Demographic, clinical and antibody characteristics of patients with digital ulcers in systemic sclerosis: data from the DUO Registry

OBJECTIVES: The Digital Ulcers Outcome (DUO) Registry was designed to describe the clinical and antibody characteristics, disease course and outcomes of patients with digital ulcers associated with systemic sclerosis (SSc). METHODS: The DUO Registry is a European, prospective, multicentre, observational, registry of SSc patients with ongoing digital ulcer disease, irrespective of treatment regimen. Data collected included demographics, SSc duration, SSc subset, internal organ manifestations, autoantibodies, previous and ongoing interventions and complications related to digital ulcers. RESULTS: Up to 19 November 2010 a total of 2439 patients had enrolled into the registry. Most were classified as either limited cutaneous SSc (lcSSc; 52.2%) or diffuse cutaneous SSc (dcSSc; 36.9%). Digital ulcers developed earlier in patients with dcSSc compared with lcSSc. Almost all patients (95.7%) tested positive for antinuclear antibodies, 45.2% for anti-scleroderma-70 and 43.6% for anticentromere antibodies (ACA). The first digital ulcer in the anti-scleroderma-70-positive patient cohort occurred approximately 5 years earlier than the ACA-positive patient group. CONCLUSIONS: This study provides data from a large cohort of SSc patients with a history of digital ulcers. The early occurrence and high frequency of digital ulcer complications are especially seen in patients with dcSSc and/or anti-scleroderma-70 antibodies

Tissue Engineering von humanen Präadipozyten am Mausmodell

Miami photographed February 2008

Evaluation von Patienten mit entzündlich-rheumatischen Erkrankungen unter Immunsuppressiva und ihrer Haltung zur Medikation im zeitlichen Verlauf der Covid-19 Pandemie

Seit 11.03.2020 spricht die WHO von einer Coronavirus Pandemie. Verursacht wird die Coronaviruserkrankung (COVID-19) durch das SARS-CoV-2 Virus. Die Erkrankung manifestiert sich als Infektion der Atemwege mit den Leitsymptomen Fieber und Husten. Bei 81% Patienten ist der Verlauf mild, 14% erkranken schwer und 5% der Patienten kritisch [1]. Das erste Auftreten wurde im Dezember 2019 in der Millionen-Stadt Wuhan in der Provinz Hubei (China) dokumentiert. Am 07.04.2020 meldet die Johns-Hopkins-Universität bereits 1.348.628 bestätigte, die Weltumspannende Infektionsfälle. Die Letalität liegt zu diesem Zeitpunkt der Pandemie bei 5,6% (n= 74.834 an Covid-19 Verstorbene). Zu diesem Zeitpunkt ist bereits klar, dass das Vorhandensein und die Zahl von Komorbiditäten (wie Diabetes mellitus, arterielle Hypertonie und koronare Herzerkrankungen) mitentscheidend ist für das Outcome der Patienten [2]. Handlungsempfehlungen basierend auf evidenzbasierten Daten für Patienten mit entzündlich- rheumatischen Erkrankungen oder die Bedeutung sowie der Einfluss einer dauerhaften immunsuppressiven oder immunmodulierenden Therapie liegen (bislang) nicht vor. Unter dem Aspekt der unklaren Bedeutung und bisher „nur“ vorliegenden Expertenempfehlungen zur Immunsystem- beeinflussenden Therapie führten wir bei unseren Patienten eine Umfrage zur Patientenmeinung über Basistherapien (DMARDs) durch

Elucidating the burden of recurrent and chronic digital ulcers in systemic sclerosis: long-term results from the DUO Registry

Objectives Digital ulcers (DUs) occur in up to half of patients with systemic sclerosis (SSc) and may lead to infection, gangrene and amputation with functional disability and reduced quality of life. This study has elucidated the burden of SSc-associated DUs through identification of four patient categories based on the pattern of DU recurrence over a 2-year observation period.Methods Patients with SSc-associated DUs enrolled in the Digital Ulcers Outcome Registry between 1 April 2008 and 19 November 2013, and with 2years of observation and 3 follow-up visits during the observation period were analysed. Incident DU-associated complications were recorded during follow-up. Work and daily activity impairment were measured using a functional assessment questionnaire completed by patients after the observation period. Potential factors that could predict incident complications were identified in patients with chronic DUs.Results From 1459 patients, four DU occurrence categories were identified: 33.2% no-DU; 9.4% episodic; 46.2% recurrent; 11.2% chronic. During the observation period, patients from the chronic category had the highest rate of incident complications, highest work impairment and greatest need for help compared with the other categories. Independent factors associated with incident complications included gastrointestinal manifestations (OR 3.73, p=0.03) and previous soft tissue infection (OR 5.86, p=0.01).Conclusions This proposed novel categorisation of patients with SSc-associated DUs based on the occurrence of DUs over time may help to identify patients in the clinic with a heavier DU burden who could benefit from more complex management to improve their functioning and quality of life