Preliminary validation of the digital ulcer clinical assessment score in systemic sclerosis

C. Bruni, T. Ngcozana, F. Braschi, T. Pucci, G. Piemonte, L. Benelli, M. Poli, Y.A. Suliman, S. Guiducci, S. Bellando-Randone, S. Balduzzi, J. Grotts, C.P. Denton, L. Rasero, C. Montecucco, D.E. Furst, M. Matucci-Cerinic

Research output: Contribution to journalArticlepeer-review


Objective. To date, “healed/non-healed” and clinical judgment are the only available assessment tools for digital ulcers (DU) in patients with systemic sclerosis (SSc). The aim of our study is to examine a preliminary composite DU clinical assessment score (DUCAS) for SSc for face, content, and construct validity. Methods. Patients with SSc presenting at least 1 finger DU were enrolled and assessed with the Health Assessment Questionnaire-Disability Index, Cochin scale, visual analog scale (VAS) for DU-related pain, patient global DU status, and global assessment as patient-reported outcomes (PRO), and physician VAS for DU status (phyGDU) as an SSc-DU expert physician/nurse measure. The DUCAS included 7 DU-related variables selected by a committee of SSc DU experts and weighted on a clinical basis. Face validity was examined by consensus and partial construct validity was tested through convergent correlation with other measures of hand function, using Spearman's correlations. A range of patients with SSc was examined. A linear regression model with backward stepwise analysis was used to determine the relationship of individual variables with the primary clinical parameter, phyGDU. Results. Forty-four patients with SSc (9 males, mean age 55 ± 15 yrs, mean disease duration 9.9 ± 5.8 yrs) were enrolled in the study. Overall DUCAS showed significant positive correlations with all abovementioned PRO (r > 0.4, p < 0.01). When all scores and scales were modeled, only DUCAS significantly predicted phyGDU (r = 0.59, R2 = 0.354, Akaike information criterion = 385.4). Conclusion. Preliminarily, we suggest that the DUCAS may be a new clinical score for SSc-related DU, having face and content validity and convergent/divergent correlations (construct validity). These early data suggest that this score deserves further evaluation. © 2019 Journal of Rheumatology. All rights reserved.
Original languageEnglish
Pages (from-to)603-608
Number of pages6
JournalJournal of Rheumatology
Issue number6
Publication statusPublished - 2019


  • Digital Ulcer
  • Disease Activity Score
  • Outcome Measures Wounds and Injuries
  • Systemic Sclerosis
  • adult
  • aged
  • Article
  • clinical article
  • clinical assessment tool
  • controlled study
  • correlation coefficient
  • correlational study
  • digital ulcer clinical assessment score
  • disease duration
  • face validity
  • female
  • finger ulcer
  • hand function
  • human
  • linear regression analysis
  • male
  • patient-reported outcome
  • priority journal
  • questionnaire
  • scoring system
  • systemic sclerosis
  • visual analog scale


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