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SAT0380 Classification, categorisation and essential items for digital ulcer (DU) evaluation in systemic sclerosis (SSC): a desscipher/eustar survey
  1. J Blagojevic1,2,3,
  2. L Cometi1,
  3. G Abignano3,4,
  4. S Guiducci1,
  5. S Bellando-Randone1,
  6. D Huscher5,
  7. J Avouac6,
  8. L Czirják7,
  9. C Denton8,
  10. O Distler9,
  11. M Frerix10,
  12. VK Jaeger11,
  13. V Lόránd7,
  14. B Maurer9,
  15. S Nihtyanova8,
  16. G Riemekasten12,
  17. E Siegert13,
  18. G Valentini14,
  19. S Vettori14,
  20. U Walker15,
  21. U Müller-Ladner10,
  22. Y Allanore16,
  23. F Del Galdo3,4,
  24. M Matucci-Cerinic1,
  25. on behalf of DeSScipher Consortium and contributing EUSTAR centres
  1. 1Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
  2. 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds
  3. 3NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust
  4. 4Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
  5. 5Department of Rheumatology and Immunology, Charité University Hospital and German Rheumatism Research Centre, Berlin, Germany
  6. 6Department of Rheumatology, University of Paris Descartes, Paris, France
  7. 7Department of Rheumatology and Immunology, University of Pécs, Pécs, Hungary
  8. 8Department of Rheumatology, University College London, Royal Free Hospital, London, United Kingdom
  9. 9Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
  10. 10Department of Rheumatology and Clinical Immunology, Justus–Liebig University Giessen, Kerckhoff Clinic Bad Nauheim, Giessen/Bad Nauheim, Germany
  11. 11Department of Rheumatology, University of Basel, Basel, Switzerland
  12. 12University Schleswig-Holstein Lübeck, Lübeck
  13. 13Department of Rheumatology and Immunology, Charité University Hospital, Berlin, Germany
  14. 14Department of Rheumatology, Second University of Naples, Naples, Italy
  15. 15Department of Rheumatology, University of Basel, Basel, Switzerland
  16. 16Department of Rheumatology, University of Paris Descartes, Paris, France


Background A consensus on DU definition in SSc has been recently reached (1),while for their evaluation,classification and categorisation it is still missing.

Objectives To identify in SSc a set of essential items for DU evaluation, to assess if the existing DU classification (2) was useful and feasible in clinical practice, and to investigate if the DU categorisation (3) was preferred to the simple division of DU in recurrent and not recurrent.

Methods The DU Desscipher items that reached >60% of completion rate were administered to EUSTAR centres via online survey.These items were: DU distal to the proximal interphalangeal joints, recurrent DU, DU history, infection, gangrene, amputation, total number of DU, number of new DU, number of healed DU, number of DU defined as loss of tissue, number of DU due to calcinosis and number of DU due to digital pitting scars (DPS).Questions about feasibility and usefulness of the existing DU classification (DU due to DPS, to loss of tissue, derived from calcinosis and gangrene) (2) and newly proposed DU categorisation (episodic, recurrent and chronic) (3) were also administered.

Results All Desscipher and 82/194 EUSTAR centres (42.3%) completed the questionnaire.Out of 27 items selected for the Desscipher study, those scored by>70% of participants as essential and feasible for DU evaluation in clinical practice were only the following: number of DU defined as a loss of tissue (level of agreement 91.1%), recurrent DU (84%) and number of new DU (74.4%).For 64.6% of the centres,the classification of DU was considered useful and feasible in clinical practice.Moreover, 80.3% of the centres preferred the categorization of DU in episodic,recurrent and chronic.

Conclusions For clinical practice, EUSTAR centres identified only three essential items for DU evaluation and considered useful and feasible the proposed classification and categorisation of DU.The set of items needs to be further validated by Delphi voting in order to implement its use in clinical practice while further implementation of DU classification and categorisation is warranted.


  1. Suliman Y et al.Preliminary musculoskeletal ultrasound (MSUS) ulcer definition does not correlate with visual observation in systemic sclerosis (SSc) patients. J. Scleroderma Relat. Disord.2017(in press).

  2. Amanzi L et al.Digital ulcers in scleroderma: staging, characteristics and sub-setting through observation of 1614 digital lesions. Rheumatology (Oxford) 2010;49:1374–82.

  3. Matucci-Cerinic M et al.Elucidating the burden of recurrent and chronic digital ulcers in systemic sclerosis: long-term results from the DUO Registry. Ann Rheum Dis. 2016;75:1770–6.


Disclosure of Interest None declared

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