• Yahia Abuowda, Raquel Sousa Almeida, Ana Alves Oliveira, Petra Pego, Cristina Santos, and João Matos-Costa.
• Clinic of autoimmune diseases, Department of Internal Medicine - III, Hospital Distrital de Santarém, Santarém, Portugal.
• Rev Assoc Med Bras (1992). 2017 May 1; 63 (5): 422-426.

Introduction:In systemic sclerosis (SSc), digital ulcers (DU) are debilitating and recurrent. They are markers of prognosis and are associated with disability and mortality. Treatment strategies have been developed to block the proposed mechanisms of this complication.Objective:Clinical description of a population of SSc patients with DU, treatment, complications and outcome.Method:Analysis of 48 SSc patients meeting 2013 ACR-EULAR criteria, followed between 1999-2015; 13 patients had DU. Treatment protocol applied included cycles of 21 days of alprostadil, which can be repeated in the absence of DU healing. After DU healing, bosentan was initiated.Results:DU healing was achieved with intravenous prostanoid in 12 patients; seven patients required repeated treatment for DU healing. Twelve patients were later treated with bosentan; three of them experienced recurrence of DU, while one was anti-B2-GPI positive. Four patients had soft tissue loss and three other suffered digital amputation, these being late diagnosis.Conclusion:Younger patients and early referrals had better outcomes. Endothelin receptor antagonist toxicity should be monitored, particularly in patients previously exposed to hepatotoxic drugs.

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