An observational cohort study of patients with newly diagnosed digital ulcer disease secondary to systemic sclerosis registered in the EUSTAR database

Clin Exp Rheumatol. 2015 Jul-Aug;33(4 Suppl 91):S47-54. Epub 2015 Aug 5.


Objectives: This study describes clinical characteristics, prognostic factors, and quality of life in patients with newly diagnosed (incident) digital ulcers (DU).

Methods: Observational cohort study of 189 consecutive SSc patients with incident DU diagnosis identified from the EUSTAR database (22 centres in 10 countries). Data were collected from medical charts and during one prospective visit between 01/2004 and 09/2010.

Results: Median age at DU diagnosis was 51 years, majority of patients were female (88%), and limited cutaneous SSc was the most common subtype (61%). At incident DU diagnosis, 41% of patients had one DU and 59% had ≥2 DU; at the prospective visit 52% had DU. Pulmonary arterial hypertension (PAH) and multiple DU at diagnosis were associated with presence of any DU at the prospective visit (odds ratios: 4.34 and 1.32). During the observation period (median follow-up was 2 years) 127 patients had ≥1 hospitalisation. The event rate of new DU per person-year was 0.66, of DU-associated complications was 0.10, and of surgical or diagnostic procedures was 0.12. At the prospective visit, patients with ≥1 DU reported impairment in daily activities by 57%, those with 0 DU by 37%. The mean difference between patients with or without DU in the SF-36 physical component was 2.2, and in the mental component 1.4. DU patients were not routinely prescribed endothelin receptor antagonists or prostanoids.

Conclusions: This real world cohort demonstrates that DU require hospital admission, and impair daily activity. PAH and multiple DU at diagnosis were associated with future occurrence of DU.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Adult
  • Cost of Illness
  • Databases, Factual
  • Europe / epidemiology
  • Female
  • Fingers / blood supply*
  • Hospitalization
  • Humans
  • Hypertension, Pulmonary / diagnosis
  • Hypertension, Pulmonary / epidemiology
  • Incidence
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Prognosis
  • Prospective Studies
  • Quality of Life
  • Recurrence
  • Risk Factors
  • Scleroderma, Systemic / diagnosis
  • Scleroderma, Systemic / epidemiology*
  • Scleroderma, Systemic / physiopathology
  • Scleroderma, Systemic / psychology
  • Scleroderma, Systemic / therapy
  • Skin Ulcer / diagnosis
  • Skin Ulcer / epidemiology*
  • Skin Ulcer / physiopathology
  • Skin Ulcer / psychology
  • Skin Ulcer / therapy
  • Time Factors