تشخیص زخم های زیر جلدی در بیماری اسکلروز سیستمیک با سونوگرافی فراصوتی Ultrasound characterization of cutaneous ulcers in systemic sclerosis

Introduction Systemic sclerosis (SSc) is an autoimmune connective tissue disease with multiple phenotypic presentations, driven by the interplay of autoimmunity and vasculopathy with excessive dermal and internal organ fibrosis. Microvascular damage is a hallmark in the pathogenesis of SSc, most often manifested clinically by Raynaud’s phenomenon, skin ulcers, and pulmonary arterial hypertension (PAH) [1, 2]. Skin ulcers represent a major challenge in SSc, affecting up to 58% of SSc patients and may involve multiple fingers and both hands. Skin ulcers are painful and have a major impact on SSc-related hand disability. SSc patients with digital ulcers (DU) have limited wrist and hand mobility, increased global and hand disabilities, and decreased health-related quality of life compared to those without active DU [3]. Ultrasound (US) is a non-invasive, low-cost, reliable method that has been increasingly used for measuring joint inflammation and damage in rheumatology [4]. It is promising in evaluation of joints and tendons in SSc patients [5]. Additionally, US has been reported to support the assessment of skin thickness in SSc patients [6]. However, there are no previous reports using ultrasonography to evaluate skin ulcers in SSc patients. Clinical assessment of skin ulcers by visual examination is commonly associated with limited ability to assess the depth of the ulcer, the degree of tissue loss, the presence or absence of underlying calcinosis, and whether the ulcer is infected or not. Skin ulcer is defined histologically as a break in the epithelial integrity of the skin which may extend to deeper structures [7]. Recently, a preliminary clinical definition of skin ulcer in SSc has been developed [8]. US scanning of skin ulcers may provide a unique opportunity to better define and assess skin ulcers. To date, there has been no sonographic characterization of SSc-related skin ulcers. The availability of an objective US image of skin ulcers in SSc may have utility in clinical trials to objectively assess ulcer morphology, extent, severity, and response to treatment. It may also be useful to define and measure skin ulcers in the clinical setting. The purpose of our study was to preliminarily evaluate the ability of ultrasound (both gray scale (GS) and power Doppler (PD)) to define the morphology and extent of cutaneous ulcers in SSc patients.