Management of Scleroderma-Related Back Pain

Introduction to Scleroderma Treatment

• The European League Against Rheumatism (EULAR) guidelines do not recommend hydroxychloroquine for any manifestation of systemic sclerosis, including back pain in Scl-70 positive patients 1

Treatment Options for Scleroderma

• Mycophenolate mofetil is the first-line therapy for musculoskeletal involvement in scleroderma, with methotrexate considered when musculoskeletal symptoms are predominant 2
• Mycophenolate mofetil is first-line therapy for SSc-ILD and can address musculoskeletal symptoms 2

Diagnosis and Evaluation of Back Pain

• Back pain requires proper characterization to determine if it is inflammatory or mechanical 3, 4
• If inflammatory back pain is present in a patient under age 45, consider screening for axial spondyloarthritis with HLA-B27 testing 3, 5

Monitoring and Prevention of Scleroderma Complications

• Regular pulmonary function tests are essential in Scl-70 positive patients 2
• Blood pressure monitoring to detect scleroderma renal crisis 2
• Screening for cardiac, gastrointestinal, and other organ involvement 2

Appropriate Use of Medications

• Avoid glucocorticoids in early diffuse cutaneous SSc due to increased risk of scleroderma renal crisis 2
• Second-line options include tocilizumab, rituximab, and nintedanib, particularly for progressive fibrosing interstitial lung disease 2