Effect of warfarin sodium therapy on excretion of 4‐carboxy‐L‐glutamic acid in scleroderma, dermatomyositis, and myositis ossificans progressiva

Abstract

The effect of warfarin sodium on excretion of calcium, phosphorus, and 4-carboxy-L-glutamic acid (Gla) was studied in 5 patients with ectopic calcification (2 with scleroderma, 1 with dermatomyositis, and 2 with myositis ossificans progressiva). Warfarin reduced urinary excretion of Gila in all patients, but no changes in calcium and phosphorus excretion or in objective parameters of calcinosis were observed during 6-36 months of treatment. Two patients experienced hemorrhagic complications during therapy, emphasizing a hazard of long-term anticoagulation treatment. Since ectopic calcium deposits contain Gla-rich protein, suppression of Gla synthesis by warfarin sodium over a longer ]period may prevent deposition and allow removal of existing calcinosis deposits. jEctopic calcification is an occasional complication of certain connective tissue diseases. It occurs rarely in systemic lupus erythematosus patients (l), in approximately 9% of patients with scleroderma (Z), and in 20% of adults and 40% of children with dermatomyositis (3). Muscle calcification also occurs in myositis ossificans (4), a relatively rare condition of unknown origin.

Treatment of calcinosis cutis by extracorporeal shock-wave lithotripsy

“…The number of isolated cases reported that were treated empirically and no organized trial has highlighted the absence of an effective and codified treatment for CC. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] The following agents have been prescribed: diltiazem, 11 aluminum hydroxide, 12 sodium thiosulfate, 13 colchicine, 14 edathamil, 15 intravenous immunoglobulins, 16 carbon-dioxide laser, 17 warfarin, 18 minocycline, 19 or bisphosphonates, 20-23 achieving variable efficacy and causing significant side effects. Excision of CC that are painful or a source of disability is sometimes proposed, but the topography (distal and periarticular site for SSC) and the extent of the lesions (CVI) can render surgical management difficult.…”

Fibrodysplasia ossificans progressiva. An unusual cause of restricted mandibular movement

“…As the exact pathogenesis of FOP is not understood no standard treatment protocol capable of stopping progression of the disease exists. Several treatment modalities have been described (Moore et al , 1986; Bruni et al , 1990; Crofford et al , 1990) including calcitonin, non‐steroidal anti‐inflammatory drugs, isotretinoin, warfarin, and diphosphonates showing diverse results.…”