Digital ulcers in systemic sclerosis.
Digital ulcers (DUs) are a common visible manifestation of the progressive vascular disease that characterizes the SSc disease process. DUs not only impact significantly on patients' quality of life and hand function, but are also a biomarker of internal organ involvement and of disease severity. The aetiology of (digital) vascular disease in SSc is multifactorial, and many of these factors are potentially amenable to therapeutic intervention. The management of DU disease in SSc is multifaceted. Patient education and non-pharmacological interventions (e.g. smoking cessation) should not be neglected. There are a number of drug therapies available to prevent (e.g. phosphodiesterase type-5 inhibitors and ET receptor-1 antagonists) and treat (e.g. i.v. iloprost) DUs. DUs are also important for two other reasons: firstly, as a primary end point in SSc-related clinical trials; and secondly, DUs are included in the ACR/EULAR SSc classification criteria. However, the reliability of rheumatologists to grade DUs is poor to moderate at best, and this poses challenges in both clinical practice and research. The purpose of this review is to provide the reader with a description of the spectrum of DU disease in SSc including pathophysiology, epidemiology and clinical burden, all of which inform the multifaceted approach to management.
Centre for Musculoskeletal Research, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester michael.hughes-6@postgrad.manchester.ac.uk.
Michael
M
Hughes
Centre for Musculoskeletal Research, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester.|NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
Ariane L
AL
Herrick
D001778:Blood Coagulation Disorders / Q000209:etiology / Q000503:physiopathology*; D065128:Endothelin Receptor Antagonists / Q000627:therapeutic use; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D016285:Iloprost / Q000627:therapeutic use; D010353:Patient Education as Topic; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use; D015427:Reperfusion Injury / Q000209:etiology / Q000503:physiopathology*; D012595:Scleroderma, Systemic / Q000150:complications / Q000503:physiopathology*; D012883:Skin Ulcer / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D016540:Smoking Cessation; D014665:Vasodilator Agents / Q000627:therapeutic use
D065128:Endothelin Receptor Antagonists; D058986:Phosphodiesterase 5 Inhibitors; D014665:Vasodilator Agents; D016285:Iloprost
digital ulcers; scleroderma; systemic sclerosis