Prevalence and clinical relevance of digital ulcers in systemic sclerosis patients from the real-life: the experience of the SPRING Registry of the Italian Society for Rheumatology in Clinical Rheumatology

2025
ASL Torino 5

Tipo pubblicazione

Article

Autori/Collaboratori (83)Vedi tutti...

Orlandi M
Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena and Reggio Emilia School of Medicine, Via del Pozzo, Modena, Italy
De Luca G
Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), & Inflammation, Fibrosis and Aging Initiative (INFLAGE), IRCCS San Raffaele Scientific Institute, Milan, Italy
Ferri C
Department of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena and Reggio Emilia School of Medicine, Via del Pozzo, Modena, Italy

et alii...

Abstract

Introduction: Digital ulcers (DU) are one of the most frequent manifestations in systemic sclerosis (SSc). The presence of DU seems to be a sentinel sign of internal organ involvement and is related to a poor prognosis of the disease. The aim of this study was to evaluate the prevalence and the relationship of DU with clinical manifestations/variants in a large SSc cohort from the SPRING registry. Methods: SSc patients fulfilling the ACR/EULAR 2013 classification criteria without missing data on digital ulcers were enrolled in a cross-sectional study. Logistic regression models were built to test the association between the presence of DU and SSc-related features. Results: Among 1873 eligible SSc patients, the presence of DU was significantly associated with gastrointestinal involvement (OR 1.88, 2.04 and 1.74; p < 0.001) and serum ATA positivity (OR 2.15; p < 0.001), as well as with telangiectasias, sclerodactyly, digital pitting scar, and calcinosis (OR 1.40, p = 0.005; OR 3.43, p < 0.001, OR 9.12, p < 0.001 and OR 2.77, p < 0.001; respectively). In the multivariable regression models, even after adjustment for covariates, ATA positivity (OR 1.76, p = 0.039), puffy fingers (OR 2.82, p < 0.001), and a higher revEUSTAR-AI (OR 6.63, p < 0.001) emerged as risk factors for the presence of DU. Moreover, a low presence of DU was recorded in SSc patients with a history of previous immunosuppressive treatments (OR 0.53, p = 0.032). Conclusion: In our Italian SSc cohort, DUs were significantly associated with the presence of puffy fingers, high revEUSTR-AI, and ATA seropositivity. Noteworthy, immunosuppressive treatments were associated with a low rate of DU, suggesting that they might contribute to the prevention of these harmful manifestations. (Table presented.)

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PMID : 40374871

DOI : 10.1007/s10067-025-07449-1

Keywords

anticoagulant agent; antithrombocytic agent; corticosteroid; iloprost; vasodilator agent; adult; article; calcinosis; clinical significance; cohort analysis; controlled study; cross-sectional study; female; finger ulcer; human; immunosuppressive treatment; major clinical study; male; medical society; scar; sclerodactyly; systemic sclerosis; telangiectasia;