Objectives To evaluate the impact of digital ulcer (DU) healing on disability and daily activity limitations in systemic sclerosis (SSc).
Methods From January 2008 and June 2009, we prospectively evaluated, 189 SSc patients for DU history, disability, employment and occupational status during meetings of the French SSc patient association (n=86, 45.5%) or during hospitalization (n=103, 54.5%)1. Among the 60 patients with at least one active DU at baseline, 40 patients were followed longitudinally over 6±3 months. Patients were evaluated for DU history, global and hand disability, Health-related quality of life (HRQOL), daily activity limitation and employment status
Results The median [IQR] age was 57.5 [43.5-68] years and the median [IQR] disease duration was 8.3 [3-16.5] years at the time of evaluation. Twenty-to (55%) patients had diffuse SSc and 34 (85%) were female. At baseline, a mean of 2.9±2.8 DU per patient was reported. Thirty-tree (82.5%) patients had ischemic UD, 7 (17.5%) patients had ≥1 DU associated with calcinosis, and 13 (32.5%) patients had mechanical DU proximal to the fingertip. Thirteen (32.5%) patients had ≥4 DU at baseline. Among the 40 patients, 16 (40%) patients showed complete ulcer healing within follow-up period. DU associated with calcinosis heal less than other (p=0.029). Comparison between healed and no-healed DU patients shows a improvement of hand disability reflected by decreased of the Cochin Hand Function score (p=0.05)) and a trend toward for HAQ subindex for dressing (p=0.056). Concerning HRQOL, there were no difference for MCS and PCS scores of SF-36 but significant improvement of Bodily Pain (p=0.0341) and Physical Role (p=0.045) in healed patients. The absence of healing was associated with decreased work productivity (p=0.047) and with no statistically significant decreased performance in ADL (p=0.154). Patients who had seak leave at the time of active DU are more likely to heal (p=0.04). New DU developed in 15 (37.5%) patients during follow-up. In multivariate analysis, diffuse form identified as independent risk factors for new digital ulcers (p=0.013).
Conclusions We have been previously shown the impact of DU on global and hand disability with significant impact on ADL and work disability. DU Healing leads to an improvement in hand function. Putting off work could promote healing
Bérezné A et al. Arhtritis Care and Research 2011; 63(2):277-285
Disclosure of Interest None Declared