Digital Ulcers Strongly Affect Pain and Daily Life in Scleroderma Patients, Spanish Study Finds

Digital ulcers (DUs) aggravate hand disability, limit daily activities, and affect work productivity in people with scleroderma, a real-world study from Spain reports.

Patients with DUs had more pain, a higher incidence of Raynaud’s phenomenon, and reported having more severe disease compared to those without these ulcers.

The study, “LAUDES Study: impact of digital ulcers on hand functional limitation, work productivity and daily activities, in systemic sclerosis patients,” was published in the journal Rheumatology International.

Most people with scleroderma develop Raynaud’s phenomenon, a condition in which excess collagen narrows small blood vessels in the fingers and toes, causing them to feel numb, prickly and frigid in response to cold temperatures or stress. This can trigger the formation of DUs, or small sores, found in around 30% of scleroderma patients.

In addition to clinical problems such as infections, digital ulcers can also impair quality of life due to pain, disability, and hospitalization. In patients with active DUs, limitations in their professional lives and daily activities have been reported. 

To better understand the limitations that DUs cause in the Spanish scleroderma population, researchers from multiple health centers across the country — known as the LAUDES Study Group — assessed overall health, hand function, and limitations to work productivity and daily life activities in scleroderma patients with or without DUs. 

A total of 199 adults, mean age 54.5 and mostly women (82%), were evaluated from September 2012 to January 2013. Patients were divided into two groups: 70 (35%) had active DUs, including those who had DUs of more than seven days, while 129 patients (65%) did not have DUs.

They were asked to complete three questionnaires. Hand function was assessed using the Cochin Hand Function Scale, overall physical disability was evaluated using the Scleroderma Health Assessment Questionnaire (SHAQ), and work and activity limitations were measured with the Work Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI-SHP). The WPAI-SHP questionnaire was also completed by attending physicians. 

Hand function assessment included five activities — personal hygiene, dressing, eating-cooking, office, other activities — as well as overall ability. 

Results revealed that scleroderma patients with active DUs had higher overall hand disability scores (32.3) compared to those without DUs (20.4). Significantly higher disability scores were shown for all five daily activities.

The SHAQ questionnaire analyzed eight domains of physical ability: getting dressed, getting up, eating, walking, hygiene, ability to reach objects, grip, and other activities. It also included questions about pain and five scleroderma symptoms — Raynaud’s phenomenon, DUs, gastrointestinal problems, pulmonary problems, and an overall personal assessment of disease severity.

Overall, no significant differences in the degree of disability was found between patients with or without DUs. However, dressing, eating, and grip were significantly more difficult in those with DUs. 

Patients with DUs experienced significantly more pain, a higher incidence of Raynaud’s phenomenon, and had a more severe assessment of their disease compared to those without DUs. 

While work productivity was impacted by DUs, it was not significantly different from those without these ulcers. In contrast, patients with DUs reported a significantly greater impact on daily activities. Results from physicians closely matched those of the patients.

Overall, “[the] findings show an impaired hand function and increased disability for daily life activities and work productivity in SSc [scleroderma] patients with DUs compared with patients without DUs in Spanish population,” the researchers wrote.