Health Care Utilization in Systemic Sclerosis Patients With Digital Ulcers

Abstract

Objective. Digital ulcers (DUs) occur in half of the patients with systemic sclerosis (SSc) and require health care interventions for treatment and monitoring for complications. Our objective was to assess the impact of DUs on resource utilization, including hospitalizations, outpatient visits, and procedures within a large SSc Canadian registry in a matched cohort study. Methods. A total of 1,698 SSc patients who completed 1 or more 84-item Resource Utilization Questionnaire (RUQ) for a 12-month recall period between September 2005 and February 2020 were included (9,077 questionnaires). Organ involvement was assessed by the Disease Severity Scale (DSS) on the Medsger scale. Unadjusted and adjusted regression analyses compared the association between DUs and resource utilization. Results. RUQs in 104 SSc patients with active DUs at 2 consecutive annual visits were compared with 104 patients without DUs matched 1:1 for age, sex, disease subtype, and duration. Over 1 year, DUs were associated with a higher number of tests (P < 0.05) and visits to health professionals, especially to a rheumatologist (P < 0.0001) and internist (P = 0.003), a greater need for an accompanying person (P < 0.05) and aids purchased/received (P < 0.05). Having DUs was associated with more severe disease, even after excluding the peripheral vascular domain from a total DSS score (9.7 +/- 4.5 versus 5.6 +/- 2.7, P < 0.0001). After adjustment for disease severity in other organs, the presence of DUs remained a significant predictor of more frequent physician visits and more tests (P for all < 0.05) by linear regression analysis. Conclusion. SSc patients with DUs used significantly more health care resources per year even after adjustment for disease severity in other organ systems.