Evidence and consensus-based recommendations for non-pharmacological treatment of fatigue, hand function loss, Raynaud’s phenomenon and digital ulcers in patients with systemic sclerosis

Stöcker, J.K.; Schouffoer, Anne A.; Spierings, Julia; Schriemer, Marisca R; Pundert, Lian de; Hoogen, F.H.J. van den; Sanden, Maria W. G. Nijhuis-van der; Staal, J. Bart; Satink, Ton; Vonk, Madelon C.; Ende, C.H.M. van den

doi:10.1093/rheumatology/keab537

Cited by 12 publications

(18 citation statements)

References 52 publications

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“…We did see an improvement in the RCS just by wearing gloves. This provides evidence for previous expert opinion statements indicating gloves should be used as part of conservative measures to improve RP burden in SSc [ 9 , 14 , 15 ]. As our study was not designed to detect a difference between wearing gloves and not wearing gloves, we cannot claim to have scientifically proven the benefit of wearing any type of gloves.…”

Section: Discussionsupporting

confidence: 77%

“…Hypothetically, silver fibre gloves might show benefit by improved containment of bodily warmth [ 12 ]. Despite a lack of previous studies on the application of silver fibre gloves in RP, these gloves are recommended in clinical practice [ 9 , 14 , 15 ]. Clinical experience indicates that some patients who previously had insufficient benefit from normal gloves experience improvement of RP when wearing silver fibre gloves.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical observations have suggested better efficacy in RP symptom reduction of silver fibre gloves compared with normal gloves [ 9 , 14 , 15 ]. SSc patients report that hand temperature increases and, as a consequence, disease burden related to RP decreases.…”

Section: Introductionmentioning

confidence: 99%

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The effect of silver fibre gloves on Raynaud’s phenomenon in patients with systemic sclerosis: a double-blind randomized crossover trial

et al. 2022

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Objectives Silver fibre gloves transport heat from the palm to the fingers, possibly reducing the burden of Raynaud’s phenomenon (RP) in systemic sclerosis (SSc) patients. We aim to evaluate the clinical efficiency of this intervention. Methods A multicentre double-blind randomized trial was performed, accounting for interindividual differences and external factors using a cross-over design. Patients were randomized in two groups: group 1 wore 8%-silver fibre gloves in period 1 and normal gloves in period 2, and group 2 vice versa. Each period lasted six weeks. The primary outcome was the Raynaud Condition Score (RCS) over time (minimal clinical important difference : 1.4), assessed three times per week using an online questionnaire. Secondary outcomes included vascular complications and Scleroderma-Health Assessment Questionnaire (SHAQ). Outcomes were evaluated before unblinding using linear mixed models. Results Eighty-five SSc-patients were included, with 76 completing the study. Mean RCS during two weeks before the study (i.e.: without gloves) was 6.4 (SD : 1.6). Both with silver fibre gloves and normal gloves the mean RCS decreased to 3.9 (SD : 2.3) with similar course over time. There was no difference in mean RCS over time between the type of gloves (β:0.067, 95% CI:-0.006–0.19). Of secondary outcomes, total SHAQ (β:0.036, 95% CI : 0.026–0.046) was slightly higher with silver fibre gloves, which is clinically irrelevant. Three patients developed new digital ulcers with normal gloves, vs one patient with silver fibre gloves (OR : 3.2, 95% CI : 0.32–31.1). Conclusion Wearing gloves in SSc patients clearly decreases the RP burden. Our results do not support the hypothesis that increased heat transport of 8%-silver fibre gloves is associated with less disease burden as measured in this study by RCS compared with normal gloves. Clinical trial registration number Netherlands Trial register; https://www.trialregister.nl/; NL7904

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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The effect of silver fibre gloves on Raynaud’s phenomenon in patients with systemic sclerosis: a double-blind randomized crossover trial

et al. 2022

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“…In both conditions, drug treatments are aimed at blocking the endothelin pathway, or supplementing either the nitric oxide pathway or the prostacyclin pathway. 22 Figure 2 summarizes current approaches to treatment, 23 which include 'general/lifestyle' measures and non-pharmacological treatments, 24 as well as specialist nursing care for patients with digital ulcers. 25 Recent advances are as follows.…”

