Which medications are used in the treatment of calcinosis in CREST syndrome?

Updated: Oct 05, 2020
  • Author: Jeanie C Yoon, MD; Chief Editor: Dirk M Elston, MD  more...
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Early case reports suggested that diltiazem was associated with regression of calcific deposits and improvement of symptoms. A 1998 case series of 12 patients by Vayssairat et al [72] did not confirm these findings.

A 1987 small randomized placebo-controlled trial by Berger et al [73] using low-dose warfarin reduced urinary levels of Gla protein and reduced extraskeletal uptake on bone scans in 2 of 3 patients after 18 months of follow-up care. No changes in plain radiographs or clinical assessment were noted in these patients. Cukierman et al [74] used low-dose dose warfarin on 3 patients with systemic sclerosis, and 2 of the patients, who had newly diagnosed, diffuse, and relatively small calcinotic lesions, responded to warfarin treatment, with complete resolution of the calcinosis. As reported in 1998, Lassoued et al [75] used warfarin in patients with extensive calcinosis and saw no benefit. Low-dose warfarin may be helpful in selected patients with early or mild disease.

Several case reports have shown that aluminum hydroxide may be useful for calcinosis. [76]

Bisphosphonate treatment has had only limited success. Etidronate appeared to help calcinosis in one patient with scleroderma; however, another study reported failure. Alendronate was used successfully in one patient with calcinosis associated with juvenile dermatomyositis. The other bisphosphonates, pamidronate, risedronate, zoledronate, and ibandronate, have not been studied for calcinosis. [76, 77, 78, 79]

In one case series, 8 of 9 patients with limited systemic sclerosis had a good response to low-dose minocycline. [80]

Suppression of intermittent local inflammatory reactions can be achieved by low-dose colchicine. [81]

Kalajian et al found intravenous immunoglobulin therapy to be unreliable. [82]

In summary, no consistently reliable pharmacological treatment seems to be available to prevent or eliminate calcinosis. One or a combination of the above treatments may be tried on a case-by-case basis; however, larger randomized trials are needed to prove efficacy.

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