectomy using botulinum toxin. Anaestesia. 2013;68(10):1077. doi: 10.1111/anae.12416

The authors declare that there are no conflicts of interest present.