Lupus Erythematosus and Scleroderma
are classified as vascular diseases, along with Polyarteritis
Nodosa, and some other diseases, but Lupus and Scleroderma also
have one other thing in common – they can be treated in
a similar manner with equally good results. Lupus Erythematosus
is a chronic, nontuberculous disease of the skin marked by disklike
patches with raised reddish edges and depressed centers, and covered
with scales or crusts. These fall off, leaving dull-white scars.
Scleroderma is a disease of the skin in which thickened, hard,
ridged, and pigmented patches occur.
The connective tissue of the skin layer beneath the epidermis
(corium) and the subcutaneous structures being increased, a hidebound
condition results. The ordinary form begins in middle life and
is often incurable.
The above is according to The
American Illustrated Medical Dictionary (W.B. Saunders).
The Rheumatoid Disease Foundation is happy to bring to you a wonderfully
successful case history of Scleroderma developed by its long-time
referral physician, Ronald M. Davis, MD (16932 Highway 3, Park Plaza
2, Webster, Texas 77598; 713-338-1889.) This is a report of a case
of severe progressive systemic sclerosis in a 49-year-old woman,
who was in good health two years prior to being seen in Dr. Davis'
office. In a year-and-a-half, the condition of the patient deteriorated
from mild stiffness of the joints and tightness of the skin to complete
immobilization, with loss of the use of her extremities and loss
of facial characteristics. Kidney involvement was extensive, necessitating
peritoneal dialysis, which she was doing at home with her husband's
assistance. During the treatment to be described below, she responded
immediately and improved continuously. It's now been over a year
since her last treatment. She has full use of her kidneys without
dialysis and was recently seen walking about Alcatraz Island on
vacation. Indeed, her quality-of-life is vastly improved. If she
is not cured, then she enjoys an extended remission of all symptoms!
Treatments used were two of our recommended Rheumatoid Disease medications,
intravenous EDTA Chelation therapy, intravenous DMSO therapy, and
as much physical therapy as could be tolerated by the patient. Since
Lupus Erythematosus and Scleroderma, like Psoriasis, have been virtually
intractable by conventional treatments, this single success story
The Reversal of Scleroderma
(Progressive Systemic Sclerosis)
Initial History and Physical Examination:
May 22, 1984
Tightness and hardening of the skin of the body, deformities of
the hands, arms, legs, and fingers. Inability to walk, progressive
kidney failure, nausea, and headache. High blood pressure.
History of Chief Complaint: The patient
first began to notice a sensation of swelling and tightness of the
skin of the face and extremities about the Spring of 1982. These
symptoms rapidly progressed to the point of rendering the patient
unable to walk or do daily household work. Evidently her kidneys
had become affected early in the disease, as hypertension and headache
were early symptoms. Patient had been on antihypertensive medication
for over one year, and on peritoneal dialysis for nearly nine months,
when we saw her in our office. She was under the care of a rheumatologist
in Houston and The Texas Kidney Institute at Hermann Hospital in
Past History: Usual childhood illnesses
without sequelae, no serious adult illnesses, and no surgeries.
No history of TB, diabetes, cardiovascular disease, or hypertension
prior to the onset of this disease. Patient is allergic to Demerol.
Family History: Essentially noncontributory,
there being no history of the rheumatoid diseases, TB, CA, diabetes,
or cardiovascular problems.
Medications: Compazine – 25 Mg.
tabs 1, four times daily as needed for nausea.
Dialome – 2, three times per day
Capoten – 75 Mg. 1, two times daily
Prednisone – 5 Mg., one daily
Catapres – 0.1 Mg., one at bedtime
Peritoneal dialysis with one liter of solution four times daily
(prepared by Texas Kidney Institute at Hermann Hospital, Houston.)
Review of Systems:
HEENT: Patient had begun to notice
numbness and coldness of tips of fingers, with a sensation of swelling
of hands, fingers, toes, arms, and legs about two years ago. The
skin of the face, at the same time, became tight and inelastic,
making facial expressions and movement very difficult and eventually
impossible. No problems with vision or hearing but had noticed difficulty
Chest & Lungs: In late 1982, the
patient was awakened in the middle of the night with a sensation
of smothering and chest tightness. She was rushed to a local hospital
Emergency Room, where she was found to have a blood pressure in
the range of 200/110. She was given anti-hypertensive medication,
the blood pressure was reduced, and the symptoms abated. She has
had to remain on medication for blood pressure control since.
