McMahan Zsuzsanna H, Wigley Fredrick M
Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD 21224.
Int J Clin Rheumtol. 2010;5(3):355-370. doi: 10.2217/ijr.10.17.
Digital ischemia is a painful and often disfiguring event. Such an ischemic event often leads to tissue loss and can significantly affect the patient's quality of life. Digital ischemia can be secondary to a vasculopathy, vasculitis, embolic disease, trauma, or extrinsic vascular compression. It is an especially serious complication in patients with scleroderma. Risk stratification of patients with scleroderma at risk for digital ischemia is now possible with clinical assessment and autoantibody profiles. Because there are a variety of conditions that lead to digital ischemia, it is important to understand the pathophysiology underlying each ischemic presentation in order to target therapy appropriately. Significant progress has been made in the last two decades in defining the pathophysiological processes leading to digital ischemia in rheumatic diseases. In this article we review the risk stratification, diagnosis, and management of patients with digital ischemia and provide a practical approach to therapy, particularly in scleroderma.
手指缺血是一种痛苦且常导致毁容的情况。这种缺血事件通常会导致组织丧失，并可能显著影响患者的生活质量。手指缺血可能继发于血管病变、血管炎、栓塞性疾病、创伤或外在血管受压。在硬皮病患者中，这是一种特别严重的并发症。通过临床评估和自身抗体谱，现在可以对有手指缺血风险的硬皮病患者进行风险分层。由于导致手指缺血的情况多种多样，了解每种缺血表现背后的病理生理学对于合理靶向治疗很重要。在过去二十年中，在确定风湿性疾病中导致手指缺血的病理生理过程方面取得了重大进展。在本文中，我们回顾了手指缺血患者的风险分层、诊断和管理，并提供了一种实用的治疗方法，特别是在硬皮病方面。
