TY - JOUR T1 - Assessment, Definition, and Classification of Lower Limb Ulcers in Systemic Sclerosis: A Challenge for the Rheumatologist JF - The Journal of Rheumatology JO - J Rheumatol DO - 10.3899/jrheum.150035 SP - jrheum.150035 AU - Jelena Blagojevic AU - Guya Piemonte AU - Laura Benelli AU - Francesca Braschi AU - Ginevra Fiori AU - Francesca Bartoli AU - Serena Guiducci AU - Silvia Bellando Randone AU - Felice Galluccio AU - Laura Cometi AU - Sergio Castellani AU - Maria Boddi AU - Alberto Moggi Pignone AU - Laura Rasero AU - Francesco Epifani AU - Marco Matucci-Cerinic Y1 - 2016/02/01 UR - http://www.jrheum.org/content/early/2016/01/26/jrheum.150035.abstract N2 - Objective To evaluate pathogenesis and clinical features of lower limb ulcers in systemic sclerosis (SSc) and to propose a classification that could be used in clinical practice. Methods Charts of 60 patients with SSc who had lower limb cutaneous lesions were reviewed. All patients had videocapillaroscopy and arterial and venous lower limb color Doppler ultrasonography (US). Arteriography was performed if occlusive peripheral arterial disease was suspected. Results The 554 lesions were classified as hyperkeratosis, ulcers, and gangrenes. There were 341 (61.6%) hyperkeratoses, 208 (37.5%) ulcers, and 5 (0.9%) gangrenes. Ulcers were divided into pure ulcers, ulcers associated with hyperkeratosis, and ulcers secondary to calcinosis. Involvement of arterial and venous macrocirculation as determined by color Doppler US was observed in 17 (18.3%) and 18 (30%) patients, respectively. Seventeen out of 37 patients with pure ulcers (45.9%) presented neither venous insufficiency nor hemodynamically significant macrovascular arterial disease. In these patients, pure ulcers were most likely caused by isolated SSc-related microvascular involvement (pure microvascular ulcers). The only significant risk factor for development of pure microvascular ulcers in the multivariate analysis was the history of lower limb ulcers (OR 26.67, 95% CI 2.75–259.28; p < 0.001). Conclusion Results of our study indicate that lower limb ulcers in SSc often have a multifactorial pathogenesis that may be difficult to manage. Further studies are needed to validate the proposed classification and to assess the most appropriate management of lower limb ulcers in SSc. ER -