Evidence map›Paper›PMID 40374871›Full record

ArticleClinical rheumatology2025

Prevalence and clinical relevance of digital ulcers in systemic sclerosis patients from the real-life: the experience of the SPRING Registry of the Italian Society for Rheumatology.

Martina Orlandi, Giacomo De Luca, Clodoveo Ferri, Amelia Spinella, Federica Lumetti, Riccardo Cuoghi Costantini, Rossella De Angelis, Valeria Riccieri, Silvia Laura Bosello, Fabio Cacciapaglia and 59 more

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Article in Clinical rheumatology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
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

2 citing papers in PubMed.

  1. Review
  2. Review
4 · The record

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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

69 authors.

Martina OrlandiDepartment of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena and Reggio Emilia School of Medicine, Via del Pozzo, 71-41125, Modena, Italy. martina.orlandi@unimore.it.ORCID http://orcid.org/0000-0001-6784-2235
Giacomo De LucaUnit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), & Inflammation, Fibrosis and Aging Initiative (INFLAGE), IRCCS San Raffaele Scientific Institute, Milan, Italy.
Clodoveo FerriDepartment of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena and Reggio Emilia School of Medicine, Via del Pozzo, 71-41125, Modena, Italy.
Amelia SpinellaDepartment of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena and Reggio Emilia School of Medicine, Via del Pozzo, 71-41125, Modena, Italy.
Federica LumettiDepartment of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena and Reggio Emilia School of Medicine, Via del Pozzo, 71-41125, Modena, Italy.
Riccardo Cuoghi CostantiniDepartment of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena and Reggio Emilia School of Medicine, Via del Pozzo, 71-41125, Modena, Italy.
Rossella De AngelisRheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.
Valeria RiccieriDepartment of Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Silvia Laura BoselloRheumatology Division, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy.
Fabio CacciapagliaRheumatology Unit, Department of Precision and Regenerative Medicine-Ionian Area, University of Bari "Aldo Moro", Bari, Italy.
Veronica CodulloDepartment of Internal Medicine and Therapeutics, Università Di Pavia, Pavia, Italy.
Gianluigi BajocchiRheumatology Unit, S. Maria Hospital-USL, IRCCS Institute, Reggio Emilia, Italy.
Corrado CampochiaroUnit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), & Inflammation, Fibrosis and Aging Initiative (INFLAGE), IRCCS San Raffaele Scientific Institute, Milan, Italy.
Giovanni ZanframundoDepartment of Internal Medicine and Therapeutics, Università Di Pavia, Pavia, Italy.
Rosario FotiRheumatology Unit, AOU Policlinico San Marco, Catania, Italy.
Giovanna CuomoDepartment of Precision Medicine, Univeristy of Campania - Luigi Vanvitelli University, Naples, Italy.
Alarico ArianiDepartment of Medicine, Internal Medicine and Rheumatology, Azienda Ospedaliero Universitaria Di Parma, Parma, Italy.
Edoardo RosatoDepartment of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
Francesco GirelliDepartment of Medicine, Rheumatology Unit, Ospedale GB Morgagni-L Pierantoni, Forlì, Italy.
Elisabetta ZanattaDepartment of Rheumatology, University of Padua, Padua, Italy.
Ilaria CavazzanaRheumatology and Clinical Immunology, ASST Spedali Civili of Brescia; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Francesca IngegnoliDivision of Clinical Rheumatology, ASST Pini, Department of Clinical Sciences & Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Research Center for Environmental Health, Università Degli Studi Di Milano, Milan, Italy.
Maria De SantisDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan and Research Hospital, Milan, Italy.
Giuseppe MurdacaDepartment of Internal Medicine, University of Genoa and Allergology and Clinical Immunology Unit, Ospedale San Bartolomeo, Sarzana, Italy.
Giuseppina AbignanoDepartment of Health Science, University of Basilicata. Rheumatology Unit, San Carlo Hospital, Potenza, Italy.
Pettiti GiorgioRheumatology Unit ASO S. Croce E Carle Hospital, Cuneo, Italy.
Alessandra Della RossaDepartment of Rheumatology, University of Pisa, Pisa, Italy.
Maurizio CaminitiDepartmental Rheumatology Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy.
Anna Maria IulianoRheumatology Unit, San Camillo-Forlanini Hospital, Rome, Italy.
Giovanni CianoLocal Health Department, Hospital of Ariano Irpino, Ariano Irpino, Italy.
Lorenzo BerettaReferral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Di Milano, Milan, Italy.
Gianluca BagnatoDepartment of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Ennio LubranoDepartment of Rheumatology, University of Molise, Campobasso, Italy.
Ilenia De AndresRheumatology Unit, Azienda Ospedaliera Di Rilievo Nazionale Ed Alta Specializzazione Garibaldi, Catania, Italy.
Alessandro GiolloRheumatology Section, Department of Medicine, University of Verona, Verona, Italy.
Marta SaraccoRheumatology Unit, Mauriziano-Umberto I Hospital, Turin, Italy.
Cecilia AgnesDepartment of Medicine, Division of Rehabilitation, Torino, ASL TO5, Carmagnola, TO, Italy.
Edoardo CipollettaRheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.
Luca MagnaniInternal Medicine Service of Rheumatology "Miulli" General Hospital - Department of Medicine and Surgery, LUM "F. De Gennaro" University, Casamassima (Bari), Italy.
Elisa VisalliRheumatology Unit, S. Maria Hospital-USL, IRCCS Institute, Reggio Emilia, Italy.
Carlo IandoliRheumatology Unit, AOU Policlinico San Marco, Catania, Italy.
Antonietta GiganteDepartment of Medicine, Internal Medicine and Rheumatology, Azienda Ospedaliero Universitaria Di Parma, Parma, Italy.
Greta PellegrinoIRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy.
Erika PigattoUOC Medicina Interna, Ospedale San Bassiano, Bassano del Grappa, Vicenza, Italy.
Maria Grazia LazzaroniRheumatology and Clinical Immunology, ASST Spedali Civili of Brescia; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Franco FranceschiniRheumatology and Clinical Immunology, ASST Spedali Civili of Brescia; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Elena GeneraliDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan and Research Hospital, Milan, Italy.
Gianna MennilloDepartment of Health Science, University of Basilicata. Rheumatology Unit, San Carlo Hospital, Potenza, Italy.
Simone BarsottiDepartment of Rheumatology, University of Pisa, Pisa, Italy.
Giuseppa Pagano MarianoDepartmental Rheumatology Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy.
Federica FuriniRheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna, Ferrara, Ferrara, Italy.
Licia VultaggioRheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna, Ferrara, Ferrara, Italy.
Simone ParisiRheumatology Unit, Azienda Ospedaliera Universitaria Città Della Salute E Della Scienza Di Torino, Turin, Italy.
Clara Lisa PeroniRheumatology Unit, Azienda Ospedaliera Universitaria Città Della Salute E Della Scienza Di Torino, Turin, Italy.
Gerolamo BianchiRheumatology Unit, Department of Medical Specialities, Local Health Trust 3, Genoa, Italy.
Enrico FusaroRheumatology Unit, Azienda Ospedaliera Universitaria Città Della Salute E Della Scienza Di Torino, Turin, Italy.
Gian Domenico SebastianiRheumatology Unit, San Camillo-Forlanini Hospital, Rome, Italy.
Marcello GovoniRheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria S. Anna, Ferrara, Ferrara, Italy.
Salvatore D'AngeloDepartment of Health Science, University of Basilicata. Rheumatology Unit, San Carlo Hospital, Potenza, Italy.
Franco CozziDepartment of Medicine, Rheumatology Section, Villa Salus Hospital, Venice, Italy.
Serena GuiducciDepartment of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy.
Andrea DoriaIRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy.
Carlo SalvaraniDepartment of Internal Medicine and Therapeutics, Università Di Pavia, Pavia, Italy.
Florenzo IannoneRheumatology Unit, Department of Precision and Regenerative Medicine-Ionian Area, University of Bari "Aldo Moro", Bari, Italy.
Lorenzo DagnaUnit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), & Inflammation, Fibrosis and Aging Initiative (INFLAGE), IRCCS San Raffaele Scientific Institute, Milan, Italy.
Marco Matucci-CerinicUnit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), & Inflammation, Fibrosis and Aging Initiative (INFLAGE), IRCCS San Raffaele Scientific Institute, Milan, Italy.
Silvia Bellando-RandoneDepartment of Experimental and Clinical Medicine, Division of Rheumatology, University of Florence, Florence, Italy.
Dilia GiuggioliDepartment of Medical and Surgical Sciences for Children and Adults, University Hospital of Modena and Reggio Emilia School of Medicine, Via del Pozzo, 71-41125, Modena, Italy.
SPRING-SIR (Systemic Sclerosis PRogression INvestiGation group of the Italian Society of Rheumatology) coworkers

