This study aimed to evaluate the prevalence and clinical correlates of peripheral arterial disease (PAD) of the upper limbs in patients with systemic sclerosis (SSc), as detected with finger brachial pressure index (FBPI) measurements.

An FBPI < 0.70 was used as the diagnostic criterion for the upper limbs’ occlusive arterial disease. Thus, the prevalence of the defined arterial disease and its clinical, biological, and capillaroscopic correlates were evaluated. Among 326 enrolled patients, 54.3% met the criterion for arterial disease (FBPI < 0.70). No correlation was observed with the type of SSc nor the type of associated antinuclear antibodies. However, a significant association was found with the duration of the disease (P < 0.001), the capillaroscopic pattern (P < 0.001), and most strikingly with the presence of digital ulcers (42.9% vs. 13.4%; P < 0.001). A quantitative relationship was found between the FBPI and the prevalence of digital ulcers and was independent of the capillaroscopic pattern.

In conclusion, this cross‐sectional study shows a high prevalence of the upper limbs’ arterial disease in patients with SSc. FBPI is observed to be an independent and strong predictor of digital ulcers. This study suggests that both macro and microangiopathy are contributing to the ischemic damage of the fingertips.