{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:24:30Z","timestamp":1777983870376,"version":"3.51.4"},"reference-count":37,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T00:00:00Z","timestamp":1745971200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Scleroderma and Related Disorders"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>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\u2019 perspectives towards treatment initiation and escalation, akin to a \u2018Treat to Target\u2019 (T2T) strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>SSc clinicians were invited to participate in an online survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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\u2009month. 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\u2009&gt;50% in the number of DU recurrence (52%) and (3) reduction in DU healing time (37%) and reduction in DU pain\u2009&gt;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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Significant heterogeneity currently exists concerning treatment initiation and escalation for SSc-DUs, potentially amenable to a T2T strategy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23971983251336616","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T01:50:21Z","timestamp":1746064221000},"page":"434-442","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinicians\u2019 perspectives concerning treatment initiation and escalation strategies for digital ulcers in patients with systemic sclerosis"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6269-2944","authenticated-orcid":false,"given":"Giulia","family":"Campanaro","sequence":"first","affiliation":[{"name":"Division of Internal Medicine, Department of Experimental and Clinical Medicine, AOUC, University of Florence, Firenze, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2076-7319","authenticated-orcid":false,"given":"Giulia","family":"Bandini","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine, Department of Experimental and Clinical Medicine, AOUC, University of Florence, Firenze, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessia","family":"Alunno","sequence":"additional","affiliation":[{"name":"Internal Medicine and Nephrology Division, Department of Clinical Medicine, Life Health and Environmental Sciences, ASL1 Avezzano-Sulmona-L\u2019Aquila, University of L\u2019Aquila, L\u2019Aquila, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Di Donato","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Begonya","family":"Alcacer-Pitarch","sequence":"additional","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9595-7582","authenticated-orcid":false,"given":"Ilaria","family":"Galetti","sequence":"additional","affiliation":[{"name":"Federation of European Scleroderma Associations (FESCA), Saint Maur, Belgium"},{"name":"Gruppo Italiano Lotta alla Sclerodermia (GILS), Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Ruaro","sequence":"additional","affiliation":[{"name":"Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia Bellando","family":"Randone","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto Moggi","family":"Pignone","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine, Department of Experimental and Clinical Medicine, AOUC, University of Florence, Firenze, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Matucci-Cerinic","sequence":"additional","affiliation":[{"name":"Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy"},{"name":"Vita Salute San Raffaele University, Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zsuzsanna H","family":"McMahan","sequence":"additional","affiliation":[{"name":"McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3361-4909","authenticated-orcid":false,"given":"Michael","family":"Hughes","sequence":"additional","affiliation":[{"name":"Northern Care Alliance NHS Foundation Trust, Salford Care Organisation, Salford, UK"},{"name":"Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, 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