Gastro-intestinal: Negative except
for extreme nausea, which has been present since earliest symptoms
began in 1982.
Genito-urinary: Patient is Gravida
(was pregnant) 5, Para 5 (had 5 children successfully), abortus
0, stillbirth 0. She has five children living and in good health.
She had been on peritoneal dialysis at Texas Institute for past
Skin & Extremities: This condition
began with a sensation of coldness and pain of the fingertips. The
fingers and hands soon became stiff and immobile, as did the legs
and feet. Within six months, the patient was unable to walk or do
ordinary daily tasks. She also complained of severe fatigue during
the course of this illness, as she had for several months before
the first symptoms began. The skin and extremities had become slick,
shiny, and very hard to the touch within six months after the onset
of the first symptoms. The skin of the face was no different.
General: The patient is a 49-year-old
Caucasian woman of Italian extraction in obvious acute and chronic
distress from kidney and musculoskeletal disease. (Blood Pressure
140/90, Pulse 94, Temperature 100, Respiration 20, Height 60",
HEENT: Head was normal. Eyes: Sclerae
and conjunctivae were clear, EOM's (Extra Ocular Movements) intact
bilaterally, pupils were equal and equally reactive to light and
accommodation. Optic fundi were not examined. Visual acuity was
not done. Ears: skin of ears was slick, shiny, and quite tender
to touch. Nose: Same. Throat: Throat was clear.
Chest: Lungs were clear to auscultation
and percussion. The breath sounds were diminished due to shallow
breathing from restriction of the rib cage. Heart: Normal sinus
rhythm, rate 110 and regular, and there were no murmurs.
Abdomen: Thin, symmetrical abdomen,
without masses, tenderness, or visceromegaly to palpation, and the
bowel sounds were normal. Rectal and pelvic exams were not done.
The catheters for peritoneal dialysis were in place; there was no
sign of infection or irritation.
Neurological: Examination was limited
due to immobility of the extremities and tenderness of the skin,
but no gross abnormalities of the neurological system were noted.
Skin & Extremities: The skin was
white and glistening and appeared to have been stretched tightly
over the bony skeleton. The joints at the elbows, wrists, knees,
and ankles were difficult to move. The fingers were fixed in flexion
and could not be moved at all. She was the classical Mauskopf face.
Initial Laboratory Data: Hemoglobin
8.4; White Blood Count 7400; Ca++ 9.3; BUN 91; Serum Creatinine
8.3; Glucose 113; Triglycerides 377; Uric Acid 6.6; SGOT 28; SGPT
23; Protein 7.0; Albumin 3.7; Globulins 3.3; LDH 204; Phosphate
4.6; 24 Hr. Creatinine Clearance 7.0; Na+ 140; K+ 5.0; C1-100; CO2
Chest X-ray: Negative; EKG: Sinus Tachycardia,
otherwise normal. Urinalysis: Specific Gravity 1.010; pH 5.0; Protein
1+; Glucose 0; Casts: 2+ Red Blood Cell; Bacteria 1+; Red Blood
Cell 4-5/high powered field; White Blood Cell 3-4/high powered field.
Impression: 1. Severe Progressive Systemic
2. Nephrosclerosis with kidney failure secondary to scleroderma.
3. Severe anemia secondary to 1. and 2.
Treatment Plan: 1. Rheumatoid Disease
2. Intravenous DMSO therapy
3. Intravenous Chelation therapy (EDTA)
4. Physical Therapy as tolerated by patient
Clinical Course: On May 22, 1984, the
Rheumatoid Disease Foundation therapy was begun in accordance with
its protocol, which is as follows: Allopurinol 300 mg. by mouth
three times per day for seven days. Metronidazole 500 mg. –
Two tablets, AM and PM, two consecutive days a week for six weeks.
