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Effects of shock wave therapy in the skin of patients with progressive systemic sclerosis: a pilot study

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Abstract

Vasculopathy, immunological abnormalities, and excessive tissue fibrosis are key elements in the pathogenesis of progressive systemic sclerosis (SSc). Extracorporeal shock waves (ESW) have anti-inflammatory and regenerative effects on different tissues. We hypothesized that ESW can reduce endothelial cell damage and skin fibrosis in patients with SSc. We enrolled 30 patients affected by SSc, 29 females and 1 male. Rodnan Skin Score (RSS) and Visuo-Analogical Scale (VAS) for skin wellness were performed before and immediately after ESW therapy (ESWT) and at 7, 30, 60, and 90 days after the treatment. Sonographic examination of the patients’ arms was performed before and 7, 30, 60, 90 days after treatment. Blood samples were obtained before and 30 and 60 days after treatment to measure serological levels of von Willebrand factor, vascular endothelial growth factor, intracellular adhesion molecule-1, monocyte chemotactic protein-1. The number of endothelial progenitor cells (EPCs) and circulating endothelial cells (CECs) were determined at the same time points. After ESWT we observed a rapid and persistent reduction of RSS and decrease of VAS. There was no difference in skin thickness before and after ESWT; however, we observed a more regular skin structure and an improvement in skin vascularization 90 days after treatment. EPCs and CECs increased 60 and 90 days after treatment, while serological biomarkers showed no variation before and after therapy. In conclusion, ESWT resulted in an improvement of VAS, RSS, and of skin vascular score, and in an increase of CECs and EPCs.

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Acknowledgment

We thanks Dr. Ernst Marlinghaus for his invaluable technical support.

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Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy

    Elisa Tinazzi, Elettra Marangoni, Orazio Michele Codella, Sara Simeoni, Roberto Corrocher & Claudio Lunardi

  2. Shock Wave Unit-Hand Surgery Section, University Hospital of Verona, P.le L.A.Scuro 10, 37134, Verona, Italy

    Ernesto Amelio, Claudio Guerra & Roberto Adani

  3. Department of Experimental Medicine, University of Genova and Institute G. Gaslini, L.go G. Gaslini 5, 16148, Genoa, Italy

    Antonio Puccetti

  4. Department of Morphological and Technical Sciences, University of Verona, St. Le Grazie 8, 37134, Verona, Italy

    Elisabetta Cavalieri

  5. Department of Morphological and Biomedical Sciences, University of Verona, P.le L.A.Scuro 10, 37134, Verona, Italy

    Martina Montagnana

Authors
  1. Elisa Tinazzi
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  2. Ernesto Amelio
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  3. Elettra Marangoni
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  4. Claudio Guerra
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  5. Antonio Puccetti
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  6. Orazio Michele Codella
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  7. Sara Simeoni
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  8. Elisabetta Cavalieri
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  9. Martina Montagnana
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  10. Roberto Adani
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  11. Roberto Corrocher
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  12. Claudio Lunardi
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Corresponding author

Correspondence to Claudio Lunardi.

Additional information

Elisa Tinazzi and Ernesto Amelio were equally contributed to the work.

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Tinazzi, E., Amelio, E., Marangoni, E. et al. Effects of shock wave therapy in the skin of patients with progressive systemic sclerosis: a pilot study. Rheumatol Int 31, 651–656 (2011). https://doi.org/10.1007/s00296-009-1339-z

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  • DOI: https://doi.org/10.1007/s00296-009-1339-z

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