Lower-limb Ulcers in Systemic Sclerosis: A Multicentre Retrospective Case-control Study

Abstract

Lower-limb ulcers in systemic sclerosis patients are rarely reported. The aim of this study was to describe the main causes and outcomes of lower-limb ulcers in systemic sclerosis patients and to assess factors associated with ischaemic causes (arterial disease and/or microvascular impairment). A retrospective, multicentre, case-control study was conducted in 2013 and 2014, including 45 systemic sclerosis patients presenting lower-limb ulcers between 2008 and 2013. The estimated prevalence of lower-limb ulcers among systemic sclerosis patients was 12.8%. Ulcers were related to venous insufficiency in 22 cases (49%), ischaemic causes in 21 (47%) and other causes in 2 (4%). Complete healing was observed in 60% of cases in a mean time of 10.3 months; 59% relapsed during a mean follow-up of 22 months. Ischaemic lower-limb ulcer outcomes were poor, with a 28.6% amputation rate. Logistic-regression multivariate analyses between ischaemic lower-limb ulcer cases and matched systemic sclerosis-controls identified past or concomitant digital ulcer and cutaneous sclerosis of the feet as independent risk factors associated with ischaemic lower-limb ulcers.

Characteristics of patients with systemic sclerosis suffering from a lower limb amputation: Results of a French collaborative study

“…10 Similarly, 24/25 patients in our series had previous ulcer of lower limbs before amputation. Bohelay et al 14 reported six amputations of lower limbs in 43 SSc patients with lower limb ulcers. Thus, patients suffering from SSc and lower limb ulcer(s) appear to be at high risk for amputation and should be followed vigilantly.…”

Ulcer on the Leg

“…Shanmugam et al 11 calculated a 4% (N=249) prevalence of ulcers in the lower limbs of systemic sclerosis patients. In a study by Bohelay et al 12 of 45 patients, the estimated prevalence of lower limb ulcers was 12.8%, and the etiologies consisted of 22 cases of venous insufficiency (49%), 21 cases of ischemic causes (47%), and 2 cases of other causes (4%).…”

Prevalence and Clinical Implications of Scleroderma-Specific Autoantibodies in Seronegative Patients with Sicca Complaints

“… - Anti-TOPO/anti-Scl-70 signifies an increased risk for fibrosis, especially in the lungs, 18 scleroderma renal crisis, and skin ulceration. 19 Conversely, their absence indicates a better prognosis and survival. 20 - ACA in lcSSc patients 21 indicates a higher risk of pulmonary hypertension and gastrointestinal involvement.…”

“…- Anti-TOPO/anti-Scl-70 signifies an increased risk for fibrosis, especially in the lungs, 18 scleroderma renal crisis, and skin ulceration. 19 Conversely, their absence indicates a better prognosis and survival. 20 …”