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Ultrasound characterization of cutaneous ulcers in systemic sclerosis

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Abstract

Skin ulcers in scleroderma (SSc) patients are considered a major challenge, both in clinical assessment and treatment decisions. The objective of our study is to assess ultrasonographic (US) morphology of skin ulcers in SSc patients and evaluate if US will be of value in enhancing our clinical information and influence our management plans. We examined a convenience sample of 21 skin ulcers reported in 10 SSc patients by US. We used a previously published US definition of normal skin and developed a preliminary US definition of skin ulcer. Skin ulcers were evaluated by gray scale (GS) and power Doppler (PD) and separated into ulcer and non-ulcer lesions; pain and ulcer measures were obtained using visual analogue scales (VAS). Lesions were characterized and ulcers were clinically and sonographically measured. Ten patients presenting with 21 skin lesions were examined by US. Applying our US definition of skin ulcer, all ulcers were available to measure by ultrasound. Eight lesions were sonographically defined as ulcers, and 13 lesions as non-ulcer lesions. Three ulcers had high PD signals suggestive of infection requiring antibiotic treatment and were monitored for 2 weeks showing a decrease of the pain, VAS, and PD signals. Five lesions showed subclinical calcinosis. This is the first study to show the promising role of US in defining skin ulcers of SSc patients. US may support the assessment of morphology and extent of skin ulcers in SSc and can be a helpful tool for detecting underlying pathology.

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Acknowledgements

The authors would like to thank Cesar P. Olmos Research Associate, UCLA Medicine Division of Rheumatology.

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Authors and Affiliations

  1. Rheumatology and Rehabilitation Department, Assiut University Hospital, Assiut, Egypt

    Yossra A. Suliman

  2. Department of Medicine, Rheumatology Division, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Yossra A. Suliman, Suzanne Kafaja, John Fitzgerald, Veena K. Ranganath & Daniel E. Furst

  3. Department of Radiology and Department of Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Clinica Servet, Faculty of Medicine, University of Chile, Santiago, Chile

    Ximena Wortsman

  4. Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Jonathan Grotts

  5. Department of Clinical and Experimental Medicine, Division of Rheumatology, University of Florence, Florence, Italy

    Marco Matucci-Cerrinic & Daniel E. Furst

  6. Department of Rheumatology, Unversity of Washington, Seattle, WA, USA

    Daniel E. Furst

Authors
  1. Yossra A. Suliman
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  2. Suzanne Kafaja
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  3. John Fitzgerald
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  4. Ximena Wortsman
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  5. Jonathan Grotts
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  6. Marco Matucci-Cerrinic
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  7. Veena K. Ranganath
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  8. Daniel E. Furst
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Corresponding author

Correspondence to Daniel E. Furst.

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Disclosures

YA Suliman funded by Egyptian government scholarship joint supervision program.

S Kafaja, J Fitzgerald, VK Ranganath, and Ximena Wortsman none.

Marco Matucci-Cerinic: bms, actelion, pfizer, lilly, hospira, and sandoz.

DE Furst: AbbVie, Actelion, Amgen, BMS, NIH, Novartis, Pfizer, and Roche/Genentech.

Additional information

Veena K. Ranganath and Daniel E Furst are co-last authors.

Yossra A Suliman and Suzanne Kafaja are co-first authors.

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Suliman, Y.A., Kafaja, S., Fitzgerald, J. et al. Ultrasound characterization of cutaneous ulcers in systemic sclerosis. Clin Rheumatol 37, 1555–1561 (2018). https://doi.org/10.1007/s10067-018-3986-5

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  • DOI: https://doi.org/10.1007/s10067-018-3986-5

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