{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T12:03:45Z","timestamp":1782561825605,"version":"3.54.5"},"reference-count":18,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,2,26]],"date-time":"2018-02-26T00:00:00Z","timestamp":1519603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arthritis Care &amp; Research"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Digital ulcers are a major problem in patients with systemic sclerosis (<jats:styled-content style=\"fixed-case\">SS<\/jats:styled-content>c), causing severe pain and impairment of hand function. In addition, digital ulcers heal slowly and sometimes become infected, which can lead to gangrene and necessitate amputation if appropriate intervention is not taken. A reliable, objective method for assessing digital ulcer healing or progression is needed in both the clinical and research arenas. This study was undertaken to compare 2 computer\u2010assisted planimetry methods of measurement of digital ulcer area on photographs (ellipse and freehand regions of interest [<jats:styled-content style=\"fixed-case\">ROI<\/jats:styled-content>s]), and to assess the reliability of photographic calibration and the 2 methods of area measurement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Photographs were taken of 107 digital ulcers in 36 patients with <jats:styled-content style=\"fixed-case\">SS<\/jats:styled-content>c spectrum disease. Three raters assessed the photographs. Custom software allowed raters to calibrate photograph dimensions and draw ellipse or freehand <jats:styled-content style=\"fixed-case\">ROI<\/jats:styled-content>s. The shapes and dimensions of the <jats:styled-content style=\"fixed-case\">ROI<\/jats:styled-content>s were saved for further analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Calibration (by a single rater performing 5 repeats per image) produced an intraclass correlation coefficient (intrarater reliability) of 0.99. The mean \u00b1 <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content> areas of digital ulcers assessed using ellipse and freehand <jats:styled-content style=\"fixed-case\">ROI<\/jats:styled-content>s were 18.7 \u00b1 20.2 mm<jats:sup>2<\/jats:sup> and 17.6 \u00b1 19.3 mm<jats:sup>2<\/jats:sup>, respectively. Intrarater and interrater reliability of the ellipse <jats:styled-content style=\"fixed-case\">ROI<\/jats:styled-content> were 0.97 and 0.77, respectively. For the freehand <jats:styled-content style=\"fixed-case\">ROI<\/jats:styled-content>, the intrarater and interrater reliability were 0.98 and 0.76, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our findings indicate that computer\u2010assisted planimetry methods applied to <jats:styled-content style=\"fixed-case\">SS<\/jats:styled-content>c\u2010related digital ulcers can be extremely reliable. Further work is needed to move toward applying these methods as outcome measures for clinical trials and in clinical settings.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.23300","type":"journal-article","created":{"date-parts":[[2017,6,2]],"date-time":"2017-06-02T12:42:45Z","timestamp":1496407365000},"page":"486-490","source":"Crossref","is-referenced-by-count":15,"title":["Quantifying Digital Ulcers in Systemic Sclerosis: Reliability of Computer\u2010Assisted Planimetry in Measuring Lesion Size"],"prefix":"10.1002","volume":"70","author":[{"given":"V.","family":"Simpson","sequence":"first","affiliation":[{"name":"University of Manchester Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Hughes","sequence":"additional","affiliation":[{"name":"University of Manchester Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Wilkinson","sequence":"additional","affiliation":[{"name":"University of Manchester Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. L.","family":"Herrick","sequence":"additional","affiliation":[{"name":"University of Manchester and Central Manchester University Hospitals NHS Foundation Trust Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Dinsdale","sequence":"additional","affiliation":[{"name":"University of Manchester Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,2,26]]},"reference":[{"issue":"3","key":"e_1_2_7_2_1","first-page":"14","article-title":"Skin disease: a cardinal feature of systemic sclerosis","volume":"48","author":"Krieg T","year":"2009","journal-title":"Rheumatology (Oxford)"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keq097"},{"key":"e_1_2_7_4_1","first-page":"2423","article-title":"Natural history of ischemic digital ulcers in systemic sclerosis: single\u2010center retrospective longitudinal study","volume":"34","author":"Hachulla E","year":"2007","journal-title":"J Rheumatol"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.081044"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.3109\/03009742.2013.780095"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20342"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2010.09.008"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kev201"},{"key":"e_1_2_7_10_1","unstructured":"NHS England Specialised Services Clinical Reference Group for Specialised Rheumatology.NHS England clinical commissioning policy: sildenafil and bosentan for the treatment of digital ulceration in systemic sclerosis.2015: URL:https:\/\/www.engage.england.nhs.uk\/consultation\/specialised-services-policies\/user_uploads\/bosntn-sildnfl-syst-sclerosis-pol.pdf."},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.20676"},{"key":"e_1_2_7_12_1","first-page":"1407","article-title":"Intravenous iloprost treatment of Raynaud's phenomenon and ischemic ulcers secondary to systemic sclerosis","volume":"19","author":"Wigley FM","year":"1992","journal-title":"J Rheumatol"},{"key":"e_1_2_7_13_1","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s10067-013-2460-7","article-title":"Consensus opinion of a North American Working Group regarding the classification of digital ulcers in systemic sclerosis","volume":"33","author":"Baron M","year":"2013","journal-title":"Clin Rheumatol"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.24333"},{"key":"e_1_2_7_15_1","first-page":"46","article-title":"A comparison of computer\u2010assisted and manual wound size measurement","volume":"48","author":"Thawer HA","year":"2002","journal-title":"Ostomy Wound Manage"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kel446"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/193229681000400405"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22833"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mvr.2015.06.009"}],"container-title":["Arthritis Care &amp; Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Facr.23300","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.23300","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T14:32:37Z","timestamp":1759415557000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/acr.23300"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,26]]},"references-count":18,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018,3]]}},"alternative-id":["10.1002\/acr.23300"],"URL":"https:\/\/doi.org\/10.1002\/acr.23300","archive":["Portico"],"relation":{},"ISSN":["2151-464X","2151-4658"],"issn-type":[{"value":"2151-464X","type":"print"},{"value":"2151-4658","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,2,26]]}}}