The Team and the Assessment

  • Cosimo Bruni
  • Tiziana Pucci
  • Laura Rasero
  • Christopher P. Denton


Digital ulcers are known as a heavy clinical burden in patients with systemic sclerosis, leading to important limitations to everyday life. Keeping in mind the partial agreement on digital ulcers definition, the assessment of skin lesions is currently focussed on count and the appearance of new ulcers. Conversely, different tools are available to monitor the effect of digital ulcers on patient’s subjective perception of quality of life, with pain, general disability and hand-centred disability being the domains generally evaluated in clinical practice (with scales and questionnaires such as the Visual Analogue Scale [VAS], the Health Assessment Questionnaire Disability Index [HAQ-DI] and the recently proposed Hand Disability in Systemic Sclerosis Digital Ulcer [HDISS-DU]). On the other hand, no objective outcome measure is now available to follow up digital ulcers evolution in clinical practice, and this represents an unmet need to be solved, in order to have a validated tool to be used also in randomized clinical trials.


Digital ulcers Definition Assessment Outcome measure Scales Questionnaires Healing Disability Hand function Pain Quality of life 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Cosimo Bruni
    • 1
  • Tiziana Pucci
    • 2
  • Laura Rasero
    • 3
  • Christopher P. Denton
    • 4
  1. 1.Department of Experimental and Clinical Medicine, Division of RheumatologyUniversity of FlorenceFlorenceItaly
  2. 2.Department of Geriatric Medicine, Division of RheumatologyAOUCFlorenceItaly
  3. 3.Department of Health SciencesUniversity of Florence – Careggi of HospitalFlorenceItaly
  4. 4.Division of MedicineUniversity College London, Centre for Rheumatology, Royal Free HospitalLondonUK

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