Digital ulcers predict a worse disease course in patients with systemic sclerosis

Carina Mihai, Robert Landewé, Désirée Van Der Heijde, Ulrich A. Walker, Paul I. Constantin, Ana Maria Gherghe, Ruxandra Ionescu, Simona Rednic, Yannick Allanore, Jéroˆme Avouac, László Czirják, Eric Hachulla, Gabriela Riemekasten, Franco Cozzi, Paolo Airò, Maurizio Cutolo, Ulf Mueller-Ladner, Marco Matucci-Cerinic, David Launay, Rucsandra DobrotaRoxana Sfrent-Cornateanu, Stefania Zingarelli, Erika Pigatto, Giovanna Cuomo, Paola Caramaschi, Lidia Ananieva, Susanne Ullman, Line Iversen, Alexandra Balbir Gurman, Yolanda Braun-Moscovici, Patricia E. Carreira, Beatriz E. Joven, Tünde Minier, Serena Guiducci, Silvia Bellando-Randone, Raffaele Pellerito, Nicolas Hunzelmann, Ingo H. Tarner, Sebastião Cezar Radominski, Carolina De Souza Müller, Florenzo Iannone, Jörg Henes, Dominique Farge Bancel, Nemanja Damjanov, Predrag Ostojic, Maria Rosa Pozzi, Roger Hesselstrand, Christopher Denton, Dorota Krasowska, Mohammed Tikly, Valeria Riccieri, Francesco Paolo Cantatore, Ada Corrado, José Antonio Pereira Da Silva, Maria João Salvador, Alan Tyndall, Armando Gabrielli, Oliver Distler, Suzan Jordan, Stefan Heitmann, Harald Burkhardt, Andrea Himsel, Blaz Rozman, Vanessa Smith, Filip De Keyser, Dusanka Martinovic Kalitena, Mislav Radic, Ileana Filipescu, Ana Petcu, Panayiotis Vlachoyiannopoulos, Eugene J. Kucharz, Malgorzata Widuchowska, Magdalena Kopec-Medrek, Anna Kotulska, Gabriella Szücs, Aleksandra Stankovic, Bojana Stamenkovic, Carlo Francesco Selmi, Maria De Santis, Bianca Marasini, Bernard Coleiro, Vera Ortiz Santamaria, René Westhovens, Radim Becvár, Srdan Novak, Merete Engelhart, Pierluigi Meroni, Francesca Ingegnoli, Silvana Zeni, Alberto Sulli, Jörg Distler, Sule Yavuz, Carlomaurizio Montecucco, Kilian Eyerich, Brigitte Krummel-Lorenz, Thierry Zenone, Øyvind Midtvedt, Carlo Chizzolini, Matthias Seidel, Mara Oleszowsky, Maria Üprus, Daniela Opriş, Laura Groseanu, Otylia Kowal Bielecka, Zea Mendoza Antonio, Jacek Szechinski, Jadranka Morovic-Vergles, Raffaella Scorza, Francesco Puppo, Alessandro Mathieu, Branimir Anic, Jiri Stork, Simon Stebbings, Murat Inanc, Paul Hasler, Carlos Alberto Von Mühlen, Martin Aringer, Sergei Popa, Mengtao Li, Edoardo Rosato

Research output: Contribution to journalArticle

57 Scopus citations

Abstract

Objective: Systemic sclerosis (SSc) is a systemic autoimmune disease with high morbidity and significant mortality. There is a great need of predictors that would allow risk stratification of patients with SSc and ultimately initiation of treatment early enough to ensure optimal clinical results. In this study, we evaluated whether a history of digital ulcers (HDU) at presentation may be a predictor of vascular outcomes and of overall clinical worsening and death in patients with SSc. Methods: Patients from the EULAR Scleroderma Trials and Research (EUSTAR) database, satisfying at inclusion the 1980 American College of Rheumatology classification criteria for SSc, who had a follow-up of at least 3 years since baseline or who have died, were included in the analysis. HDU at presentation as a predictor of disease worsening or death was evaluated by Cox proportional hazards regression analysis. Results :3196 patients matched the inclusion criteria (male sex 13.2%, 33.4% diffuse subset). At presentation, 1092/3196 patients had an HDU (34.1%). In multivariable analysis adjusting for age, gender and all parameters considered potentially significant, HDU was predictive for the presence of active digital ulcers (DUs) at prospective visits (HR (95% CI)): 2.41(1.91 to 3.03), p<0.001, for an elevated systolic pulmonary arterial pressure on heart ultrasound (US-PAPs):1.36 (1.03 to 1.80), p=0.032, for any cardiovascular event (new DUs, elevated US-PAPs or LV failure):3.56 (2.26 to 5.62), p<0.001, and for death (1.53 (1.16 to 2.02), p=0.003). Conclusions :In patients with SSc, HDU at presentation predicts the occurrence of DUs at follow-up and is associated with cardiovascular worsening and decreased survival.

Original languageEnglish (US)
Pages (from-to)681-686
Number of pages6
JournalAnnals of the Rheumatic Diseases
Volume75
Issue number4
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

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ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Mihai, C., Landewé, R., Van Der Heijde, D., Walker, U. A., Constantin, P. I., Gherghe, A. M., Ionescu, R., Rednic, S., Allanore, Y., Avouac, J., Czirják, L., Hachulla, E., Riemekasten, G., Cozzi, F., Airò, P., Cutolo, M., Mueller-Ladner, U., Matucci-Cerinic, M., Launay, D., ... Rosato, E. (2016). Digital ulcers predict a worse disease course in patients with systemic sclerosis. Annals of the Rheumatic Diseases, 75(4), 681-686. https://doi.org/10.1136/annrheumdis-2014-205897