AB0679 SKIN ULCERS IN SYSTEMIC SCLEROSIS: 10 YEARS’ FOLLOW-UP OF 211 PATIENTS FROM A MONOCENTRIC COHORT IN THE NORTH EAST OF ITALY
Authors: Pamela Polito, Elisabetta Zanatta, Mara Felicetti, Maria Favaro, Mariagrazia Lorenzin, Roberta Ramonda, Franco Cozzi, Andrea Doria
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Microvascular involvement plays a pivotal role in the pathogenesis of systemic sclerosis (SSc). Among vasculopathic manifestations, skin ulcers (SU) stand out for their high prevalence. <h3>Objectives:</h3> The aim of this study was to evaluate the prevalence and the subtype of SU, the association with clinical phenotype and pharmacological approach in the cohort of scleroderma patients attending our tertiary referral Centre. <h3>Methods:</h3> We retrospectively evaluated clinical records of patients affected with SSc according to aCR/EULAR 2013 criteria, attending the Rheumatology Unit of Padova University. Patients with SSc <i>sine scleroderma</i>, <i>overlap</i> syndrome and with a follow-up lower than 24 months were excluded. We evaluated the epidemiological and clinico-serological data, including autoantibody pattern, laboratory data (such as haemoglobin, ESR, CRP), organ involvement and pharmacological treatments. Prevalence of SU, type of occurrence (isolated, recurrent and persistent episodes) and site (digital and localized at the lower limbs, between knees and ankle-feet) were recorded. Statistical analysis was performed by SPSS v. 24. <h3>Results:</h3> 211 patients were included in the study: 187 female and 24 male, aged 60.8 ±12.4 years, 147 (70%) with limited cutaneous and 64 (30%) with diffuse form. During the follow-up period of 120 months (50-216), 105 (50%) patients experienced at least one episode of SU: 74 experienced digital ulcers, 11 presented only SU at lower limbs and 20 both kinds of ulcers. Demographic, laboratoristic and clinical features of our cohort are shown in Table 1. At the multivariate analysis, diffuse cutaneous form, younger age at diagnosis, telangiectasias and joint involvement were independently associated to SU. Among 105 patients who experienced at least one episode of SU, 69 (66%) had recurrent/persistent ulcers. The latter group needed a combination of drugs, including: calcium-channel blockers (90%), low-dose aspirin (75%), prostanoids (85%) and/or endothelin receptor antagonists (58%); 27% requested opioids for analgesia. Concerning SU at lower limbs, 19/31 patients (61%) had macrovascular involvement and 14/31 (45%) persistent ulcers; 6/31 (19%) underwent autologous skin grafting. <h3>Conclusion:</h3> In our cohort SU occur more frequently in SSc diffuse cutaneous form and are associated with visceral and articular involvement. Digital ulcers tend to recur during the disease course requiring several drugs, while SU at lower limbs tend to be more persistent. <h3>References</h3> [1] Hughes M, Herrick aL. Digital ulcers in systemic sclerosis. Rheumatology (Oxford). 2017;56:14–25. [2] Giuggioli D, Manfredi a, Lumetti F, Colaci M, Ferri C. Scleroderma skin ulcers definition, classification and treatment strategies our experience and review of the literature. Autoimmun Rev. 2018;17:155–64. <h3>Disclosure of interests:</h3> None declared