Related Experiment Video
Updated: Mar 26, 2026
Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
Published on: June 16, 2020
Assessment, Definition, and Classification of Lower Limb Ulcers in Systemic Sclerosis: A Challenge for the
Jelena Blagojevic1, Guya Piemonte1, Laura Benelli1
1From the University of Florence: Department of Clinical and Experimental Medicine, Division of Rheumatology; Department of Internal Medicine; Interinstitutional Department of Didactics, Florence, Italy.J. Blagojevic, MD, Doctoral Candidate, University of Siena and University of Florence Joint Doctoral Program, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Piemonte, BSN, RN, Doctoral Candidate, University of Florence, Department of Clinical and Experimental Medicine, Division of Rheumatology; L. Benelli, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Braschi, BSN, RN, Registered Nurse, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; G. Fiori, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Bartoli, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Guiducci, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Bellando Randone, PhD, Researcher, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; F. Galluccio, MD, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; L. Cometi, MD, Rheumatology Resident, Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence; S. Castellani, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; M. Boddi, PhD, Associate Professor, Department of Clinical and Experimental Medicine, University of Florence; A. Moggi Pignone, PhD, Associate Professor, Department of Internal Medicine, University of Florence; L. Rasero, BSN, RN, Associate Professor, Department of Clinical and Experimental Medicin
Objective:
To evaluate pathogenesis and clinical features of lower limb ulcers in systemic sclerosis (SSc) and to propose a classification that could be used in clinical practice.
Methods:
Charts of 60 patients with SSc who had lower limb cutaneous lesions were reviewed. All patients had videocapillaroscopy and arterial and venous lower limb color Doppler ultrasonography (US). Arteriography was performed if occlusive peripheral arterial disease was suspected.
Results:
The 554 lesions were classified as hyperkeratosis, ulcers, and gangrenes. There were 341 (61.6%) hyperkeratoses, 208 (37.5%) ulcers, and 5 (0.9%) gangrenes. Ulcers were divided into pure ulcers, ulcers associated with hyperkeratosis, and ulcers secondary to calcinosis. Involvement of arterial and venous macrocirculation as determined by color Doppler US was observed in 17 (18.3%) and 18 (30%) patients, respectively. Seventeen out of 37 patients with pure ulcers (45.9%) presented neither venous insufficiency nor hemodynamically significant macrovascular arterial disease. In these patients, pure ulcers were most likely caused by isolated SSc-related microvascular involvement (pure microvascular ulcers). The only significant risk factor for development of pure microvascular ulcers in the multivariate analysis was the history of lower limb ulcers (OR 26.67, 95% CI 2.75-259.28; p < 0.001).
Conclusion:
Results of our study indicate that lower limb ulcers in SSc often have a multifactorial pathogenesis that may be difficult to manage. Further studies are needed to validate the proposed classification and to assess the most appropriate management of lower limb ulcers in SSc.
More Related Videos
07:25Author Spotlight: A Focus on Standardized Salivary Gland Ultrasound Protocol in Connective Tissue Disease Research
Published on: October 13, 2023
08:05Occlusion of the Great and Small Saphenous Vein Using Copolymeric Glue Based on N-Butyl Cyanoacrylate and Methacryloxy Sulfolane
Published on: December 9, 2022
Related Concept Videos
01:27Assessment of the Cardiovascular System III: Palpation
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above...
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:26Peripheral Artery Disease IV: Nursing Management
01:29Assessment of the Cardiovascular System II: Inspection
Head and Neck
01:30Peripheral Artery Disease I: Introduction
01:17Chronic Bowel Disorders: Introduction
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...