Increased risk of mortality in systemic sclerosis‐associated digital ulcers: a systematic review and meta‐analysis

Background Survival can be threatened in certain forms of systemic sclerosis ( SS c) so clear prognostic factors are needed. Objectives The aim of this meta‐analysis was to assess the association between the presence of digital ulcers ( DU s) and mortality in SS c. Methods We performed a systematic review and meta‐analysis in the Pubmed and Scopus databases from the earliest records to May 2017. Two research strategies were performed: « systemic sclerosis » and « digital ulcers » (strategy A); « systemic sclerosis » and « mortality » (strategy B). The primary outcome was the mortality associated with the presence of DU s in patients with SS c. Results The literature search identified 1473 citations. Fifty‐nine studies were examined for full text. Ten articles were included for the meta‐analysis. SS c patients with DU s had an increased pooled mortality risk: RR = 1.53 ( IC 95%: [1.23–1.90]). Conclusions This meta‐analysis revealed a higher mortality in SS c patients with associated DU s. Having DU s may be a predictive factor of developing organ involvement such as pulmonary or cardiovascular events that could be associated with poor survival. It suggests that early screening of DU s in SS c patients is important to identify patients most at risk of poor survival.