DMSO Background Literature
U.V. Murav´ev, A.P. Aliab´eva, I.A. Sigidin, and N.G. Guseva
Dimethyl sulfoxide (DMSO has been used since 1974 in the complex cure of systemic scleroderma in the Institute of Rheumatology AMS USSR. By using open method, applying 50% solution of DMSO for 30-40 mins., we studied the influence of this drug on the skin syndrome and vessel pathology (permeability of cappillaries, pronounced Raynaud syndrome. [The following] convincing results of [the] positive effect of DMSO on the clinical manifestation of the disease were received:
dense skin edema lessened
Moreover, the study of excretion of glycosaminoglycan (GAG) and of hydroxyproline showed intensification of metabolism of ground substance of connective tissues under the influence of DMSO. This is witnessed by the increase of the level of GAG and the normalization of its qualitative composition, although the research described above was based on a relatively short (2 weeks) testing period of this drug.
Now, for the first time, we conducted a double blind method controlled study of the influence of an uninterrupted long-term (from 7 to 12 month) DMSO therapy of different concentrations.
In this research, 20 women with systemic scleroderma were observed. Diagnosis was confirmed clinically and also on the basis of special practical tests (Roentgenography of chest, of esophagus, and skeletal system, also electrocardiography and cardiophonography). Progress of the disease was assessed on the basis of the value of exponents of sedimentary rate, fabrinogen, seramucoid, C-reactive protein, rheumatoid factor. Clinical characteristics of patients (according to N.G. Gusev's classification) are listed in Table 1, which shows that the predominant number of patients were from 30 to 60 years old and had the disease for 3 years or longer, with subactive and chronic characteristics, I -- II levels of intensity of process, and I -- II stages of disease.
Patients were divided into two groups randomly. First group consists of 11 patients who received the 50% solution of DMSO. Second groups consists of 9 patients who received the 10% solution of the drug.
Presence of symetrical sclerodermic affliction of the skin of hands and forearms was obligatory. Patients, who received D-penicillamine and corticosterone (Prednisone) in daily dosage of not less than 10 mg, were not included. Nonsteroide anti-inflammatory drugs, which patients were receiving before hospitalization, were still given to them in the same dosages. DMSO was applied to both hands in the form of so-called "long gloves."
Clinical characteristics of patients with systemic scleroderma under long-term applification of DMSO with different concentrations
Standard clinical indicators were used as criteria for efficacy of DMSO -- circumference of proximal interphalangeal joints of hands, (in mm); the strength of grip measured with manometer (in mm mercury) separately for each hand; thickness of the skin fold of the lower third part of forearm (in cm). In addition, blood flow in skin and muscles was mearsured also by the Clarence method 133Xe, and morphological changes in samples of skin by the method of light microscopy. Just as for clinical exponents, the same double blind method was used for evaluation of results.
Results of curing the patients with systemic scleroderma are shown in Table 2. The table shows that a curing effect was visible only when the 50% solution of DMSO was applied. The thickness of skin fold of those who received it became smaller, circumference of proximal interphalangeal joints lessened, muscle blood flow grew significantly. Increase of hand strength reached the level of certainty. At the same time, the 10% solution of DMSO did not show any positive effect. The results of Morphological tests of samples of skin indicate that only the application of 50% solution of DMSO lessened the inflammation. Productive and cell reactions of walls of blood vessels and perivascular fibers decreased especially and practically disappeared. Some increase in the amount of blood vessels was observed. Fabrinoide changes of collagen lessened somewhat. The 10% solution did not improve morphological indicators. In some cases, some increase in fabrinoide changes of skin and the walls of vessels was noticed, as well as increase in pervascular infiltration. No side effects of this therapy were observed in any patients.
Influence of DMSO with different concentrations on clinical-instrumental exponents of patients with systemic scleroderma.
As a result, the present study is the first research done with the use of the double blind method for the evaluation of the efficacy of DMSO, which is used for the cure of patients with systemic scleroderma. Important features of this study are the sygnificant length of the duration of the cure (up to one year) and the hystological criteria for the efficacy of the therapy. The results obtained can be considered sufficiently objective.
Thus, DMSO has a curing effect on the skin with systemic scleroderma, decreasing clinical symptoms of affected skin and inflammation processes in it. The working concentration of DMSO should be considered the 50% solution, which corresponds to the preliminary results of the researches conducted earlier in the Institute of Rheumotology AMS USSR. The 10% solution of DMSO does not have any therapeutical effect. Use of the higher concentration of this drug (more than 50%) also does not seem to be advisable, because it might be connected with some risk of local skin irritation. It should be noticed that patients reacted very well to the concentration used of DMSO.
The advantage of using this drug is its simplicity and availability, which makes it possible to use it an ambulatory way. It also should be noted that, because of its external use, stomach and intestines are not affected.
Thus, long-term application of the 50% solution of DMSO is a convenient, effective, and harmless way of curing systemic scleroderma. It can be recommended for a wide use in a complex therapy of this disease.
Institute of Rheumatology (Director: Academic AMS USSR Prof. V.A. Nasonova) AMS USSR.
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