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Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
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Digital ulcers and outcomes assessment in scleroderma.

M Matucci-Cerinic1, J R Seibold

  • 1Department of Biomedicine, Division of Rheumatology, AOUC, Denothe Center, University of Florence, Florence, Italy.

Rheumatology (Oxford, England)
|September 17, 2008
PubMed
Summary

Digital ulcers (DUs) in systemic sclerosis (SSc) are painful and disabling. Current treatments may prevent new ulcers but do not effectively heal existing ones, highlighting the need for better outcome measures.

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Area of Science:

  • Rheumatology
  • Dermatology
  • Vascular Medicine

Background:

  • Ischaemic digital ulcers (DUs) are a common and debilitating complication of systemic sclerosis (SSc).
  • Intravenous iloprost has shown efficacy in healing DUs, while bosentan has demonstrated a reduction in new DU occurrence over 4-6 months.
  • Existing outcome measures may not be sensitive enough to changes in digital ischaemia.

Purpose of the Study:

  • To evaluate the effectiveness of current treatments for ischaemic digital ulcers in SSc.
  • To assess the suitability of existing outcome measures for evaluating therapies targeting digital ischaemia in SSc.

Main Methods:

  • Review of studies on intravenous iloprost and bosentan for SSc-related digital ulcers.
  • Analysis of secondary outcome measures including pain and hand functionality.
  • Evaluation of the sensitivity of Scleroderma Health Assessment Questionnaire (SHAQ), UK Functional Score, and Michigan Hand Questionnaire.

Main Results:

  • Bosentan reduced the occurrence of new digital ulcers but did not demonstrate benefit in healing existing DUs.
  • The net burden of digital ulcers remained similar between bosentan and placebo groups.
  • Secondary outcome measures like pain and hand function were inconsistently affected.
  • Current outcome measures may lack sensitivity to changes in digital ischaemia.

Conclusions:

  • While bosentan may reduce the incidence of new digital ulcers in SSc, it does not improve healing of existing ulcers.
  • There is a critical need for the development of ulcer-specific outcome measures for future clinical trials evaluating digital ulcer therapies in SSc.