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A prospective, international observational study of systemic sclerosis patients enrolled in the Digital Ulcers Outcome (DUO) Registry: Patients were required to have ≥3 follow-up visits over at least a 2 year observation period between 2008-2013. Incident digital ulcerations (DU) were identified along with their associated complications.
From the 1459 patients enrolled, patients could be categorized as having either: 1) no-DU (33.2%); 2) episodic (9.4%); 3) recurrent (46.2%); and 4) chronic ( 11.2%) DU. Limited SS was seen in 51-59% of groups 1-3, but only 44% of group 4 - chronic DU patients. Thus those with chronic DU were more likely to have diffuse than limited SS (46 vs 44%).
The highest rate of incident complications was seen in the chronic DU group. Pain medication (72%), hospitalization (52%), infection (61%) and amputatoin 16%) were greatest in the chronic DU group. Risk factors associated with incident complications included gastrointestinal manifestations (OR 3.73, p=0.03) and previous soft tissue infection (OR 5.86, p=0.01).
These categories may be instrumental in identifying which SS patients may need more aggressive treatment interventions.