title: Digital ulcers score: a scoring system to assess digital ulcers in patients suffering from systemic sclerosis.
abstract: OBJECTIVE
  To develop a standardized scoring system to assess the severity of DUs in SSc patients and correlate it with functional outcomes.
  
  
  METHODS
  In this cross-sectional, longitudinal study in SSc patients with DUs (n=65) we developed a digital ulcers score (DUS) for the assessment of DUs. DUS and the ABILHAND score were measured at each visit and differences were analysed using Tamhane's T2 test. Spearman's Rho test was applied for correlational analysis of DUS and functional outcomes. We calculated a linear regression model using clustered standard errors for correlation analysis between DUS and ABILHAND over time.
  
  
  RESULTS
  117 assessments of DUS were performed in 65 SSc patients. Mean DUS was 11.6±1.9 (range: 0-68). Subgroup analyses showed a higher DUS in patients suffering from diffuse cutaneous SSc when compared to patients with limited cutaneous SSc (12.8±3.0 vs. 9.7±2.2 p=0.18). There was no correlation between the DUS and manual ability using the ABILHAND score (overall: n=106 r=-0.138, p=0.22). We observed a small but significant linear correlation between the DUS and the ABILHAND score for a single patient over time (n=14, R2=0.31, r=0.06, p=0.02).
  
  
  CONCLUSIONS
  The DUS is a feasible scoring instrument to assess severity of DUs in SSc patients. In accordance with the literature the severity of DUs correlates with clinical parameters but also severity of the disease. Further study is needed to establish the DUS as a standardized tool for the assessment of DUs.
authors.affiliation: Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Germany.
authors.forename: Hannah Clara
authors.initials: HC
authors.lastname: Ahrens
authors.affiliation: Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Germany.
authors.forename: Elise
authors.initials: E
authors.lastname: Siegert
authors.affiliation: Department of Dermatology and Allergy Biederstein, Technical University Munich, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Tomsitz
authors.affiliation: Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Mattat
authors.affiliation: Department of Rheumatology and Clinical Immunology, Charité University Medicine Berlin, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: March
authors.affiliation: Department of Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Germany. margitta.worm@charite.de.
authors.forename: Margitta
authors.initials: M
authors.lastname: Worm
authors.affiliation: 4Department of Rheumatology, University Hospital of Schleswig-Holstein, Lübeck, Germany.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Riemekasten
mesh_terms: D000328:Adult; D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005240:Feasibility Studies; D005260:Female; D005385:Fingers; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012307:Risk Factors; D045743:Scleroderma, Diffuse / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D045745:Scleroderma, Limited / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D012720:Severity of Illness Index; D012867:Skin / Q000187:drug effects / Q000473:pathology* / Q000503:physiopathology; D012883:Skin Ulcer / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D002317:Cardiovascular Agents; D007166:Immunosuppressive Agents