Evidence map›Paper›PMID 37335850›Full record

SynthesisRheumatology (Oxford, England)2023

Systemic pharmacological treatment of digital ulcers in systemic sclerosis: a systematic literature review.

Laura Ross, Nancy Maltez, Michael Hughes, Jan W Schoones, Murray Baron, Lorinda Chung, Dilia Giuggioli, Pia Moinzadeh, Yossra A Suliman, Corrado Campochiaro and 11 more

Open access · hybridAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Rheumatology (Oxford, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
3.8field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.

  1. Biological effects of statins in systemic sclerosis: a systematic review and meta-analysis of 323 patients.Daru : journal of Faculty of Pharmacy, Tehran University of Medical Sciences · 2026
    Pooled it
  2. Article
  3. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors at 20 institutions in 11 countries.

Laura RossDepartment of Medicine and Rheumatology, University of Melbourne at St Vincent's Hospital, Melbourne, Victoria, Australia.ORCID 0000-0003-4636-729X
Nancy MaltezDepartment of Medicine, Division of Rheumatology, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
Michael HughesDepartment of Rheumatology, Northern Care Alliance NHS Foundation Trust, Salford Care Organisation, Salford, UK.
Jan W SchoonesDirectorate of Research Policy (formerly Walaeus Library), Leiden University Medical Center, Leiden, The Netherlands.
Murray BaronDivision of Rheumatology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Lorinda ChungDepartment of Rheumatology, Stanford University School of Medicine and Palo Alto VA Health Care System, Palo Alto, CA, USA.
Dilia GiuggioliDepartment of Rheumatology, Division of Rheumatology, University of Modena and Reggio Emilia, Policlinico of Modena, Modena, Italy.
Pia MoinzadehDepartment of Dermatology and Venereology, University Hospital Cologne, Cologne, Germany.
Yossra A SulimanDepartment of Rheumatology and Rehabilitation, Assiut University Hospital, Assiut, Egypt.
Corrado CampochiaroDepartment of Immunology, Rheumatology, Allergy and Rare Diseases, Raffaele Hospital, Vita-Salute San Raffaele Università, Milan, Italy.ORCID 0000-0001-6806-3794
Yannick AllanoreDepartment of Rheumatology, Cochin Hospital, AP-HP, Paris Descartes University, Paris, France.
Christopher P DentonCentre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital, London, UK.ORCID 0000-0003-3975-8938
Oliver DistlerDepartment of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.ORCID 0000-0002-0546-8310
Tracy FrechDepartment of Medicine, Division of Rheumatology and Immunology, Vanderbilt University Medical Center, Veterans Affairs Medical Center, Nashville, TN, USA.ORCID 0000-0002-5472-3840
Daniel E FurstDepartment of Rheumatology and Medicine, University of California, Los Angeles, Los Angeles, CA, USA.ORCID 0000-0001-7857-2373
Dinesh KhannaDepartment of Rheumatology, University of Michigan, Ann Arbor, MI, USA.ORCID 0000-0003-1412-4453
Thomas KriegDepartment of Rheumatology, Division of Rheumatology, University of Modena and Reggio Emilia, Policlinico of Modena, Modena, Italy.
Masataka KuwanaDepartment of Allergy and Rheumatology, Nippon Medical School, Tokyo, Japan.ORCID 0000-0001-8352-6136
Marco Matucci-CerinicDepartment of Experimental and Clinical Medicine, Division of Rheumatology, Careggi University Hospital, University of Florence, Florence, Italy.
Janet PopeSchulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.ORCID 0000-0003-1479-5302
Alessia AlunnoDepartment of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.ORCID 0000-0003-1105-5640
University of Modena and Reggio Emilia · ITAssiut University · EGDélégation Paris 5 · FRJewish General Hospital · CALeiden University Medical Center · NLNippon Medical School · JPThe Royal Free Hospital · GBThe University of Melbourne · AUUniversity Hospital Cologne · DEUniversity of California, Los Angeles · USUniversity of Florence · ITUniversity of L'Aquila · ITUniversity of Manchester · GBUniversity of Michigan · USUniversity of Ottawa · CAUniversity of Zurich · CHVanderbilt University Medical Center · USVA Palo Alto Health Care System · USVita-Salute San Raffaele University · ITWestern University · CA

Funding

World Scleroderma Foundation Digital Ulcer Working Group
6 · The paper itself

Abstract

objectiveTo evaluate the evidence concerning systemic pharmacological treatments for SSc digital ulcers (DUs) to inform the development of evidence-based treatment guidelines.

methodsA systematic literature review of seven databases was performed to identify all original research studies of adult patients with SSc DUs. Randomized controlled trials (RCTs) and prospective longitudinal observational studies (OBSs) were eligible for inclusion. Data were extracted, applying the patient, intervention, comparison, outcome framework, and risk of bias (RoB) was assessed. Due to study heterogeneity, narrative summaries were used to present data.

resultsForty-seven studies that evaluated the treatment efficacy or safety of pharmacological therapies were identified among 4250 references. Data from 18 RCTs of 1927 patients and 29 OBSs of 661 patients, at various RoB (total 2588 patients) showed that i.v. iloprost, phosphodiesterase-5 inhibitors and atorvastatin are effective for the treatment of active DUs. Bosentan reduced the rate of future DUs in two RCTs (moderate RoB) and eight OBSs at low to high RoB. Two small studies (moderate RoB) indicate that Janus kinase inhibitors may be effective for the treatment of active DUs, otherwise there are no data to support the use of immunosuppression or anti-platelet agents in the management of DUs.

conclusionThere are several systemic treatments, across four medication classes, that are effective therapies for the management of SSc DUs. However, a lack of robust data means it is not possible to define the optimal treatment regimen for SSc DUs. The relatively low quality of evidence available has highlighted further areas of research need.

Indexed as

Scleroderma, SystemicSkin UlcerAdultBosentanFingersHumansBosentandigital ulcersmanagementpharmacotherapySSc (scleroderma)systemic treatment

Identifiers

PMID37335850
PMCPMC10691932
OpenAlexW4381163456

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.