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionDigital ulcers (DU) are one of the most frequent manifestations in systemic sclerosis (SSc). The presence of DU seems to be a sentinel sign of internal organ involvement and is related to a poor prognosis of the disease. The aim of this study was to evaluate the prevalence and the relationship of DU with clinical manifestations/variants in a large SSc cohort from the SPRING registry.

methodsSSc patients fulfilling the ACR/EULAR 2013 classification criteria without missing data on digital ulcers were enrolled in a cross-sectional study. Logistic regression models were built to test the association between the presence of DU and SSc-related features.

resultsAmong 1873 eligible SSc patients, the presence of DU was significantly associated with gastrointestinal involvement (OR 1.88, 2.04 and 1.74; p < 0.001) and serum ATA positivity (OR 2.15; p < 0.001), as well as with telangiectasias, sclerodactyly, digital pitting scar, and calcinosis (OR 1.40, p = 0.005; OR 3.43, p < 0.001, OR 9.12, p < 0.001 and OR 2.77, p < 0.001; respectively). In the multivariable regression models, even after adjustment for covariates, ATA positivity (OR 1.76, p = 0.039), puffy fingers (OR 2.82, p < 0.001), and a higher revEUSTAR-AI (OR 6.63, p < 0.001) emerged as risk factors for the presence of DU. Moreover, a low presence of DU was recorded in SSc patients with a history of previous immunosuppressive treatments (OR 0.53, p = 0.032).

conclusionIn our Italian SSc cohort, DUs were significantly associated with the presence of puffy fingers, high revEUSTR-AI, and ATA seropositivity. Noteworthy, immunosuppressive treatments were associated with a low rate of DU, suggesting that they might contribute to the prevention of these harmful manifestations. Key Points • Digital ulcers were significantly associated with the presence of puffy fingers, high disease activity, and anti-Scl70 seropositivity. • Immunosuppressive treatments were associated with a low rate of digital ulcers, suggesting that they might contribute to the prevention of these harmful manifestations.

Indexed as

FingersScleroderma, SystemicSkin UlcerUlcerAdultAgedClinical RelevanceCross-Sectional StudiesFemaleHumansItalyLogistic ModelsMaleMiddle AgedPrevalenceRegistriesDigital ulcersImmunosuppressive therapySystemic sclerosisVascular disease

Identifiers

PMID40374871
PMCPMC12234588

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