Prolonged improvement of raynaud's phenomenon and scleroderma after recombinant tissue plasminogen activator therapy

Corresponding Author

Marvin J. Fritzler PhD, MD

Joint Injury and Diseases Research Group, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.

Department of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, Alberta, T2N 4N1, CanadaSearch for more papers by this author

David A. Hart PhD,

David A. Hart PhD

Joint Injury and Diseases Research Group, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.

Search for more papers by this author

Marvin J. Fritzler PhD, MD,

Corresponding Author

Marvin J. Fritzler PhD, MD

Joint Injury and Diseases Research Group, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.

Department of Medicine, University of Calgary, 3330 Hospital Drive, NW, Calgary, Alberta, T2N 4N1, CanadaSearch for more papers by this author

David A. Hart PhD,

David A. Hart PhD

Joint Injury and Diseases Research Group, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.

Search for more papers by this author

First published: February 1990

https://doi.org/10.1002/art.1780330218

Citations: 23

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Abstract

We describe a patient with systemic sclerosis (SSc; scleroderma) characterized by severe Raynaud's phenomenon, cutaneous sclerosis, and digital ulceration and subsequent amputation who was treated with recombinant tissue plasminogen activator (rt-PA) after acute myocardial infarction. She showed prompt improvement of the Raynaud's phenomenon and healing of the digital ulceration. After 18 months of followup, the Raynaud's phenomenon has remained mild, and there has been improvement in the cutaneous sclerosis. Since the pathophysiology of SSc has been associated with disorders of fibrinolysis and coagulation, this patient represents an interesting index case that might prompt further evaluation of rt-PA therapy in carefully selected patients.

References

1 Kahaleh MB, Sherer GK, LeRoy EC: Endothelial injury in scleroderma. J Exp Med 149: 1326–1335, 1979
10.1084/jem.149.6.1326
CAS PubMed Web of Science® Google Scholar
2 Rodnan GP, LeRoy EC: The vascular hypothesis in scleroderma, Current Topics in Rheumatology: Systemic Sclerosis (Scleroderma). Edited by CM Black, AR Myers. New York, Gower Medical Publishing, 1985
Google Scholar
3 Cohen S, Johnson AR, Hurd E: Cytotoxicity of sera from patients with scleroderma: effects on human endothelial cells and fibroblasts in culture. Arthritis Rheum 26: 170–178, 1983
10.1002/art.1780260208
CAS PubMed Web of Science® Google Scholar
4 Campbell PM, LeRoy EC: Pathogenesis of systemic sclerosis: a vascular hypothesis. Semin Arthritis Rheum 4: 351–368, 1975
10.1016/0049-0172(75)90017-7
CAS PubMed Google Scholar
5 Holland CD, Jayson MIV: Venous blood fibrinolysis and fibrinolytic potential in primary Raynaud's phenomenon and systemic sclerosis associated with Raynaud's phenomenon, Current Topics in Rheumatology: Systemic Sclerosis (Scleroderma). Edited by CM Black, AR Myers. New York, Gower Medical Publishing, 1985
Google Scholar
6 Furey N, Schmid F, Kwaan H, Friederici HHRR: Arterial thrombosis in scleroderma. Br J Dermatol 93: 683–693, 1975
10.1111/j.1365-2133.1975.tb05119.x
CAS PubMed Web of Science® Google Scholar
7 Baumgartner S, Deng J-S, Grau R, Franks J, Steigerwald J, Tan EM: Evidence for low grade coagulation abnormalities in progressive systemic sclerosis (abstract). Arthritis Rheum 23: 652, 1980
Web of Science® Google Scholar
8 Lee P, Norman C, Sukenik S, Alderdice CA: The clinical significance of coagulation abnormalities in systemic sclerosis (scleroderma). J Rheumatol 12: 514–517, 1985
PubMed Web of Science® Google Scholar
9 Hart DA, Fritzler MJ: Regulation of plasminogen activators and their inhibitors in rheumatic diseases: new understanding and the potential for new directions. J Rheumatol 16: 1184–1191, 1189
Google Scholar
10 Steen VD, Medsger TA, Rodnan GP: D-penicillamine therapy in progressive systemic sclerosis (scleroderma): a retrospective analysis. Ann Intern Med 97: 652–659, 1982
10.7326/0003-4819-97-5-652
PubMed Web of Science® Google Scholar
11 LeRoy EC: Systemic sclerosis (scleroderma), Rheumatic Diseases: Diagnosis and Management. Edited by WA Katz. New York, JB Lippincott, 1977
Google Scholar
12 Hart D, Rehemtulla A: Plasminogen activators and their inhibitors: regulators of extracellular proteolysis and cell function. Comp Biochem Physiol [B] 90: 691–708, 1988
10.1016/0305-0491(88)90323-9
CAS PubMed Web of Science® Google Scholar
13 Kahan A, Awada H, Sultan Y, Menkès CJ, Amor B: Tissue plasminogen activator activity and t-PA inhibition in systemic sclerosis (abstract). Arthritis Rheum 31 (suppl 4): S112, 1988
Google Scholar
14 Rapaport E: Thrombolytic agents in acute myocardial infarction. N Engl J Med 320: 861–864, 1989
10.1056/NEJM198903303201309
CAS PubMed Web of Science® Google Scholar
15 Klimiuk P, Kay E, Illingworth K, Morris W, Taylor L, Gush R, Jayson M: Tissue plasminogen activator in the treatment of digital ischemia in systemic sclerosis: further observations (abstract). Fibrinolysis 2 (suppl 1): 158, 1988
Google Scholar

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Volume33, Issue2

February 1990

Pages 274-276

Prolonged improvement of raynaud's phenomenon and scleroderma after recombinant tissue plasminogen activator therapy

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Prolonged improvement of raynaud's phenomenon and scleroderma after recombinant tissue plasminogen activator therapy

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