The patient was told to continue all current medicines. She experienced
increased nausea and headache, plus she had rather severe joint
pains, as well as increased muscular aches and pains. These symptoms
were believed to be due to Herxheimer type reaction, for they were
most bothersome following taking the Metronidazole on Tuesdays and
Wednesdays. Moderate relief of these symptoms was obtained by increasing
the Prednisone by one tablet on these days.
5/29/84: Condition unchanged, patient
complaining of increased nausea from the medication and dialysis.
Blood Pressure 140/70; Temperature 98.6; Weight 107#.
6/19/84: Patient complaining of worse
nausea, with retching and more joint stiffness. She doesn't feel
that she is "getting any better." Blood pressure 140/70,
Temperature 98, Weight 106#, Rx – Take Allopurinol 300 mg.
2 times daily for 1 week, and gradually reduce and discontinue Prednisone
over the next 3-4 weeks.
7/23/84: Nausea continues, still feels
terrible. (Blood pressure 140/74; Temperature 98; weight 104#; Rx
– DMSO 5cc in 500 cc D5W [5% Dextrose Solution] Intravenous
over 1 hour.)
7/25/84: Less nausea today, but really
not feeling any better. Blood Pressure 142/76; Temperature 99; Weight
103#; Rx – DMSO 5cc infusion #2 no problems encountered.
7/27/84-8/17/84: Patient received 5cc
DMSO in 500 cc D5W (5% Dextrose Solution) over a 3 hour time span
without adverse effects of any sort. Her vital signs remained the
same. These infusions were given 3 times weekly.
8/27/84: This date I talked with Dr.
Stanley Jacobs, M.D. of the University of Oregon regarding his treatment
of scleroderma and rheumatoid arthritis with DMSO. He uses 0.5-Gm.
of DMSO per kilogram of body weight three times weekly. Since this
patient had been on only 5 cc DMSO per treatment, it was decided
to increase her DMSO by 5-10cc per treatment until her maximum dose
of 50 Gm. DMSO in 500cc D5W (5% Dextrose Solution) was reached,
and then to continue treatments three times per week at that level.
She was given 10cc DMSO today in the infusion, without untoward
9/10/84: Intravenous #19 today with
32-1/2ccDMSO. Blood Pressure 122/70; Weight 105. Patient appears
somewhat improved, as the nausea is mild and intermittent. She seems
to be improving and gaining strength weekly. She can now wrinkle
her forehead, smile, and walk slowly with assistance. Serum Creatinine
3.9; Serum Creatinine Clearance 13. Kidneys are evidently regaining
9/24/84: 45cc DMSO given today in 23rd
treatment. Patient is responding well to therapy, skin is softening,
joints are mobile, except for fingers, and she is walking almost
normally without assistance. BUN 57; Creatinine 4.2; Liver function
studies were normal. Hb 8.9; White Blood Count 7300. Patient told
to keep taking Fe script for low hemoglobin. I talked with Dr. Thompson
at Hermann Hospital. She is pleased with patient's progress and
said we should continue the treatments, and that she would be happy
to continue to assist in the care of this patient.
9/26/84: 50cc DMSO given intravenous
today without side effect except for the garlic-like odor DMSO gives.
The patient continues to improve and feel well. Blood Pressure 122/70;
10/12/84: Continues improving, offers
no complaints. Treatment #29 today. Hemoglobin 8.7; Ca 9.4; BUN
48; Creatinine 3.8; Glucose 88; Triglycerides 391; HDL 44.2; Alkaline
Phosphatase 46.9; SGOT 16; LDH 90; P 4.8; Cholesterol 314; Uric
Acid 3.8; Na+ 156; K+4.7; 24 Hr. Creatinine Clearance 13.1; Urinalysis:
Specific Gravity 1.010; pH 6; Rest of Urinalysis negative; Vital
11/27/84: Patient has not had a treatment
in one month, so we will go back to 30cc DMSO and go back to 50cc
with next infusion. Patient looks great, is walking briskly without
any problem, and is free of any discomfort. The skin appears normal
and is normal to the touch, having lost its slick, shiny appearance.
Hemoglobin 9.6; White Blood Count 6000; Ca 9.2; BUN 51; Creatinine
3.0; Triglycerides 398; Electrolytes and liver tests were normal.
