Foot problems in patients with systemic sclerosis

Sari-Kouzel, H; Hutchinson, C.E.; Middleton, A.; Webb, Frank; Moore, Tonia; Griffin, Kerry; Herrick, Ariane L.

doi:10.1093/rheumatology/40.4.410

Cited by 46 publications

(46 citation statements)

References 6 publications

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“…However, the few published studies show that podiatric problems are common and potentially disabling for patients with SSc (3,7). This is confirmed in our study by FFI results that indicate an average intensity of pain of 50% and disability of approximately 50%, while the foot activities are limited to approximately 30%.…”

Section: Discussionsupporting

confidence: 88%

Biomechanical podiatric evaluation in an Italian cohort of patients with systemic sclerosis: A pilot study

et al. 2017

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Section: Discussionsupporting

confidence: 88%

Biomechanical podiatric evaluation in an Italian cohort of patients with systemic sclerosis: A pilot study

et al. 2017

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“…First, the study focused solely on finger ulcers, but toe ulcers in SSc are also a major cause of morbidity, with the results of a previous investigation suggesting that ϳ26% of SSc patients experience foot ulceration (9). Second, examination of photographs may not be the exact equivalent of direct assessment of ulcers.…”

Section: Discussionmentioning

confidence: 99%

Lack of agreement between rheumatologists in defining digital ulceration in systemic sclerosis

Herrick

Roberts

Tracey

et al. 2009

Arthritis & Rheumatism

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Objective. To test the intra-and interobserver variability, among clinicians with an interest in systemic sclerosis (SSc), in defining digital ulcers.Methods. Thirty-five images of finger lesions, incorporating a wide range of abnormalities at different sites, were duplicated, yielding a data set of 70 images. Physicians with an interest in SSc were invited to take part in the Web-based study, which involved looking through the images in a random sequence. The sequence differed for individual participants and prevented crosschecking with previous images. Participants were asked to grade each image as depicting "ulcer" or "no ulcer," and if "ulcer," then either "inactive" or "active." Images of a range of exemplar lesions were available for reference purposes while participants viewed the test images. Intrarater reliability was assessed using a weighted kappa coefficient with quadratic weights. Interrater reliability was estimated using a multirater weighted kappa coefficient.Results. Conclusion.The poor interrater reliability suggests that if digital ulceration is to be used as an end point in multicenter clinical trials of SSc, then strict definitions must be developed. The present investigation also demonstrates the feasibility of Web-based studies, for which large numbers of participants can be recruited over a short time frame.Digital ulcers, which are common in patients with systemic sclerosis (SSc) (1,2), are painful and disabling. These types of ulcers are often used as a primary end point in clinical trials of SSc-related digital ischemia and vasculopathy, as was the case in 2 recent multicenter placebo-controlled trials (3,4). Patient-assessed digital ulcer "activity" was among a core set of measures proposed for use in trials of SSc-related Raynaud's phenomenon (5). However, digital ulcers are difficult to define, which raises concerns about their reliability as an outcome measure. Problems include 1) making the distinction between "healed" and "nonhealed" ulcers, which can be difficult with lesions situated on the fingertips and the extensor surfaces, since an ulcer crater can persist for months after an acute episode, and 2) determining which sites to use. The study by Korn et al (3) included only those ulcers at or distal to the proximal interphalangeal joints, and yet, more proximal ulcers (e.g., those over the metacarpophalangeal joints) can be very painful, and healing can be difficult.

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“…Obwohl die Symptomatik im Bereich der Hände häufig im Vordergrund steht, sollten die Patienten gezielt im Hinblick auf ein RP, Ulzerationen und eine Calcinosis cutis im Bereich der Füße befragt und untersucht werden [38].…”

Section: Diagnostikunclassified

Therapeutisches Management akraler Manifestationen der systemischen Sklerose

et al. 2007

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Acral manifestations of systemic sclerosis include Raynaud's phenomenon, calcinosis cutis, and sclerodactyly. In the later stages of the disease, contractures of the skin and joints as well as obliterative vasculopathy leading to digital ulcers and necrotic lesions may occur. Patients with acral manifestations of systemic sclerosis are ideally treated by a team that includes a rheumatologist, dermatologist, hand surgeon, physiotherapist, and, eventually, a psychologist. Calcium channel antagonists, alpha(1)-adrenergic blockade with prazosin, and prostacyclin analogs were proven to be effective in the treatment of scleroderma-related Raynaud's phenomenon. Losartan, an angiotensin II receptor inhibitor, and fluoxetine, a selective serotonin reuptake inhibitor, have been beneficial for systemic sclerosis-associated Raynaud's phenomenon in pilot studies. Parenteral prostacyclin analogs, e. g., iloprost, can be recommended as first-line treatment of ischemic digital ulcers. When prostacyclin analogs fail, the phosphodiesterase type 5 inhibitor sildenafil can be tried to improve ulcer healing. Bosentan, an endothelin receptor antagonist, may prevent new digital ulcers. At present, there are no medical agents agreed to be generally effective in the reduction of calcinotic deposits or cutaneous fibrosis, although some drugs have been identified as potentially beneficial. Surgical treatment of acral manifestations consists of excision or curettage of symptomatic calcific deposits, digital sympathectomy, arterial reconstruction, and amputation in rare cases. Flexion contractures of the proximal interphalangeal joints, with secondary hyperextension of the metacarpophalangeal joints, can be treated by arthrodesis of the proximal interphalangeal joints and resection arthroplasty or prostheses at the metacarpophalangeal joints to improve hand function.

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Foot problems in patients with systemic sclerosis

Abstract: Although problems with the hands are well recognized in SSc, foot problems also occur in the majority of patients, and can be a cause of major disability. Care of the feet is therefore an important part of the management of SSC.

Cited by 46 publications

References 6 publications

Biomechanical podiatric evaluation in an Italian cohort of patients with systemic sclerosis: A pilot study

Biomechanical podiatric evaluation in an Italian cohort of patients with systemic sclerosis: A pilot study

Lack of agreement between rheumatologists in defining digital ulceration in systemic sclerosis

Therapeutisches Management akraler Manifestationen der systemischen Sklerose

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