<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0121-8123</journal-id>
<journal-title><![CDATA[Revista Colombiana de Reumatología]]></journal-title>
<abbrev-journal-title><![CDATA[Rev.Colomb.Reumatol.]]></abbrev-journal-title>
<issn>0121-8123</issn>
<publisher>
<publisher-name><![CDATA[Asociación Colombiana de Reumatología]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0121-81232020000500026</article-id>
<article-id pub-id-type="doi">10.1016/j.rcreu.2020.02.006</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Digital ulcers in systemic sclerosis]]></article-title>
<article-title xml:lang="es"><![CDATA[Úlceras digitales en esclerosis sistémica]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Quintana-López]]></surname>
<given-names><![CDATA[Gerardo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Barahona-Correa]]></surname>
<given-names><![CDATA[Julián E.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Allanore]]></surname>
<given-names><![CDATA[Yannick]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Nacional de Colombia Department of Internal Medicine, School of Medicine ]]></institution>
<addr-line><![CDATA[Bogota, DC ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Fundación Santa Fe de Bogotá University Hospital  ]]></institution>
<addr-line><![CDATA[Bogota, DC ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Pontificia Universidad, Javeriana  ]]></institution>
<addr-line><![CDATA[Bogota ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Hôpital Cochin  ]]></institution>
<addr-line><![CDATA[Paris ]]></addr-line>
<country>France</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2020</year>
</pub-date>
<volume>27</volume>
<fpage>26</fpage>
<lpage>35</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_arttext&amp;pid=S0121-81232020000500026&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_abstract&amp;pid=S0121-81232020000500026&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_pdf&amp;pid=S0121-81232020000500026&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT Vascular compromise in systemic sclerosis is a pivotal feature of the disease and plays a fundamental role in its morbidity and mortality. Raynaud's syndrome is present in almost every patient and is often reported as the first clinical manifestation. Digital ulcers may present several etiologies, although an ischemic cause is the most frequent origin and occurs in up to 50% of patients. A profound impact on daily life is often observed due to pain and functional impairment. Their primary pathophysiological mechanism is microvascular compromise, although larger vessels may be affected as well. When recurrent lesions are observed, large vessel compromise should be assessed, which may be due to the disease itself or due to atherosclerosis, whenever risk factors are present. Further, these ulcers present an increased risk of infection and progression to gangrene. The presence of digital lesions may be a marker of severity of the disease, as some reports have suggested an association with pulmonary hypertension and cardiac involvement. Treatment strategies have progressed significantly over the last years. Vasodilatation using calcium channel inhibitors is universally offered. When ischemic signs are observed, treatment should be started readily. Prostacyclin infusions should be considered in severe cases, as they have shown the capacity to foster ulceration healing. Whenever recurring lesions are observed, bosentan may be offered. Management with phosphodiesterase inhibitors may be proposed, although their positioning is unclear. Local treatment is equally important over the course of the disease. Surgical interventions are seldom needed.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN El compromiso vascular en la esclerosis sistémica es una característica principal de la enfermedad y desempeña un papel fundamental en su morbimortalidad. El síndrome de Raynaud está presente en casi todos los pacientes, y con frecuencia es reportado como la primera manifestación clínica. Las úlceras digitales pueden tener varias etiologías, aunque una causa isquémica es el origen más frecuente y ocurre hasta en 50% de los pacientes. A menudo se observa un profundo impacto en la vida diaria debido al dolor y al deterioro funcional. Su mecanismo fisiopatológico primario es el compromiso microvascular, aunque los vasos más grandes también pueden verse afectados. Cuando se observan lesiones recurrentes se debe evaluar el compromiso de los vasos grandes, que puede deberse a la enfermedad en sí o a aterosclerosis, siempre que existan factores de riesgo. Además, estas úlceras presentan un mayor riesgo de infección y progresión a gangrena. La presencia de lesiones digitales puede ser un marcador de la gravedad de la enfermedad, ya que algunos informes han sugerido una asociación con hipertensión pulmonar y compromiso cardíaco. Las estrategias de tratamiento han progresado significativamente en los últimos anos. La vasodilatación con inhibidores de los canales de calcio se ofrece universalmente. Cuando se observan signos isquémicos el tratamiento debe iniciarse de inmediato. Las infusiones de prostaciclina se deben considerar en casos graves, ya que han demostrado la capacidad de promover la curación de la ulceración. Siempre que se observen lesiones recurrentes se puede administrar bosentán. Se puede proponer el manejo con inhibidores de la fosfodiesterasa, aunque su posicionamiento no está claro. El tratamiento local es igualmente importante durante el curso de la enfermedad. Las intervenciones quirúrgicas rara vez son necesarias.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Digital ulcers]]></kwd>
<kwd lng="en"><![CDATA[Systemic sclerosis]]></kwd>
<kwd lng="en"><![CDATA[Treatment]]></kwd>
<kwd lng="es"><![CDATA[Ulceras digitales]]></kwd>
<kwd lng="es"><![CDATA[Esclerosis sistémica]]></kwd>
<kwd lng="es"><![CDATA[Tratamiento]]></kwd>
</kwd-group>
</article-meta>
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