Effect of Dexamethasone Cyclophosphamide Pulse Therapy in Collagen Vascular Diseases

INTRODUCTION : Collagen vascular diseases like Systemic Lupus Erythematosus (SLE) and Systemic Sclerosis (SSc) are always a challenge to the treating dermatologists. Though complete cure remains an enigma, therapeutic advances have aimed at inducing quick remission and improving the quality of life of the patients. Pulse therapy is administration of single or multiple daily infusions of suprapharmacological doses of drugs to achieve a desired therapeutic effect. It is otherwise called as the “big shot". The history of pulse therapy began in 1969 when Kountz and Cohn introduced methylprednislone pulse therapy to prevent renal graft rejection. The monumental success of Dexamethasone Cyclophosphamide pulse therapy (DCP) in autoimmune bullous diseases (eg.Pemphigus) reported by Pasrischa et al., has prompted dermatologists to use DCP in collagen vascular diseases. Collagen vascular disorders are a group of diseases characterized by generalised alteration in connective tissue and have certain common features like autoimmunity, disordered cell mediated immunity, vascular abnormalities, arthralgia and skin disease. The diseases grouped under this category include lupus erythematosus, systemic sclerosis, localised and generalised morphoea, dermatomyositis, rheumatoid arthritis and Sjogren’s syndrome. AIMS & OBJECTIVES : To study the efficacy of Dexamethasone –Cyclophosphamide pulse therapy in collagen vascular disorders. 1. To evaluate the degree of clinical and serological remission in Systemic Lupus Erythematosus and Systemic Sclerosis. 2. To evaluate the duration required to induce clinical remission. 3. To evaluate side effects of pulse therapy. MATERIALS AND METHODS : TYPE OF STUDY : This is a type of open labelled non randomised prospective therapeutic study. Here the patients act as their own control. SAMPLE SIZE : A sample size of 36 patients was selected. Out of these, 20 patients had systemic lupus erythematosus and the other 16 had Systemic Sclerosis. STUDY PLACE : This study was conducted at the Department of Dermatology, Stanley Medical College in association with other departments for evaluation of systemic involvement. STUDY PERIOD : The study was conducted over a period of 2 years from November 2009 to October 2011. PATIENT SELECTION CRITERIA : INCLUSION CRITERIA : 1. Systemic lupus erythematosus and systemic sclerosis patients diagnosed as per ARA criteria. 1. Age: 13 to 60 years. 2. Severe skin lesions not responding to high dose daily steroids 3. Presence of systemic involvement. EXCLUSION CRITERIA : 1. Pregnancy. 2. Lactating mothers. 3. Children