title: Digital ulcers in scleroderma: staging, characteristics and sub-setting through observation of 1614 digital lesions.
abstract: OBJECTIVE
  To evaluate in SSc, the frequency of digital lesions and the morphology, characteristics, natural course and time to healing of 1614 digital ulcers (DUs).
  
  
  METHODS
  One hundred SSc patients were followed up for 4 years. In the first step, the digital lesions were observed and classified at the time of presentation [digital pitting scar (DPS); DU; calcinosis; gangrene]. In the second step, DUs were divided into subsets according to their origin and main features. In the third step, the time to healing was recorded for each DU and the influence of DU main characteristics on time to healing was also evaluated.
  
  
  RESULTS
  In the first step, 1614 digital lesions were observed: DPS, 712 (44.1%) lesions; DU, 785 (48.6%); calcinosis, 110 (6.8%); and gangrene, 7 (0.8%). In the second step, DUs were subsetted as follows: DU developed on DPS (8.8%), pure DU; DU developed on calcinosis (60%); DU derived from gangrene. In the third step, the mean time to healing was 25.6 (15.6) days in DPS, 76.2 (64) days in pure DU, 93.6 (59.2) days in calcinosis ulcers and 281.1 (263.3) in gangrene.
  
  
  CONCLUSIONS
  In SSc, digital lesions are represented by DPS, DU, calcinosis and gangrene, and provide an evidence-based DU subsetting according to their origin and main characteristics. Subsetting may be helpful for a precise DU evaluation and staging, and in randomized controlled trials for a precise identification of those DUs that are to be included in therapeutic studies.
authors.affiliation: Department of Biomedicine, Division of Rheumatology, AOUC, Denothe Centre, Firenze, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Amanzi
authors.forename: Francesca
authors.initials: F
authors.lastname: Braschi
authors.forename: Ginevra
authors.initials: G
authors.lastname: Fiori
authors.forename: Felice
authors.initials: F
authors.lastname: Galluccio
authors.forename: Irene
authors.initials: I
authors.lastname: Miniati
authors.forename: Serena
authors.initials: S
authors.lastname: Guiducci
authors.forename: Maria-Letizia
authors.initials: ML
authors.lastname: Conforti
authors.forename: Olga
authors.initials: O
authors.lastname: Kaloudi
authors.forename: Francesca
authors.initials: F
authors.lastname: Nacci
authors.forename: Oana
authors.initials: O
authors.lastname: Sacu
authors.forename: Antonio
authors.initials: A
authors.lastname: Candelieri
authors.forename: Alberto
authors.initials: A
authors.lastname: Pignone
authors.forename: Laura
authors.initials: L
authors.lastname: Rasero
authors.forename: Domenico
authors.initials: D
authors.lastname: Conforti
authors.forename: Marco
authors.initials: M
authors.lastname: Matucci-Cerinic
mesh_terms: D002114:Calcinosis / Q000209:etiology* / Q000473:pathology; D015331:Cohort Studies; D005121:Extremities; D005260:Female; D005734:Gangrene / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008297:Male; D012595:Scleroderma, Systemic / Q000145:classification / Q000150:complications* / Q000473:pathology; D012720:Severity of Illness Index; D012883:Skin Ulcer / Q000209:etiology* / Q000473:pathology; D013223:Statistics as Topic; D013997:Time Factors