All of these drugs also require frequent laboratory monitoring for toxicity and secondary effects. The skin tightening associated with scleroderma may occur rapidly, producing a sudden increase in the pressure under the skin and a rubbing of the muscles and tendons below the skin. In these cases, a blood test will show elevated levels of muscle enzymes. Such symptoms demand an immediate cessation of exercise. Low-dose oral steroids are used to treat myositis.
Fibrosis also affects the lungs.
Once doctors detect, or even suspect, the presence of an inflammatory lesion, the present consensus is that treatment with the oral drug Cytoxan is justified, but the proper dosage has not yet been established in double-blind studies. In our experience, it can be started at 150 milligrams per day, quickly lowered to as little as 25 milligrams per day and continued for less than one year. Patients on Cytoxan require careful monitoring of their blood and urine. Other drug treatments for lung fibrosis include Cuprimine and Methotrexate, but trials to test their efficacy in reverting early lung inflammation or late fibrosis remain to be done. This work is being supported by the Scleroderma Research Center, which funds two collaborative research center, one at Johns Hopkins University and one at the University of California, San Francisco.