Editorials

How can treatment of systemic sclerosis be improved?

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7154.294 (Published 01 August 1998) Cite this as: BMJ 1998;317:294

By setting up a national database of all cases and entering patients into trials 

  1. UK Scleroderma Study Group*
  1. c/o Carol Black, Royal Free Academic Unit of Rheumatology and Connective Tissue Diseases, London NW3 2PF
  2. *P Amlot, P Bacon, JJF Belch, CM Black, RM du Bois, D Briggs, CP Denton, A Gough, A Herrick, MIV Jayson, A MacGregor, K MacRae, N McHugh, P Maddison, M Pugh, AJ Silman, A Smyth, D Veale, T Wallington, KI Welsh

    Systemic sclerosis is a rare disease (about 10 cases/1 000 000/year) with a substantially higher mortality than other autoimmune rheumatic diseases.1 This, and an even greater morbidity, make it an unwelcome diagnosis for clinicians and a fearful one for patients. No cure exists, though much can be done to alleviate the organ based complications of the condition, and many different agents are used in an attempt to modify disease progression. Unfortunately, few drugs have been properly evaluated in clinical trials and even the standard treatments are not of proved efficacy.2 More aggressive therapies are now being tried in some centres—for example, immunoablation with autologous peripheral stem cell rescue3—and there is an urgent need to compare these novel regimens with standard treatments. How can we improve the management of this condition and ensure that management is based on the best possible evidence?

    Research over the past 20 years has led to a clearer understanding of the cellular and molecular pathology of systemic sclerosis and implicated new causal agents. Substantial advances havealso been …

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