Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.

Associations with Digital Ulcers (DU) in a Large Cohort of Systemic Sclerosis (SSc)

Khimdas1,  Sarit, Harding2,  Sarah, Bonner3,  Ash, Zummer2,  Brittany, Canadian Scleroderma Research Group,  , Baron4,  Murray, Pope5,  Janet

Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON,
University of Western Ontario, London, ON,
McMaster University, Hamilton, ON,
Jewish General Hospital, Montreal, QC,
St Joseph Health Care, London, ON


Digital ulcers (DU) are a common disabling complication of systemic sclerosis/scleroderma (SSc) and can be associated with devastating complications such as osteomyelitis and amputation. There is debate as to whether DUs are increased in SSc with pulmonary arterial hypertension (PAH) as the literature is controversial in this area1, 2. Although occurring in 30 to 50% of patients, information is lacking on whether DUs are associated with other organ complications and SSc subsets.


Data from the CSRG (Canadian Scleroderma Research Group) are collected annually on an incident and prevalent SSc cohort. Presence, location and number of digital ulcers are collected annually as well as complications and other internal organ involvement, skin score and labs results. Correlation coefficients, Chi squared and logistic regression modeling were done to determine the associations of DUs (and subset of complicated DU) with other factors such as internal organ complications


938 patients were included. 86% were women, mean age was 56 and disease duration was 14 years. 53% had limited SSc. 15% had a DU currently, 46% had a DU ever and 53% had digital pits. DUs were not associated with PAH (P=0.35). Complicated DUs including gangrenous (P=0.72) and amputated (P=0.93) digits were not associated with PAH. In patients with a disease duration longer than three years, DUs were associated with higher skin scores (P=0.00). Gender (P=0.95) and smoking (0.91) were not associated with DUs. Organ involvement including renal crisis (P= 0.66) and interstitial lung disease (P=0.20) were not associated with DUs. DUs were associated with: a decreased DLCO in diffuse SSc (P=0.01) and both earlier age of Raynaud's (P=0.00) and first non-Raynaud's symptom (P=0.00). DUs were further associated with GERD in diffuse SSc (P=0.00) and esophageal hypomotility as measured by esophageal dilatation (P=0.00). DUs were associated with the presence of topoisomerase 1 (Scl-70) antibodies (P=0.00). Patients with diffuse SSc were almost twice as likely to have had a DU than patients with limited SSc. However, neither patients with gangrenous (P=0.61) nor amputated digits (P=0.46) were associated with a subtype of SSc.


It appears that DUs are not associated with PAH. DUs increase with diffuse SSc, early onset of disease, low DLCO, esophageal involvement and presence of topoisomerase 1 (Scl-70) antibodies. Complicated DUs are not associated with an SSc subtype or specific organ involvement. Some of the associations are confounded as diffuse SSc onsets earlier than limited and thus earlier age of onset increases DU risk. Understanding the associations with digital ulcers in scleroderma may help to risk stratify patients and better treat or prevent this disabling complications.

1.Sunderkotter, C. British J Dermatology, 2009

2.Tiev, KP. J Rheumatol, 2009

To cite this abstract, please use the following information:
Khimdas, Sarit, Harding, Sarah, Bonner, Ash, Zummer, Brittany, Canadian Scleroderma Research Group, , Baron, Murray, et al; Associations with Digital Ulcers (DU) in a Large Cohort of Systemic Sclerosis (SSc) [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1741
DOI: 10.1002/art.26815

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