{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T14:42:17Z","timestamp":1781188937312,"version":"3.54.1"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T00:00:00Z","timestamp":1747267200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T00:00:00Z","timestamp":1747267200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100009104","name":"Universit\u00e0 degli Studi di Modena e Reggio Emilia","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100009104","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Rheumatol"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Introduction<\/jats:title>\n            <jats:p>Digital 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>SSc 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Among 1873 eligible SSc patients, the presence of DU was significantly associated with gastrointestinal involvement (OR 1.88, 2.04 and 1.74; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and serum ATA positivity (OR 2.15; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), as well as with telangiectasias, sclerodactyly, digital pitting scar, and calcinosis (OR 1.40, <jats:italic>p<\/jats:italic>\u2009=\u20090.005; OR 3.43, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, OR 9.12, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001 and OR 2.77, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001; respectively). In the multivariable regression models, even after adjustment for covariates, ATA positivity (OR 1.76, <jats:italic>p<\/jats:italic>\u2009=\u20090.039), puffy fingers (OR 2.82, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and a higher revEUSTAR-AI (OR 6.63, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) 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, <jats:italic>p<\/jats:italic>\u2009=\u20090.032).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>In 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.<\/jats:p>\n            <jats:p>\n              <jats:table-wrap>\n                <jats:table>\n                  <jats:tbody>\n                    <jats:tr>\n                      <jats:td align=\"left\">\n                        <jats:bold>Key Points<\/jats:bold>\n                      <\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td align=\"left\">\u2022 <jats:italic>Digital ulcers were significantly associated with the presence of puffy fingers, high disease activity, and anti-Scl70 seropositivity.<\/jats:italic>\u2022 <jats:italic>Immunosuppressive treatments were associated with a low rate of digital ulcers, suggesting that they might contribute to the prevention of these harmful manifestations.<\/jats:italic>\n                      <\/jats:td>\n                    <\/jats:tr>\n                  <\/jats:tbody>\n                <\/jats:table>\n              <\/jats:table-wrap>\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s10067-025-07449-1","type":"journal-article","created":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T15:49:17Z","timestamp":1747324157000},"page":"2849-2860","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["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"],"prefix":"10.1007","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6784-2235","authenticated-orcid":false,"given":"Martina","family":"Orlandi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"De 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