Rheumatology, Vol 38, 309-315, Copyright © 1999 by British Society for Rheumatology
CP Denton, TD Bunce, MB Darado, Z Roberts, H Wilson, K Howell, KR Bruckdorfer and CM Black
OBJECTIVE: Reactive oxygen species have been implicated in the pathogenesis
of inflammatory and vascular disease. We have undertaken a controlled trial
to evaluate probucol, a synthetic antioxidant, as a potential therapy for
Raynaud's phenomenon. METHODS: The study cohort included patients with
systemic sclerosis (SSc; n = 20), primary Raynaud's phenomenon (n = 15) or
'autoimmune Raynaud's' (n = 5). Patients were allocated to receive either
probucol (500 mg daily) or nifedipine (20 mg daily) for 12 weeks. Clinical
and biochemical variables at baseline were compared with those at
completion of treatment. Evaluation included assessment of Raynaud's attack
frequency and severity by visual analogue scale, measurement of low-density
lipoprotein (LDL) oxidation lag time, and plasma concentrations of
cholesterol, triglyceride, vitamin E and vitamin C. RESULTS: There was a
significant reduction of both the frequency and severity of Raynaud's
attacks in the patients who received probucol, but not in the control
group. LDL oxidation lag time, reflecting in vitro susceptibility to
oxidation, was also increased by probucol therapy and serum cholesterol
levels were significantly reduced. Similar changes were observed in both
SSc- and non-SSc-associated Raynaud's cases. CONCLUSION: These data suggest
that probucol may be useful for the symptomatic treatment of Raynaud's
phenomenon and also reduces LDL oxidation susceptibility. Since oxidized
lipoproteins may mediate vascular damage in SSc, the use of probucol could
have additional disease-modifying benefits. Based upon the results of this
pilot study, further evaluation of this novel form of therapy is warranted.
ORIGINAL PAPERS
Probucol improves symptoms and reduces lipoprotein oxidation susceptibility in patients with Raynaud's phenomenon
Academic Unit of Rheumatology, Royal Free Hospital School of Medicine, London, UK.
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