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Rheumatology Advance Access originally published online on January 11, 2005
Rheumatology 2005 44(4):536-538; doi:10.1093/rheumatology/keh536
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Rheumatology Vol. 44 No. 4 © British Society for Rheumatology 2005; all rights reserved

A pilot study of acetic acid iontophoresis and ultrasound in the treatment of systemic sclerosis-related calcinosis

S. Shetty, T. L. Moore, S. Jackson1, D. Brettle2 and A. L. Herrick

University of Manchester Rheumatic Diseases Centre and 1 Radiology Directorate, Hope Hospital, Salford M6 8HD and 2 Medical Physics and Engineering, St James's University Hospital, Leeds LS9 7TF, UK.

Correspondence to: A. L. Herrick. E-mail: aherrick{at}fs1.ho.man.ac.uk

Objectives. Our aim was to perform a pilot study to investigate whether iontophoresis of acetic acid, followed by ultrasound, might be a safe and effective treatment for systemic sclerosis (SSc)-related calcinosis. This combination treatment has been used in other calcifying disorders.

Methods. Three female patients (ages 51, 62 and 59 yr) were studied. Each underwent treatment nine times over a 3-week period. Iontophoresis was with 2–5% acetic acid at 100 µA for 20 min, followed by ultrasound at 1.5 W/cm2 for 8 min at each visit. The primary endpoint was the degree of radiographic calcinosis as quantified by image analysis after adjusting for soft tissue change.

Results. There were no side-effects from treatment. Mean radiographic intensity fell in all patients (by 18.0, 8.9 and 8.5%), although the maximum density and the area of calcinosis fell in only one patient. However, none of the patients reported any benefits from the treatment.

Conclusions. In this small pilot study none of the patients experienced clinical improvement, despite an intensive treatment schedule over 3 weeks. However, there may have been some radiographic improvement. Given that there is currently no effective treatment for SSc-related calcinosis a larger study incorporating higher ‘doses’ of iontophoresis is indicated.

KEY WORDS: Calcinosis, Iontophoresis, Acetic acid, Ultrasound, Systemic sclerosis


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