The Doctor Is In

By Laura Carbone, M.D., Associate Professor of Medicine, University of Tennessee Health Science Center (originally published in "Scleroderma Voice," 2004 #1)

Questions:

Chronic Anemia in CREST

Q. My question regards chronic anemia in scleroderma patients. What are some of the treatments recommended?

I was diagnosed with CREST over 30 years ago. For the past few years I have developed progressive anemia and am getting injections of Procrit-epoetin (5,000 units) weekly along with iron supplements. It has helped with the anemia but I have developed severe joint and muscle pain, sometimes quite debilitating.

Is anemia commonly associated with scleroderma? Is joint and muscle pain associated with the use of Procrit?

A. Several types of anemia can occur in scleroderma patients and the treatment of the anemia depends on which type is present. Iron-deficiency anemia, usually from gastrointestinal blood loss, is common, and a search for where the blood loss is coming from is essential before iron supplementation is given.

Both anemia of chronic disease and hemolytic anemia are seen in scleroderma patients who have had renal crisis. In scleroderma patients with anemia of chronic disease resulting from kidney disease, procrit is often used. Although it is a rare side effect, procrit may be associated with joint and muscle pain.

Dietary Restructions in Scleroderma?

Q. Are there dietary restrictions for persons diagnosed with scleroderma? My friend was diagnosed with this disease and was advised to limit foods containing copper (liver, chocolate, prunes).

A. There are no specific dietary restrictions for persons diagnosed with scleroderma.

Scleroderma and Dental Problems

Q. Is there any research on scleroderma affecting the dentin in teeth? Our patient is a female, age 48, who continually has dental challenges. Teeth are brittle and breaking and she continues to have decay. Are there any reported connections with scleroderma affecting the teeth?

A. There are reports of patients with scleroderma having dental problems. Decreased oral apertures, with xerostomia (dry mouth), may contribute to dental caries (cavities) and periodontal disease. Widening of the perio-dontal membrane has been seen on x-rays.

Scleroderma and Optional Surgery

Q. I am 36 years old and have been diagnosed with limited scleroderma for 5 years.

For several years I have wanted to have LASIK surgery to correct my nearsightedness. I have been told that I was a perfect candidate for the procedure, but when I mentioned that I had scleroderma no one wanted to take the risk.

Are risks associated with this type of eye surgery for scleroderma patients? One doctor suggested that healing could be delayed, because he had a lupus patient who did not heal as well as anticipated.

A. In any patient, LASIK surgery may rarely be complicated by infections.

Patients with scleroderma have impairments in wound healing, and may experience delayed wound healing.

I generally do not recommend surgery in patients with scleroderma unless it is absolutely necessary.

Itching Related to Scleroderma

Q. My girlfriend is suffering from scleroderma. Recently she also battled breast cancer and the tightening of her skin accelerated, presumably because of her weary immune system.

Is there anything you can recommend to manage the constant itching that she experiences? Her physicians have not found anything that has helped and it has worsened to the point that she is itching all day and night.

A. Itching is a serious problem for patients with scleroderma and there are no perfect treatments for this. Antihistamines such as atarax may be helpful. If the skin is dry, moisturizing lotions such as eucerin may also help.

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