This article appears in the following Rheumatology issue: Ten years of partnership: translating ideas into progress in systemic sclerosis [View the issue table of contents]
Reviews |
Digital ulcers: overt vascular disease in systemic sclerosis
1Department of Medicine, Georgetown University Medical Center, Washington, DC, USA, 2Centre for Rheumatology, Royal Free Hospital and University College School of Medicine, London, UK, 3Department of Medicine, St Joseph's Health Center, London, Ontario, Canada and 4Department of Biomedicine, Centre DenoThe, Division of Rheumatology, AOUC University of Florence, Florence, Italy.
Correspondence to: V. Steen, Department of Medicine, Georgetown University, 3800 Reservoir Road, LL Kober-Cogan, Washington, DC 20007, USA. E-mail: steenv{at}georgetown.edu
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Abstract |
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RP is an almost universal manifestation of SSc, with 95% of all patients being affected, and resulting in digital ulcers (DUs) in 
30% of the patients each year. DUs are a major clinical problem, being associated with substantial morbidity (reduced quality of life, pain, disability and disfigurement) that can escalate to gangrene and amputation. Ideally, the treatment of DUs would improve tissue integrity and viability, promote ulcer healing and reduce the formation of new ulcers. Treatments that have shown potential include calcium channel blockers, prostacyclin analogues and endothelin receptor antagonists. However, until recently, management was based on empirical experience. The recent approval (in Europe) of the dual endothelin receptor antagonist, bosentan, to reduce the number of new DUs in patients with SSc and ongoing DU disease, means that there is now an approved therapy—and new hope—for the treatment of DUs in these severely afflicted patients.
KEY WORDS: RP, Endothelin receptor antagonist, Digital ulcers, Systemic sclerosis
Submitted 11 February 2008;
revised version accepted 2 April 2009.
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