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Assessing digital vasculopathy in systemic sclerosis

Ariane L Herrick^1,2,3

¹Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.

Rheumatology (Oxford, England)

|February 14, 2026

Insights

Digital vasculopathy in systemic sclerosis (SSc) significantly impacts quality of life due to limited treatment efficacy. This review covers assessment, outcome measures, and emerging technologies for this unmet medical need.

Area of Science:

Rheumatology
Vascular Biology
Systemic Sclerosis Research

Background:

Digital vasculopathy, encompassing Raynaud's phenomenon, digital ulceration, and critical ischemia, is a hallmark manifestation of systemic sclerosis (SSc).
This condition represents a significant unmet need, severely impacting patient quality of life due to the limited effectiveness of current therapeutic strategies.
The pathophysiology involves both structural and functional changes in the microcirculation and digital arteries, contributing to its severity.

Purpose of the Study:

To review the current understanding of digital vasculopathy in systemic sclerosis (SSc).
To discuss clinical assessment, diagnostic approaches, and monitoring strategies for SSc-related digital vasculopathy.
To highlight recent advances in outcome measures and emerging non-invasive technologies for studying SSc vasculopathy.

Main Methods:

Literature review focusing on digital vasculopathy in systemic sclerosis.
Analysis of current clinical assessment and diagnostic tools.
Examination of established and novel outcome measures for Raynaud's phenomenon and digital ulcers.
Overview of emerging non-invasive technologies for pathophysiological insights.

Main Results:

Digital vasculopathy in SSc is characterized by microcirculatory and digital artery changes, leading to poor treatment outcomes.
Reliable patient-reported and laboratory-based outcome measures are crucial for advancing clinical trials in SSc.
Emerging non-invasive technologies offer new perspectives on the underlying pathophysiology of SSc-related vascular complications.

Conclusions:

Digital vasculopathy in SSc requires improved therapeutic strategies and robust outcome measures.
Further research into pathophysiology using advanced technologies is essential for developing effective treatments.
This review provides a comprehensive overview to guide future research and clinical practice in managing SSc vasculopathy.

Read full analysis

Abstract:

Digital vasculopathy (a spectrum of Raynaud's phenomenon, digital ulceration and critical ischaemia) is one of the most characteristic manifestations of systemic sclerosis (SSc). It is an area of unmet need with a major impact on quality of life: current treatments are only poorly effective. SSc-related digital vasculopathy is a result of structural as well as functional change at the level of both the microcirculation and the digital artery, explaining its severity. This review begins with a brief description of digital vasculopathy, followed by its assessment in the clinical setting, relevant to both diagnosis and monitoring of SSc. Outcome measures of Raynaud's phenomenon and of digital ulcers are then discussed, focusing on recent advances. These outcome measures are a 'hot topic' because reliable patient-reported and laboratory-based outcome measures will facilitate much needed clinical trials. Finally, some of the emerging non-invasive technologies which are providing new insights into pathophysiology are briefly described.

Keywords:

Raynaud’s phenomenon digital ulcers nailfold capillaroscopy outcome measures systemic sclerosis

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