Faculty, Staff and Student Publications
Publication Date
4-30-2025
Journal
Journal of Scleroderma and Related Disorders
Abstract
Objectives: Digital ulcers (DUs) are a major cause of pain and disability in systemic sclerosis (SSc) patients and remain a major treatment challenge. Our aim was to explore clinicians' perspectives towards treatment initiation and escalation, akin to a 'Treat to Target' (T2T) strategy.
Methods: SSc clinicians were invited to participate in an online survey.
Results: A total of 173 responses (75% rheumatologists) were obtained from 33 countries. When initiating a change in oral drug therapy for SSc-DUs, most (80%) respondents would consider adding new medication to existing treatment, and 50% would increase existing treatment dose. Time to assess the impact of treatment change varied considerably, with around half (43.6%) waiting 1 month. Endothelin receptor antagonists, phosphodiesterase type-5 inhibitors and prostanoids were considered most efficacious for DU prevention, with good perceived efficacy from calcium channel blockers and moderate benefit from anti-platelet agents and immunosuppression. Side effects (e.g. headache and peripheral oedema) are perceived to be a significant issue with oral vasodilatory/vasoactive therapies in many patients. The highest rated T2T targets were (1) complete absence of new/recurrent DUs (63%), (2) reduction >50% in the number of DU recurrence (52%) and (3) reduction in DU healing time (37%) and reduction in DU pain >50% (37%). The most frequent reasons for hospitalisation were to administer intravenous treatment (91%) and DU complications (87%). Surgery is reserved for the threatened digit (e.g. gangrene), underlying calcinosis and failure of medical therapy.
Conclusion: Significant heterogeneity currently exists concerning treatment initiation and escalation for SSc-DUs, potentially amenable to a T2T strategy.
Keywords
Digital ulcers, systemic sclerosis, scleroderma, T2T, management, pharmacological, vascular, Raynaud’s
DOI
10.1177/23971983251336616
PMID
40321746
PMCID
PMC12045939
PubMedCentral® Posted Date
4-30-2025
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes