Patients with SSc-related digital ulcers use “significantly more” health resources

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Disclosures: The authors do not report relevant financial disclosures.


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Patients with systemic sclerosis who demonstrate digital ulcers use “significantly more” health resources per year than patients without digital ulcers, according to data published in Arthritis care and research.

“[Digital ulcers (DUs)] they heal slowly, especially if there is calcification, and may be complicated by soft tissue infections, wet and dry necrosis, escarpment, exposure to underlying tissue, gangrene, osteomyelitis, and amputation. Tatiana Nevskayadr, dr, from the Schulich School of Medicine and Dentistry in Ontario and colleagues write.

an image showing outstanding features of the study
Patients with systemic sclerosis who demonstrate digital ulcers use “significantly more” health resources per year than patients without digital ulcers, according to data from Nevskaya T, et al. Arthritis Care Res. 2022; doi: 10.1002 / acr.24902.

“DUS leads to significant morbidity and reduced quality of life through functional impairment and pain,” they added. “Patients with DU have a greater disability at work and need paid care at home due to difficulties in performing daily activities. Patients with DU may need more health resources, given the medical and functional complications inherent in the disease.

To analyze the use of health care among patients with SSc who have digital ulcers, Nevskaya and colleagues reviewed data from the register of the Canadian Scleroderma Research Group. The authors analyzed patients from the registry who met the criteria for the 2013 American College of Rheumatology / EULAR classification for SSc and completed the Resource Utilization Questionnaire (RUQ). This questionnaire measures indicators, including visits to healthcare providers, diagnostic procedures performed, hospitalizations, outpatient procedures, time spent in examinations of healthcare providers, and time spent by other people accompanying patients to visits to the provider.

A total of 208 patients were included in the analysis. Patients were divided into two groups – one group consisting of patients with digital ulcers and the control group, which included patients without digital ulcers. In total, 104 patients with SSc with active digital ulcers at two consecutive annual visits were compared with 104 patients without ulcers. Patients were compared by age, sex, disease subtype, and duration. There was a 1: 1 match between the cases and the controls for the purposes of the analysis.

The researchers used a sum of severity rates using the Medgser disease severity scale as a global measure of disease severity and characterized ischemic complications by collecting data from the registry. Data contributing to the measurement of severity include total numbers of ulcers, digital necrosis or gangrene, history of amputation and cured digital ulcers. The impact of ulcers on daily life is measured with an analog scale ranging from one to 10.

For 1 year, patients with digital ulcers were associated with a larger number of tests (P <.05) and more visits to rheumatologistsP <.0001) and internistsP = .003), according to researchers. In addition, patients with digital ulcers have shown a greater need for someone to accompany them to meetings (P <.05) and received or purchased a larger number of aids, including mobility aids and bath aidsP <.05). Patients with digital ulcers are also associated with more severe disease (P <.0001).

“Compared to patients with SS without DU (controls), those with active DU used significantly more health resources,” Nevskaya and colleagues wrote.

“In particular, DUs lead to an increase in the number of medical visits and tests per year,” they added. “Patients with DU also buy or receive more aids and more often need a companion for visits and tests, which can be explained in part by concomitant severe damage to internal organs and skin.

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