Prognosis now looks good.
12/22/84: Dr. Thompson discontinued
peritoneal dialysis, but left the catheters in place in the event
we have to re-institute dialysis. Patient is improving very well
at this time, having a lot of energy, and carries out her normal
household duties. Fingers are much more flexible and patient can
almost clench fists. She has had 39 DMSO infusions to date. Blood
pressure 140/70; Weight 106#; Serum Creatinine 3.0.
1/21/85: Infusion #44, 35cc DMSO. Blood
Pressure 160/80; Weight 107#.
1/31/85: Patient complaining of slight
headache. Physical exam not remarkable, and I can only explain increase
in Blood Pressure by the fact that she hasn't been getting her treatments
very regularly. Blood Pressure 160/102; Weight 105#. She was told
to increase Capoten from 75 Mg at bedtime, to 50 Mg. a.m. and 75
Mg. at bedtime; Hemoglobin 11.5; White Blood Count 13,900; Normal
Differential Urinalysis negative; BUN 57.1; Creatinine 3.0; Na+
145; K+ 5.0.
2/26/85: Infusion #49, 35cc DMSO. Patient
continues to improve, although lab data remain at December 84 levels.
We have started adding 2 cc B6 and 15cc (7.5 Gm.) ascorbic acid
to each intravenous beginning 2/8/85. No unwanted side effects have
3/26/85: 30cc DMSO today in treatment
#53. Patient is doing very well, offering no complaints. Hemoglobin
10.9; White Blood Count 6000; BUN 68; Creatinine 3.3; Urine output
normal; Blood Pressure 130/80 Weight 101#.
4/25/85: Infusion #57, with 50cc DMSO.
No problems. Patient seems to continue improving. Blood Pressure
140/84; Weight 102#; BUN 57.2; Serum Creatinine 2.7.
5/30/85: Infusion #65 today. No DMSO,
just 1cc EDTA in 500cc D5W, with 2cc B6 and 15cc ascorbic acid given
intravenous over 3 hours. No adverse effects noted. Preinfusion
Blood Pressure 140/82. Post infusion Blood Pressure 140/80. Hemoglobin
10.6; White Blood Count 5000; 24 Hr. Creatinine Clearance 21.37;
Serum Creatinine 2.7.
6/6/85: Infusion #66 with 50cc. DMSO.
No Problems. Blood Pressure 140/80; BUN 48; Serum Creatinine 2.8.
Skin of face, arms, legs, and hands approaching normal. Patient
has lost her Mauskopf appearance, and has normal mobility of the
6/10/85: Infusion #67, with 2cc EDTA
without problem. Preinfusion Blood Pressure 160/80. Postinfusion
Blood Pressure 162/76; Weight 107#. Patient offered no complaints
during, or after infusion. BUN 45.8; Creatinine 3.0; 24 Hr. Creatinine
Clearance 21.37; Urinalysis Specific Gravity 1.010; pH 5.0; Protein
trace; 1-2 White Blood Count/high powered field.
6/20/85: Infusion #68, 50cc DMSO and
2cc EDTA. Patient complained of nausea, and had one episode of vomiting
during the infusion, which she felt was due to the DMSO. Will reduce
DMSO to 40cc next infusion. Preinfusion Blood Pressure 160/90. Postinfusion
Blood Pressure 162/88; Weight 105#.
7/11/85: Treatment #70 continued with
40cc DMSO and 2cc EDTA – no complaints or problems. Preinfusion
Blood Pressure 150/92. Postinfusion Blood Pressure 150/90; Hemoglobin
11.2; 24 Hr. Creatinine Clearance 23.71. Patient appears and says
she feels normal.
7/22/85: EDTA increased to 3cc, along
with 40cc DMSO for infusion #72. Preinfusion Blood Pressure 150/90.
Postinfusion Blood Pressure 150/86; Weight 105#. Procedure was tolerated
well by patient. BUN 58.7; Creatinine 2.6; Urinalysis; Negative.
7/30/85: For infusion #73, EDTA was
increased to 5cc, again with 40cc DMSO. No problems encountered
during or after treatment. Pre, and post infusion Blood Pressure
150/86; Weight 106#; BUN 55.4; Creatinine 2.8.