Section: Advances In Managementmentioning

confidence: 99%

Advances in the Treatment of Systemic Sclerosis

Herrick¹

2022

Rheumatology

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Although systemic sclerosis (SSc) is currently incurable, there have been recent advances in treatment. This review article begins by providing a brief background to SSc in terms of disease subtyping and autoantibodies, because both predict disease trajectory and help clinicians to select appropriate monitoring and treatment protocols. Broad principles of management are then described: ‘disease-modifying’ therapies and therapies directed at reducing disease burden and/or progression of SSc-related digital vascular disease and of internal organ involvement. Next, advances in the management of digital vasculopathy, pulmonary arterial hypertension (PAH), interstitial lung disease (ILD) and early diffuse cutaneous SSc are discussed in turn, for example: (a) increased use of phosphodiesterase inhibitors and endothelin receptor antagonists for digital vasculopathy; (b) early recognition and treatment of PAH, including with combination therapies; (c) increased use of mycophenolate mofetil and of nintedanib in ILD; and (d) immunosuppression now as standard practice in early diffuse cutaneous SSc, and autologous haematopoietic stem cell transplantation for highly selected patients with progressive diffuse disease. Finally, future challenges are discussed, including ensuring that all patients with SSc are monitored and treated according to best practice guidelines, and whenever possible giving patients the opportunity to participate in clinical trials.

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“…Non-pharmacological management and self-management strategies are progressively substantiated through growing evidence 5. While a substantial use of non-pharmacological interventions is generally seen, the usage, content, delivery methods and access to such interventions are not always optimised, or even suitable.…”

Section: Introductionmentioning

confidence: 99%

EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis

Parodis,

Girard-Guyonvarc’h,

Arnaud

et al. 2023

Ann Rheum Dis

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ObjectiveTo develop evidence-based recommendations for the non-pharmacological management of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc).MethodsA task force comprising 7 rheumatologists, 15 other healthcare professionals and 3 patients was established. Following a systematic literature review performed to inform the recommendations, statements were formulated, discussed during online meetings and graded based on risk of bias assessment, level of evidence (LoE) and strength of recommendation (SoR; scale A–D, A comprising consistent LoE 1 studies, D comprising LoE 4 or inconsistent studies), following the European Alliance of Associations for Rheumatology standard operating procedure. Level of agreement (LoA; scale 0–10, 0 denoting complete disagreement, 10 denoting complete agreement) was determined for each statement through online voting.ResultsFour overarching principles and 12 recommendations were developed. These concerned common and disease-specific aspects of non-pharmacological management. SoR ranged from A to D. The mean LoA with the overarching principles and recommendations ranged from 8.4 to 9.7. Briefly, non-pharmacological management of SLE and SSc should be tailored, person-centred and participatory. It is not intended to preclude but rather complement pharmacotherapy. Patients should be offered education and support for physical exercise, smoking cessation and avoidance of cold exposure. Photoprotection and psychosocial interventions are important for SLE patients, while mouth and hand exercises are important in SSc.ConclusionsThe recommendations will guide healthcare professionals and patients towards a holistic and personalised management of SLE and SSc. Research and educational agendas were developed to address needs towards a higher evidence level, enhancement of clinician–patient communication and improved outcomes.

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Evidence and consensus-based recommendations for non-pharmacological treatment of fatigue, hand function loss, Raynaud’s phenomenon and digital ulcers in patients with systemic sclerosis

Cited by 12 publications

References 52 publications

The effect of silver fibre gloves on Raynaud’s phenomenon in patients with systemic sclerosis: a double-blind randomized crossover trial

The effect of silver fibre gloves on Raynaud’s phenomenon in patients with systemic sclerosis: a double-blind randomized crossover trial

Advances in the Treatment of Systemic Sclerosis

EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis

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