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Ischemic digital ulcers affect hand disability and pain in systemic sclerosis
Luc Mouthon1, Patrick H Carpentier1, Catherine Lok1
1From the Université Paris Descartes, Faculté de Médecine, Service de Médecine interne, Centre de référence pour les vascularites nécrosantes et la sclérodermie systémique, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris; Service de Médecine vasculaire, CHU de Grenoble, Grenoble; Service de Dermatologie, Hôpital Sud, CHU Amiens, Amiens; Orgamétrie, Roubaix; Actelion Pharmaceuticals France, Paris; Service de Médecine interne, Centre de référence pour la sclérodermie systémique, Hôpital Claude Huriez, Université Lille 2, Lille; Service de Médecine interne, Hôpital Bretonneau, Tours; Service de Médecine interne, Hôpital Saint Eloi, Montpellier; Service de Médecine interne, Hôpital Sud, Rennes; Service de Médecine Interne, Centre Hospitalier Universitaire Hôtel Dieu, Nantes; Service de Dermatologie, Hôpital Charles Nicolle, Centre Hospitalier Universitaire, Rouen; Service de Dermatologie, Hôpital Dupuytren, CHU Limoges; Hôpital Saint Jacques, Besançon; Service de Dermatologie, Université Aix-Marseille, UMR 911, INSERM CRO2 UMR 911, Centre de recherche en oncologie biologique et oncopharmacologie, Hôpital de la Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France.L. Mouthon, MD, PhD, Deputy Chief of Internal Medicine Department, Université Paris Descartes, Faculté de Médecine, Service de Médecine interne, Centre de référence pour les vascularites nécrosantes et la sclérodermie systémique, Hôpital Cochin, APHP; P.H. Carpentier, MD, Chief of Vascular Medicine Department, Service de Médecine vasculaire, CHU de Grenoble; C. Lok, MD, Chief of Dermatology Department, Service de Dermatologie, Hôpital Sud, CHU Amiens; P. Clerson, MD, Director, Orgamétrie; V. Gressin, MD, Medical Director, Actelion Pharmaceuticals France; E. Hachulla, MD, PhD, Deputy Chief of Internal Medicine Department, Service de Médecine interne, Centre de référence pour la sclérodermie systémique, Hôpital Claude Huriez,
Systemic sclerosis patients with digital ulcers (DU) experience significant pain and hand disability. These ulcers are a major sign of SSc, frequently impacting multiple fingers and both hands.
Area of Science:
- Rheumatology
- Dermatology
- Vascular Medicine
Background:
- Ischemic digital ulcers (DU) are severe complications of systemic sclerosis (SSc).
- DU significantly impact patients' quality of life and disease progression.
Purpose of the Study:
- To assess the effect of digital ulcers (DU) on hand disability and pain in patients with systemic sclerosis (SSc).
Main Methods:
- Prospective, multicenter, noninterventional study (ECLIPSE) with 2-year follow-up.
- Included 190 SSc patients with at least one DU in the prior year, treated with bosentan.
- Data collected on DU occurrence, affected fingers, pain (VAS), and hand function (Cochin Hand Function Scale).
Main Results:
- 56.2% of patients had DU as the first non-Raynaud symptom of SSc.
- Active DU at inclusion significantly correlated with higher pain scores (6.2 vs 2.5, p<0.0001).
- Active DU were also associated with greater hand disability (Cochin score 38 vs 25, p<0.0001).
Conclusions:
- Digital ulcers are a major clinical sign in systemic sclerosis.
- DU frequently affect multiple fingers and both hands in SSc patients.
- The presence of active DU is significantly linked to increased pain and hand dysfunction.
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