Management of Calcinosis Associated with Systemic Sclerosis

Calcinosis is a common and debilitating manifestation of systemic sclerosis (SSc). It most commonly involves the hands, particularly the fingers, and it is often associated with pain, recurrent episodes of local inflammation, and functional impairment. We recommend preventative measures such as smoking cessation, avoidance of cold, stress, and trauma in all patients, along with aggressive treatment of Raynaud phenomenon and digital ulcers. If pain and inflammation are present, we recommend acetaminophen and/or non-steroidal anti-inflammatory agents; however, narcotics may be necessary in some cases. Corticosteroid injections with 20 mg/mL of triamcinolone acetonide suspension may also be effective in reducing secondary inflammation from calcinosis, as well as minocycline 50 or 100 mg/day in cyclic long-term use, and colchicine 1 mg/day orally. In case of infection, we add antibiotics with appropriate coverage for streptococci and staphylococci, such as cephalexin, dicloxacillin or clindamycin. The pharmacological treatment aimed to reduce calcinosis is challenging given that no therapies have consistently been found to be effective and no randomized controlled trials have been completed to date. We refer a significant proportion of patients with large, localized, and symptomatic lesions for surgical excision. Randomized controlled trials using novel outcome measures are necessary to evaluate the efficacy of proposed and emerging therapies.