title: Digital ulcers as a sentinel sign for early internal organ involvement in very early systemic sclerosis.
abstract: OBJECTIVE
  The aim of this study was to evaluate the presence of digital lesions in very early diagnosis of SSc (VEDOSS) patients and its possible association with internal organ involvement.
  
  
  METHODS
  One hundred and ten VEDOSS patients were investigated for the presence of digital ulcers (DUs), digital pitting scars, calcinosis, necrosis or gangrene, nailfold videocapillaroscopic abnormalities, disease-specific autoantibodies (ACA and anti-topo I) and internal organ involvement.
  
  
  RESULTS
  Four patients reported a history of digital pitting scars, while 25 patients presented an active DU or reported a history of DUs. In particular, 16 patients presented with active DUs (14/16 also reporting a history of previous DUs), while the other 9 patients reported a history of DUs only. A statistically significant association between DUs and oesophageal manometry alteration was found in the whole DU population, as well as in the history of DU and the presence of active DU with/without a history of DU subgroups (P < 0.01, P = 0.01 and P < 0.05, respectively). DUs were observed in VEDOSS patients with internal organ involvement but not in those without organ involvement.
  
  
  CONCLUSIONS
  DUs are already present in VEDOSS patients characterized by internal organ involvement, significantly correlating and associating with gastrointestinal involvement. DUs may be a sentinel sign for early organ involvement in VEDOSS patients.
authors: Department of Clinical and Experimental Medicine, Section of Rheumatology, University of Florence, Florence, Italy.
authors: Cosimo
authors: C
authors: Bruni
authors: Department of Clinical and Experimental Medicine, Section of Rheumatology, University of Florence, Florence, Italy.
authors: Serena
authors: S
authors: Guiducci
authors: Department of Clinical and Experimental Medicine, Section of Rheumatology, University of Florence, Florence, Italy.
authors: Silvia
authors: S
authors: Bellando-Randone
authors: Department of Clinical and Experimental Medicine, Section of Rheumatology, University of Florence, Florence, Italy.
authors: Gemma
authors: G
authors: Lepri
authors: Department of Clinical and Experimental Medicine, Section of Rheumatology, University of Florence, Florence, Italy.
authors: Francesca
authors: F
authors: Braschi
authors: Department of Clinical and Experimental Medicine, Section of Rheumatology, University of Florence, Florence, Italy.
authors: Ginevra
authors: G
authors: Fiori
authors: Department of Clinical and Experimental Medicine, Section of Rheumatology, University of Florence, Florence, Italy.
authors: Francesca
authors: F
authors: Bartoli
authors: Department of Clinical and Experimental Medicine, Section of Rheumatology, University of Florence, Florence, Italy.
authors: Francesca
authors: F
authors: Peruzzi
authors: Department of Clinical and Experimental Medicine, Section of Rheumatology, University of Florence, Florence, Italy.
authors: Jelena
authors: J
authors: Blagojevic
authors: Department of Clinical and Experimental Medicine, Section of Rheumatology, University of Florence, Florence, Italy. marco.matuccicerinic@unifi.it.
authors: Marco
authors: M
authors: Matucci-Cerinic
mesh_terms: D000328:Adult; D002114:Calcinosis / Q000175:diagnosis / Q000473:pathology; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D005385:Fingers; D005767:Gastrointestinal Diseases / Q000209:etiology*; D006801:Humans; D008171:Lung Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009262:Nails / Q000098:blood supply; D009336:Necrosis / Q000175:diagnosis / Q000473:pathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000150:complications* / Q000175:diagnosis*; D014456:Ulcer / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology
keywords: digital ulcers; oesophageal involvement; very early systemic sclerosis