Study Of Effectiveness Of Pulse Therapy In Various Autoimmune Dermatoses
Study Of Effectiveness Of Pulse Therapy In Various Autoimmune Dermatoses
DOI:
https://doi.org/10.70284/njirm.v8i3.1253Keywords:
Pulse Therapy, Pemphigus, Systemic Sclerosis, Systemic Lupus Erythematosus, Mixed Connective Tissue DiseaseAbstract
Background: Autoimmune dermatoses are the disorders of immune systems in which auto antibodies are being generated against own cells. Many therapeutic measures are available but none is highly efficacious as well as free of side effects. Objective: To evaluate the effectiveness of different regimens and modifications of pulse therapy in various autoimmune dermatoses. Methods: We have selected the patients consecutively, according to inclusion criteria, after informed written consent, and divided into fourgroups (1) pemphigus vulgaris (PV) (2) systemic sclerosis (SS) (3) systemic lupus erythematosus (SLE) (4) mixed connective tissue disease (MCTD).Various modified pulse regimens were given according to the disease entity. Monitoring of pulse therapy was done by investigating before and after the pulse.Other immunomodulator drugs and supportive treatments were given. Overall evaluation was done every three monthly. Results:Total21 patients were enrolled for this study of two years duration, which included 09 patients ofpemphigusvulgaris, 03 patients of pemphigus foliaceous,05 patients of systemic sclerosis,02 patients of systemic lupus erythematosus and 02 patients of mixed connective Tissue disease. Different scales were used for evaluation of different entities. According to patient satisfaction score, we found excellent response in cases of systemic sclerosis and mixed connective tissue disease, while good in cases of pemphigus and SLE. Conclusion: Modifications of original pulse therapy in pemphigus vulgarisand use of regimens other than DCPin connective tissue disease are highlyeffective. [Maitri S NJIRM 2017; 8(3):81-88]
References
2. Kountz SL, Cohn R. Initial treatment of renal allografts with large intrarenal doses of immunosuppressive drugs. Lancet 1969; i: 338-40.
3. Amagai M, Komai A, Hashimoto T, Shirakata Y, Hashimoto K,Yamada T, et al. Usefulness of enzyme-linked immunosorbent assay using recombinant desmogleins 1 and 3 for serodiagnosis of pemphigus. Br J Dermatol 1999;140:351-7.
4. Parmar NV, Kanwar AJ, Minz RW, Parsad D, Vinay K, Tsuruta D, et al. Assessment of the therapeuticbenefit of dexamethasone cyclophosphamide pulse versus only oral cyclophosphamide in phase II of the dexamethasone cyclophosphamide pulse therapy: A preliminary prospective randomized controlled study. Indian J Dermatol Venereol Leprol 2013;79:70-6.
5. Rao P N, Lakshmi T S. Pulse therapy and its modifications in pemphigus: A six year study. Indian J DermatolVenereolLeprol 2003;69:329-33
6. David A. Isenberg, W. John W. Morrow, Michael L. Snaith. Methyl prednisolone pulse therapy in the treatment of systemic lupus erythematosus. Annals of the Rheumatic Diseases, 1982, 41, 347-351
7. Grover S. Scoring systems in pemphigus. Indian Journal of Dermatology. 2011;56(2):145-149. doi:10.4103/0019-5154.80403.
8. Clements PJ, Hurwitz EL, Wong WK, Seibold JR, Mayes M, White B, et al. Skin thickness score as a predictor and correlate of outcome in systemic sclerosis: high-dose versus low-dose penicillamine trial. Arthritis Rheum 2000;43:2445–54.
9. Amjadi S., et al. , “Course of the modified Rodnan skin thickness score in systemic sclerosis clinical trials: analysis of three large multicenter, double-blind, randomized controlled trials,†Arthritis Rheum. 2009:60(8),2490–2498. 10. Klippel JH. Raynaud′s phenomenon. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, editors. Fitzpatrick′s Dermatology in General Medicine, 6 th ed. United States of America: McGraw Hill; 2003. p. 1763.
11. Gupta G, Jain A, Narayanasetty NK. Steroid pulse therapies in dermatology. Muller J Med Sci Res 2014;5:155-8
12. Roy R, Kalla G. Dexamethasone - Cyclophosphamide pulse (DCP) therapy in Pemphigus. Indian J Dermatol Venereol Leprol 1997;63:354-6
13. Masood Q, Hassan I, Majid I, Khan D, Manzooi S, Qayoom S, Singh G, Sameem F. Dexamethasone cyclophosphamide pulse therapy in pemphigus: experience in Kashmir valley. Indian J Dermatol Venereol Leprol 2003;69:97-9
14. Dhabhai R, Kalla G, Singhi M K, Ghiya B C, Kachhawa D. Dexamethasone-cyclophosphamide pulse therapy in systemic lupus erythematosus. Indian J Dermatol Venereol Leprol 2005;71:9-13
15. Amigues JM, Cantagrel A, Abbal M et al. Comparative study of 4 diagnosis criteria sets for mixed connective tissue disease in patients with
anti-RNP antibodies. J Rheumatol,1996;23:2055–62.
16. Kandan S, Thappa DM. Outcome of dexamethasone−cyclophosphamide pulse therapy in pemphigus: A caseseries. Indian J Dermatol Venereol Leprol 2009;75:373-8.
17. Paola Caramaschi, DomenicoBiasi, Ilaria Dal Forno, and SilvanoAdami, “Osteonecrosis in Systemic Lupus Erythematosus: An Early, Frequent, and Not Always Symptomatic Complication,†Autoimmune Diseases, vol. 2012, Article ID 725249, 7 pages, 2012. doi:10.1155/2012/725249
