Studies of Pathogenesis, Epidemiology, Functional Impact and Treatment Response. Written by Dr Ariane Herrick, Consultant Rheumatologist, Salford Royal Hospital.
Aim
Our overall aim is to increase our understanding of the pathogenesis, functional impact and treatment response of digital ulcers in systemic sclerosis (SSc) in a 2-year programme of research.
Progress so far
Preparation/setting up of study. Ethics approval for the study was obtained from Salford and Trafford Research Ethics Committee and from the University of Manchester. Adrienne Taylor was appointed as part-time research nurse (in tissue viability) and took up this post at the beginning of November 2008. Since appointed, she has familiarised herself with the different assessment methods to be used in the study including the Hand Mobility in Scleroderma Test (HAMIS), and has prepared the booklet/diary which is given to all patients recruited into the study, in which details of any ulcers are entered.
Recruitment. Recruitment began in December 2008 and so far 47 patients have been recruited (Figure). We are therefore almost on target to recruit over 12 months the 200 patients anticipated. So far 14 patients invited to participate have declined, commonly due to constraints on time at their outpatient appointment.
Of the 47 patients recruited at the outpatient clinic, 3 have had digital ulcers (5 ulcers in these 3 patients) at the time of recruitment (prevalent ulcers) and 3 patients have since developed new ulcers (incident ulcers).
Tissue viability assessment. A key feature of the study is the setting up of an ulcer clinic for the 2 year study period, run by a senior tissue viability nurse (Adrienne Taylor). This clinic is now well-established and runs on a Wednesday morning. Patients with active ulcers are seen there approximately weekly. Adrienne’s initial observations are as follows:
‘The need for moisture to promote wound healing is well documented. Unfortunately most of the patients who I have interviewed thought it was better to let the wound dry out. Dry eschar or necrosis is a potential problem for infection. There are limitations in dressings available to treat digital ulcers. The aim of treating damaged or broken skin Is to promote moisture and prevent infection. I have encouraged patients with the potential problem of tissue breakdown to use extra thin hydrocolloid dressings, the feedback so far has been quite positive.
For the treatment of digital ulceration I have again used hydrocolloid dressings with hydrogel to promote wound healing. I am particularly keen to promote the use of dressings patients can manage themselves.
I am in the process of organizing a focus group supported by a dressings manufacturer to establish what patients themselves feel they need from suitable dressings for digital ulcers. I have discussed the idea with some of the patients who would be willing to participate’.
Summary
The study is recruiting well and the initial impression is that patients are benefitting from attending the ulcer clinic.
