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
 |
| Laura
Carbone, M.D. |
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 Restrictions 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. |
