[2009] [THU0326] DIGITAL LESIONS (DL) IN SYSTEMIC SCLEROSIS (SSC): EVIDENCE FOR A NEW CLASSIFICATION OF DIGITAL ULCERS (DU)
F. Braschi1, L. Amanzi1, G. Fiori1, F. Galluccio2, L. Conforti1, S. Guiducci1, I. Miniati1, O. Kaloudi1, F. Nacci1, O. Sacu1, A. Candelieri3, A. Pignone4, L. Rasero5, D. Conforti3, M. Matucci Cerinic1 1Department of Biomedicine, Division of Rheumatology; 2Department of biomedicine, University of Florence, Florence; 3Laboratory of Decision Engineering for Health Care Delivery, University of Calabria, Cosenza; 4Department of Emergency; 5Department of Public Healt, University of Florence, Florence, Italy
Background: In SSc digital lesions (DL) are linked to microvascular sufferance, frequently leading to DU, gangrene and amputation.
Objectives: The lack of classification in SSc has prompted us to evaluate the morphology and characteristics of DL to provide a new classification that may correctly define DL and DU.
Methods: 100 SSc patients were consecutively followed up in 4 years. DL were observed and methodologically classified. In every identified DU subset, pain, stage and the single characteristics of DU were identified.
Results: In 4 years, 1614 DL were observed and classified in Digital Pitting Scar - 712 lesions (44,1%), Digital Ulcer - 792 lesions (49,1%), and Calcinosis 110 (6,8%). DU were classified in subsets as follows: DU developed on Digital Pitting Scar, found in 1,41% of DPS, were all superficial, characterized by inflammation and edema of perilesional skin and by spontaneous mild or moderate pain; DU characterised by Loss of Tissue characterised by irregular edges (80,3%), edema (56,44%), inflammation of perilesional skin (75%) and the stage was usually intermediate (59,85%) or deep (39,90%). Only in few cases, muscle or bone and tendons (1,77%) were exposed. DU, developed in 60% of preexisting calcinosis, were always deep with irregular edges and inflammation of perilesional skin and spontaneous severe pain (83,33%).
Conclusion: DL are mainly represented by Digital pitting scars, DU and calcinosis. The patient follow up has allowed a morphological DU classification with the definition of the main DU characteristics, of DU pain and staging. This classification may be helpful in practice and in future RCTs for a precise identification of those DU that are to be included or excluded in specific therapeutic studies.
Disclosure of Interest: None declared
Ann Rheum Dis 2009;68(Suppl3):280
Scleroderma, myositis and related syndromes
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