Campanaro Giulia, Bandini Giulia, Alunno Alessia, Di Donato Stefano, Alcacer-Pitarch Begonya, Galetti Ilaria, Ruaro Barbara, Randone Silvia Bellando, Pignone Alberto Moggi, Matucci-Cerinic Marco, McMahan Zsuzsanna H, Hughes Michael
Division of Internal Medicine, Department of Experimental and Clinical Medicine, AOUC, University of Florence, Firenze, Italy.
Internal Medicine and Nephrology Division, Department of Clinical Medicine, Life Health and Environmental Sciences, ASL1 Avezzano-Sulmona-L'Aquila, University of L'Aquila, L'Aquila, Italy.
J Scleroderma Relat Disord. 2025 Apr 30:23971983251336616. doi: 10.1177/23971983251336616.
Digital ulcers (DUs) are a major cause of pain and disability in systemic sclerosis (SSc) patients and remain a major treatment challenge. Our aim was to explore clinicians' perspectives towards treatment initiation and escalation, akin to a 'Treat to Target' (T2T) strategy.
SSc clinicians were invited to participate in an online survey.
A total of 173 responses (75% rheumatologists) were obtained from 33 countries. When initiating a change in oral drug therapy for SSc-DUs, most (80%) respondents would consider adding new medication to existing treatment, and 50% would increase existing treatment dose. Time to assess the impact of treatment change varied considerably, with around half (43.6%) waiting 1 month. Endothelin receptor antagonists, phosphodiesterase type-5 inhibitors and prostanoids were considered most efficacious for DU prevention, with good perceived efficacy from calcium channel blockers and moderate benefit from anti-platelet agents and immunosuppression. Side effects (e.g. headache and peripheral oedema) are perceived to be a significant issue with oral vasodilatory/vasoactive therapies in many patients. The highest rated T2T targets were (1) complete absence of new/recurrent DUs (63%), (2) reduction >50% in the number of DU recurrence (52%) and (3) reduction in DU healing time (37%) and reduction in DU pain >50% (37%). The most frequent reasons for hospitalisation were to administer intravenous treatment (91%) and DU complications (87%). Surgery is reserved for the threatened digit (e.g. gangrene), underlying calcinosis and failure of medical therapy.
Significant heterogeneity currently exists concerning treatment initiation and escalation for SSc-DUs, potentially amenable to a T2T strategy.
指端溃疡（DUs）是系统性硬化症（SSc）患者疼痛和致残的主要原因，仍然是一个重大的治疗挑战。我们的目的是探讨临床医生对治疗起始和升级的看法，类似于“目标治疗”（T2T）策略。
邀请SSc临床医生参与在线调查。
共收到来自33个国家的173份回复（75%为风湿病学家）。在开始改变SSc-DUs的口服药物治疗时，大多数（80%）受访者会考虑在现有治疗基础上加用新药物，50%会增加现有治疗剂量。评估治疗改变影响的时间差异很大，约一半（43.6%）的人等待1个月。内皮素受体拮抗剂、5型磷酸二酯酶抑制剂和前列腺素被认为对预防DU最有效，钙通道阻滞剂有良好的疗效，抗血小板药物和免疫抑制有中度益处。在许多患者中，副作用（如头痛和外周水肿）被认为是口服血管舒张/血管活性疗法的一个重要问题。评分最高的T2T目标是：（1）完全没有新的/复发性DUs（63%），（2）DU复发次数减少>50%（52%），（3）DU愈合时间缩短（37%）和DU疼痛减轻>50%（37%）。住院最常见的原因是进行静脉治疗（91%）和DU并发症（87%）。手术仅用于有截肢风险的手指（如坏疽）、潜在的钙质沉着和药物治疗无效的情况。
目前在SSc-DUs的治疗起始和升级方面存在显著异质性，可能适合采用T2T策略。
