Assessing digital vasculopathy in systemic sclerosis

Digital vasculopathy (a spectrum of Raynaud's phenomenon, digital ulceration and critical ischaemia) is one of the most characteristic manifestations of systemic sclerosis (SSc). It is an area of unmet need with a major impact on quality of life: current treatments are only poorly effective. SSc-related digital vasculopathy is a result of structural as well as functional change at the level of both the microcirculation and the digital artery, explaining its severity. This review begins with a brief description of digital vasculopathy, followed by its assessment in the clinical setting, relevant to both diagnosis and monitoring of SSc. Outcome measures of Raynaud's phenomenon and of digital ulcers are then discussed, focusing on recent advances. These outcome measures are a 'hot topic' because reliable patient-reported and laboratory-based outcome measures will facilitate much needed clinical trials. Finally, some of the emerging non-invasive technologies which are providing new insights into pathophysiology are briefly described.