8/19/85: Infusion #74 with 5cc EDTA
and 40cc DMSO was well tolerated by the patient, and there were
no difficulties during or following the treatment. Preinfusion Blood
Pressure 142/90, Postinfusion Blood Pressure 140/90; Weight 105#;
BUN 45.7; Creatinine 3.0.
10/18/85: Infusions 74 thru 81 were
given with 5cc EDTA only and were without incident. Blood Pressure
remained in the 150/84 range, and patient continued to progress
very well. Her weight remained the same, but she was having to diet
to keep her weight 105# or below. BUN 41; Creatinine 2.7; Creatinine
11/5/85: Since it had been almost a
month from the last treatment, only 20cc DMSO were given in infusion
#82. It was without incident. BUN 47.9; Creatinine 2.4; Creatinine
Clearance 28.39; Blood Pressure 142/80; Urinalysis; negative; Weight
12/11/85: Infusion #83 was with 7cc
EDTA, 5cc ascorbic acid, and 5cc (1250Mg) Pantothenic Acid all in
50cc D5W (5% Dextrose Solution) intravenous. This was given in 1
hour, there were no adverse effects, lab values and blood pressure
readings remained the same.
1/6/86: About middle of December 85,
Dr. Thompson removed the peritoneal dialysis catheters, since they
had not been used for one year.
7/25/86: Since 2/5/86 patient has received
infusions 84-90 on the average of one per month, with no adverse
effects. All of these treatments contained EDTA 8cc, ascorbic acid
15cc, in 50cc D5W (5% Dextrose Solution), given in one hour. BUN
48; Creatinine 1.6, Creatinine Clearance 38.66. Infusion #91 was
given this date. Blood Pressure 150/90; Weight 110#. Patient has
felt well and has led a normal life for the past six months.
The patient has not been seen at the Kidney Institute at Hermann
Hospital since January 1986, although Dr. Thompson has followed
her progress by phone, through my office, and with the patient.
Dr. Ronald Davis expresses his heartfelt gratitude to Dr. Katy Thompson
of the Texas Kidney Institute at Hermann Hospital, Houston, Texas
and to Dr. Stanley Jacobs of the University of Oregon for their
kind and able assistance and cooperation in the treatment of this
to The Art of Getting Well
by Anthony di Fabio
Copyright 1989 / All rights reserved by The Rheumatoid Disease Foundation,
7111 Sweetgum Drive SW, Suite A, Fairview, Tennessee 37062 USA
Publications from The
Rheumatoid Disease Foundation
1. The Art of Getting Well, by Anthony
di Fabio: Intended for Rheumatoid Disease victims, but can also
be used by the family physician. Includes recommended primary treatments
plus important complementary treatments. All arthritics must read
and understand this book! ($25 or more donation).
2. Intraneural Injections for Rheumatoid
Arthritis and Osteoarthritis and
The Control of Pain in Arthritis of the Knee, by Dr. Paul
K. Pybus. A new concept on treating the pain of arthritis. Partly
written for physicians and partly for layfolks, but all arthritics
should read and understand this book! ($11.00 or more donation).
3. Fight Back Against Arthritis,
by Robert Bingham, M.D.: Intended for Arthritic victims. Includes
variety of conventional and non-conventional treatments and practical
information that arthritics should know. ($25 donation or more).
4. Rheumatoid Diseases Cured At Last,
by Anthony di Fabio: Intended for rheumatoid disease and osteoarthritis
victims. This book covers the original "amoebae theory,"
the hypothesis that serendipitously developed the presently successful
medical treatment. ($15 donation or more).
5. Supplement to The Art of Getting Well,
by Anthony di Fabio: Additional chapters to The
Art of Getting Well published as they are prepared and mailed
to all donor/members without charge.
Mail check or money order to:
The Rheumatoid Disease Foundation
7111 Sweetgum Drive SW, Suite A
Fairview, Tennessee 37062 USA.
The Rheumatoid Disease Foundation is a project
of The Roger Wyburn-Mason and Jack M. Blount Foundation for The
Eradication of Rheumatoid Disease, Inc.