Skin ulcers in systemic sclerosis: correlation with clinical phenotype in a monocentric cohort from the north-east of Italy.

OBJECTIVES To evaluate the prevalence of skin ulcers (SUs) and their association with clinical phenotype in a monocentric cohort of patients affected with systemic sclerosis (SSc). METHODS Patients affected with SSc (ACR/EULAR 2013 criteria) in regular follow-up at the Rheumatology Unit of Padova University Hospital, Italy, were considered and retrospectively evaluated. Demographic, clinical and laboratory data, organ involvement and therapy were recorded. We analysed the occurrence, timing (single episode, recurrent/chronic) and site of SUs. The association between SUs and demographic and clinical variables was assessed by logistic regression analysis. RESULTS We evaluated 211 SSc patients, aged 60.8±12.4 years, 187 (89%) females, 147 (70%) affected with limited cutaneous SSc. During a median follow-up of 120 months (50-216), 105 (50%) patients experienced at least one episode of SU; among them, 66% had recurrent or persistent SUs. Patients with a history of SUs compared with those never affected were younger at SSc diagnosis (p=0.009), had more frequently a diffuse cutaneous form (p=0.001), chronic anaemia (p<0.001), systemic inflammation (p=0.001), lung (p=0.002) and cardiac (p=0.004) involvement, and calcinosis (p=0.001). At multivariate analysis a younger age at SSc diagnosis (p=0.031), articular involvement (p=0.005) and telangiectasia (p=0.003) were independently associated with SUs. Telangiectasia, articular involvement, chronic anaemia and inflammatory state were found to be associated with the recurrence/chronicisation of SUs. CONCLUSIONS SUs represent a common complication in our cohort of patients with a long-term follow-up. The association of SUs with some clinical manifestations of SSc suggests a combined role of microcirculatory damage and inflammation in their origin.