Digital Ulcers in SSc Result in More Tests, Visits to Doctors

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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Among people with systemic scleroderma (SSc), those who have digital ulcers (DUs) — sores on their fingers or toes — tend to use more healthcare resources, a new study suggests.

“Our study demonstrates increased health resource utilization by SSc patients with DUs compared to those without DUs in a large Canadian SSc registry,” its researchers wrote.

“Specifically, DUs lead to increased number of medical visits and tests per year. Patients with DUs also purchase or receive more aids, and more frequently require an accompanying person for visits and tests,” they added.

The study, “Health Care Utilization Is Increased In Systemic Sclerosis Patients Who Have Digital Ulcers,” was published in Arthritis Care & Research.

About half of SSc patients will develop DUs. These sores, usually located on the fingertips, can be painful and interfere with day-to-day activities. Management of DUs generally involves avoiding damage that could worsen the injury, and applying appropriate wound-healing techniques.

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Here, a team of scientists in Canada conducted an analysis using patient-reported data from the Canadian Scleroderma Research Group registry to assess how the presence of DUs affected the use of healthcare resources among SSc patients.

“Patients with DUs may require more healthcare resources given the medical and functional complications inherent to this disease manifestation. The purpose of this study was to elucidate the healthcare utilization within one year in SSc patients with DUs compared to those without DUs in a well-established Canadian systemic sclerosis registry which collects data annually on patients,” the scientists wrote.

From the registry data, the researchers identified 104 SSc patients with DUs. About 90% were white, more than 80% were women, the mean age was 52, and the mean disease duration was nearly 13 years. About three-quarters had limited SSc, while the rest had diffuse disease.

For comparison, the researchers also identified 104 SSc patients who had no history of DUs, who were matched to the DU group by age, sex, SSc subtype, and disease duration.

Based on scores on the Medsger scale, patients with DUs had significantly more severe disease, even when the portions of this scale specifically relevant to DUs were excluded from the analysis (9.7 vs. 5.6).

Compared to those without DUs, patients with DUs reported significantly more yearly visits to doctors or other medical professionals on average (18 vs. 12.9). Patients with DUs were especially more likely to see a rheumatologist or internal medicine specialist.

Patients with DUs also had significantly more medical tests done per year (15.9 vs. 11.5); X-rays were especially more common for people with DUs. The DU group was more likely to receive an aid such as a shower chair, bath rail, or cane (30% vs 17%), and also are significantly more likely to need someone to accompany them on healthcare visits (54% vs. 38%).

Further analysis also suggested that, among patients with DUs, those with more severe sores — meaning a higher number of affected digits and a greater impact of DUs on daily activities — were more likely to have medical tests done or receive an assistive device.

“SSc patients with DUs received or purchased a greater number of aids overall, including mobility and bathroom aids, compared to those without DUs. That supports the previous findings of reduced wrist and hand mobility, functional impairment, and decreased ability to perform activities of daily living in SSc patients with DUs,” the researchers wrote.

“These aids facilitate maintenance of quality of life and functionality but represent another economic burden for patients and the healthcare system,” they added.

Notably, these differences remained significant even after the researchers made statistical adjustments to take into account the differences in non-DU disease severity between the groups.

This suggests that “DUs both reflect a more severe disease phenotype [observable trait] and are intrinsically associated with increased healthcare resource utilization,” the researchers wrote.