Scleroderma.

Figure 2 - Finger stretch

Management and treatment

Treatment

After studying your symptoms, test results, and the overall pattern of your illness, your doctor will suggest a treatment program to manage the disease.

This program will include:

• medication
• exercises
• joint protection techniques
• skin protection techniques
• stress management

Diet

No diet will cure scleroderma, but you should eat balanced meals and stay at a sensible weight. If you have trouble swallowing, eat slowly and chew thoroughly. Also drink water or another beverage to soften food. Eat high fiber foods to help cut down on constipation. Try eating six small meals a day rather than three large ones, so food digests better.

To help prevent stomach problems:

• Avoid foods that cause heartburn or gas, such as spicy foods.
• Use antacids for relief from heartburn. Do not lay down for about four hours after a large meal.
• Eat your largest meal in the middle of the day rather than close to bedtime.
• Raise the head of your bed by putting six-inch blocks under the end. This will help keep stomach acid from washing into your esophagus while you sleep.

Exercise and therapy

Regular exercise helps improve overall health and fitness. For people who have scleroderma, it also helps keep the skin and joints flexible, maintain better blood flow, and prevent contractures. General exercise, such as swimming, cycling, or walking keeps you fit and flexible. Special range of motions exercises help keep skin and specific joints flexible. These should be practiced twice daily.

You can do range-of-motion exercises by yourself or with help from a therapist or family member. Examples of range of motion exercises include:

• stretching your fingers on a flat table top to help keep them from becoming stiff or fixed in one position (see figure 2)
• slowly opening your mouth as wide as you can to keep the facial area flexible

A physical or occupational therapist, or other health professional, can help you with these and other exercises.

Medications

Although there's not yet a cure for scleroderma, there are many drugs that help control it. Some work well for some people and not at all for others, so what someone else is taking may not be right for you.

• Aspirin may be used in large doses to treat joint pain and swelling.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) work like aspirin. They may be used to treat joint pain and swelling.
• Steroids are synthetic forms of a naturally occurring hormone in the body. They are sometimes used to treat muscle problems. The side effects of these drugs usually outweigh any slight benefit they might produce.
• Antacids may be used to treat heartburn and to protect the esophagus. You may also be given drugs to decrease stomach acid, protect the stomach, or improve intestinal motion.
• Blood pressure medication may be used to treat high blood pressure. It is extremely important to take the medicine the doctor prescribes for you even if you are feeling fine.High blood pressure is known as the "silent" disease and has no symptoms. Taking the medicine faithfully is the only way to keep it under control.
• Drugs that increase blood flow to your fingers and toes may be used to treat Raynaud's phenomenon.
• Other drugs may be used to treat the skin, or to control the disease.

Caution: Never change your medications without first talking to your doctor.

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