c. n. a. rajapakse^1
1rheumatology, hutt valley health, lower hutt, New Zealand

Objectives: To confirm personal clinical observation of improvement of hand puffiness immediately after Iloprost infusions in Scleroderma, given primarily to improve peripheral circulation
Methods: All patients admitted to the WRRU for courses of Iloprost infusions between August ’03 and May 05 were studied prospectively. Hand Volume and mobility measurements were carried out pre and post infusion on both hands. The results of all patients diagnosed as Scleroderma by the admitting physician and who had at least one pair of pre and post infusion volume or mobility values recorded, were analysed. Hand volumes were measured using a Volumeter (Eccles etal J Phys Med 19:5,1956), and mobility using Modified Kapandji Index (Arch Phys Med Rehabil 84:7.’03)
Results: A total of 20 patient had analyzable data from 36 courses.9 had a single course,7, 3,&1 had 2, 3 & 4 courses respectively. Sex F 20, M 0, Age 51yrs (range 20-86) , Diagnosis CREST 10, Diffuse Scl 10.Disease Duration 4.7yr( range1-14).Mean number of infusions between recordings 4.7 (range 3-5).Mean Volume Changes: - 7.3cc (95%CI 0.19,13.7 no 50) p 0.029 . Mean Mobility Changes: +6 (95%CI 2.9,9.1 ,no 36 ) p 0.0009 Difference In Volume Reduction <10yrs disease vs >10yrs, 17 (95%CI 2,32 )p=0.026

Conclusion: The results confirm the clinical observation of immediate improvements in Scleroderma hand puffiness following Iloprost infusions. The complementary findings of improved mobility supports this conclusion. The volume reduction is significantly more in early disease <10yrs vs .10yrs. Iloprost seems to reduced vascular permeability in addition to causing vasodialatation suggesting a disease modifying effect in Scleroderma