Nondigital skin ulcers in systemic sclerosis: A neglected entity
Background: Skin ulcers (SUs) are a common and difficult to manage problem in systemic sclerosis (SSc) and can be broadly classified into two types: digital ulcers (DUs) and non-DUs. Objective: The objective of this study was to analyze prevalence, associated factors, and response to therapy for non...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2021-01-01
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| Series: | Indian Journal of Rheumatology |
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| Online Access: | http://www.indianjrheumatol.com/article.asp?issn=0973-3698;year=2021;volume=16;issue=2;spage=139;epage=144;aulast=Pinto |
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| _version_ | 1832569190226067456 |
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| author | Benzeeta Pinto Ramya Janardana Sowmya Kaimal B Sheba Charles K N Sangeeta Jasmine Mathew Kodishala Chanakya John Michael Raj Vineeta Shobha |
| author_facet | Benzeeta Pinto Ramya Janardana Sowmya Kaimal B Sheba Charles K N Sangeeta Jasmine Mathew Kodishala Chanakya John Michael Raj Vineeta Shobha |
| author_sort | Benzeeta Pinto |
| collection | DOAJ |
| description | Background: Skin ulcers (SUs) are a common and difficult to manage problem in systemic sclerosis (SSc) and can be broadly classified into two types: digital ulcers (DUs) and non-DUs.
Objective: The objective of this study was to analyze prevalence, associated factors, and response to therapy for non-DU.
Patients and Methods: All patients with SSc who fulfilled the 2013 ACR/EULAR criteria were included in the study. SUs were divided into DU and various types of non-DU (SU on bony prominences, SU on calcinosis, SU on lower limbs, and SU with gangrene).
Results: We included 146 patients with SSc (83.6' females) with a median follow-up of 20.5 months (interquartile range: 52). Eighty-four patients (57.5') had at least one episode of DU. Recurrent DUs despite vasodilators were seen in 36 (24.7') patients. Thirty-four patients (23.3') had non-DU. The most common type of non-DU was SU of lower limbs (23), followed by SU on bony prominences (19). The most common ulcer site was on the malleoli in the lower limbs and elbow in the upper limbs. Most of the ulcers healed in 3–6 months. Three patients developed osteomyelitis. The presence of non-DU was associated with longer duration of disease (P = 0.0009), occurrence of DU (P = 0.011), presence of gangrene (P < 0.001), or calcinosis (P < 0.001), and higher modified Rodnan skin score (P = 0.0013).
Conclusion: Non-DUs were found in a quarter of patients with SSc. They are associated with advanced disease and vasculopathy. There is an unmet need to incorporate non-DU in clinical trial outcomes and address them in patient management guidelines. |
| format | Article |
| id | doaj-art-5fd9b434e0dc493a86f1f57f750a49f7 |
| institution | Kabale University |
| issn | 0973-3698 0973-3701 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Indian Journal of Rheumatology |
| spelling | doaj-art-5fd9b434e0dc493a86f1f57f750a49f72025-02-02T22:47:45ZengSAGE PublishingIndian Journal of Rheumatology0973-36980973-37012021-01-0116213914410.4103/injr.injr_253_20Nondigital skin ulcers in systemic sclerosis: A neglected entityBenzeeta PintoRamya JanardanaSowmya KaimalB Sheba CharlesK N SangeetaJasmine MathewKodishala ChanakyaJohn Michael RajVineeta ShobhaBackground: Skin ulcers (SUs) are a common and difficult to manage problem in systemic sclerosis (SSc) and can be broadly classified into two types: digital ulcers (DUs) and non-DUs. Objective: The objective of this study was to analyze prevalence, associated factors, and response to therapy for non-DU. Patients and Methods: All patients with SSc who fulfilled the 2013 ACR/EULAR criteria were included in the study. SUs were divided into DU and various types of non-DU (SU on bony prominences, SU on calcinosis, SU on lower limbs, and SU with gangrene). Results: We included 146 patients with SSc (83.6' females) with a median follow-up of 20.5 months (interquartile range: 52). Eighty-four patients (57.5') had at least one episode of DU. Recurrent DUs despite vasodilators were seen in 36 (24.7') patients. Thirty-four patients (23.3') had non-DU. The most common type of non-DU was SU of lower limbs (23), followed by SU on bony prominences (19). The most common ulcer site was on the malleoli in the lower limbs and elbow in the upper limbs. Most of the ulcers healed in 3–6 months. Three patients developed osteomyelitis. The presence of non-DU was associated with longer duration of disease (P = 0.0009), occurrence of DU (P = 0.011), presence of gangrene (P < 0.001), or calcinosis (P < 0.001), and higher modified Rodnan skin score (P = 0.0013). Conclusion: Non-DUs were found in a quarter of patients with SSc. They are associated with advanced disease and vasculopathy. There is an unmet need to incorporate non-DU in clinical trial outcomes and address them in patient management guidelines.http://www.indianjrheumatol.com/article.asp?issn=0973-3698;year=2021;volume=16;issue=2;spage=139;epage=144;aulast=Pintoleg ulcersnondigital ulcerssystemic sclerosis |
| spellingShingle | Benzeeta Pinto Ramya Janardana Sowmya Kaimal B Sheba Charles K N Sangeeta Jasmine Mathew Kodishala Chanakya John Michael Raj Vineeta Shobha Nondigital skin ulcers in systemic sclerosis: A neglected entity Indian Journal of Rheumatology leg ulcers nondigital ulcers systemic sclerosis |
| title | Nondigital skin ulcers in systemic sclerosis: A neglected entity |
| title_full | Nondigital skin ulcers in systemic sclerosis: A neglected entity |
| title_fullStr | Nondigital skin ulcers in systemic sclerosis: A neglected entity |
| title_full_unstemmed | Nondigital skin ulcers in systemic sclerosis: A neglected entity |
| title_short | Nondigital skin ulcers in systemic sclerosis: A neglected entity |
| title_sort | nondigital skin ulcers in systemic sclerosis a neglected entity |
| topic | leg ulcers nondigital ulcers systemic sclerosis |
| url | http://www.indianjrheumatol.com/article.asp?issn=0973-3698;year=2021;volume=16;issue=2;spage=139;epage=144;aulast=Pinto |
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