Managing complicated digital ulcers

Short title: Managing complex SSc-DU Digital ulcers (DU) are a major cause of disease-related morbidity in systemic sclerosis (DU). DU occur in over half of patients with systemic sclerosis (SSc) throughout the disease course and are not uncommonly a presenting feature of SSc. SSc-DU represent a major challenge for clinicians who need to undertake careful clinical, laboratory and imaging assessment to establish relevant potential aetiopathogenic drivers to facilitate targeted therapeutic intervention. In this chapter, we report six cases of complicated DU. Each case highlights important aspects of DU aetiopathogenesis and management. Each case is accompanied with practical implications for management designed to support clinicians managing patients with complex SSc-DU.