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Rheumatology International

, Volume 31, Issue 5, pp 651–656 | Cite as

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

  • Elisa Tinazzi
  • Ernesto Amelio
  • Elettra Marangoni
  • Claudio Guerra
  • Antonio Puccetti
  • Orazio Michele Codella
  • Sara Simeoni
  • Elisabetta Cavalieri
  • Martina Montagnana
  • Roberto Adani
  • Roberto Corrocher
  • Claudio Lunardi
Original Article

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.

Keywords

ESWT: extracorporeal shock wave therapy SSc: progressive systemic sclerosis Skin fibrosis Endothelial cell damage 

Notes

Acknowledgment

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

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Elisa Tinazzi
    • 1
  • Ernesto Amelio
    • 2
  • Elettra Marangoni
    • 1
  • Claudio Guerra
    • 2
  • Antonio Puccetti
    • 3
  • Orazio Michele Codella
    • 1
  • Sara Simeoni
    • 1
  • Elisabetta Cavalieri
    • 4
  • Martina Montagnana
    • 5
  • Roberto Adani
    • 2
  • Roberto Corrocher
    • 1
  • Claudio Lunardi
    • 1
  1. 1.Department of Clinical and Experimental MedicineUniversity of VeronaVeronaItaly
  2. 2.Shock Wave Unit-Hand Surgery SectionUniversity Hospital of VeronaVeronaItaly
  3. 3.Department of Experimental MedicineUniversity of Genova and Institute G. GasliniGenoaItaly
  4. 4.Department of Morphological and Technical SciencesUniversity of VeronaVeronaItaly
  5. 5.Department of Morphological and Biomedical SciencesUniversity of VeronaVeronaItaly

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