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 Dobrota & 100 others Roxana 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

50 Citations (Scopus)

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

Fingerprint

Systemic Scleroderma
Ulcer
Regression analysis
Hazards
Ultrasonics
Autoimmune Diseases
Blood Vessels
Arterial Pressure
Regression Analysis
Databases
Morbidity
Lung
Survival
Mortality
Research

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., ... 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

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

In: Annals of the Rheumatic Diseases, Vol. 75, No. 4, 01.04.2016, p. 681-686.

Research output: Contribution to journalArticle

Mihai, C, Landewé, R, Van Der Heijde, D, Walker, UA, Constantin, PI, Gherghe, AM, 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, Dobrota, R, Sfrent-Cornateanu, R, Zingarelli, S, Pigatto, E, Cuomo, G, Caramaschi, P, Ananieva, L, Ullman, S, Iversen, L, Gurman, AB, Braun-Moscovici, Y, Carreira, PE, Joven, BE, Minier, T, Guiducci, S, Bellando-Randone, S, Pellerito, R, Hunzelmann, N, Tarner, IH, Radominski, SC, De Souza Müller, C, Iannone, F, Henes, J, Bancel, DF, Damjanov, N, Ostojic, P, Pozzi, MR, Hesselstrand, R, Denton, C, Krasowska, D, Tikly, M, Riccieri, V, Cantatore, FP, Corrado, A, Da Silva, JAP, Salvador, MJ, Tyndall, A, Gabrielli, A, Distler, O, Jordan, S, Heitmann, S, Burkhardt, H, Himsel, A, Rozman, B, Smith, V, Keyser, FD, Kalitena, DM, Radic, M, Filipescu, I, Petcu, A, Vlachoyiannopoulos, P, Kucharz, EJ, Widuchowska, M, Kopec-Medrek, M, Kotulska, A, Szücs, G, Stankovic, A, Stamenkovic, B, Selmi, CF, Santis, MD, Marasini, B, Coleiro, B, Santamaria, VO, Westhovens, R, Becvár, R, Novak, S, Engelhart, M, Meroni, P, Ingegnoli, F, Zeni, S, Sulli, A, Distler, J, Yavuz, S, Montecucco, C, Eyerich, K, Krummel-Lorenz, B, Zenone, T, Midtvedt, Ø, Chizzolini, C, Seidel, M, Oleszowsky, M, Üprus, M, Opriş, D, Groseanu, L, Bielecka, OK, Antonio, ZM, Szechinski, J, Morovic-Vergles, J, Scorza, R, Puppo, F, Mathieu, A, Anic, B, Stork, J, Stebbings, S, Inanc, M, Hasler, P, Von Mühlen, CA, Aringer, M, Popa, S, Li, M & Rosato, E 2016, 'Digital ulcers predict a worse disease course in patients with systemic sclerosis', Annals of the Rheumatic Diseases, vol. 75, no. 4, pp. 681-686. https://doi.org/10.1136/annrheumdis-2014-205897
Mihai C, Landewé R, Van Der Heijde D, Walker UA, Constantin PI, Gherghe AM et al. Digital ulcers predict a worse disease course in patients with systemic sclerosis. Annals of the Rheumatic Diseases. 2016 Apr 1;75(4):681-686. https://doi.org/10.1136/annrheumdis-2014-205897
Mihai, Carina ; Landewé, Robert ; Van Der Heijde, Désirée ; Walker, Ulrich A. ; Constantin, Paul I. ; Gherghe, Ana Maria ; Ionescu, Ruxandra ; Rednic, Simona ; Allanore, Yannick ; Avouac, Jéroˆme ; Czirják, László ; Hachulla, Eric ; Riemekasten, Gabriela ; Cozzi, Franco ; Airò, Paolo ; Cutolo, Maurizio ; Mueller-Ladner, Ulf ; Matucci-Cerinic, Marco ; Launay, David ; Dobrota, Rucsandra ; Sfrent-Cornateanu, Roxana ; Zingarelli, Stefania ; Pigatto, Erika ; Cuomo, Giovanna ; Caramaschi, Paola ; Ananieva, Lidia ; Ullman, Susanne ; Iversen, Line ; Gurman, Alexandra Balbir ; Braun-Moscovici, Yolanda ; Carreira, Patricia E. ; Joven, Beatriz E. ; Minier, Tünde ; Guiducci, Serena ; Bellando-Randone, Silvia ; Pellerito, Raffaele ; Hunzelmann, Nicolas ; Tarner, Ingo H. ; Radominski, Sebastião Cezar ; De Souza Müller, Carolina ; Iannone, Florenzo ; Henes, Jörg ; Bancel, Dominique Farge ; Damjanov, Nemanja ; Ostojic, Predrag ; Pozzi, Maria Rosa ; Hesselstrand, Roger ; Denton, Christopher ; Krasowska, Dorota ; Tikly, Mohammed ; Riccieri, Valeria ; Cantatore, Francesco Paolo ; Corrado, Ada ; Da Silva, José Antonio Pereira ; Salvador, Maria João ; Tyndall, Alan ; Gabrielli, Armando ; Distler, Oliver ; Jordan, Suzan ; Heitmann, Stefan ; Burkhardt, Harald ; Himsel, Andrea ; Rozman, Blaz ; Smith, Vanessa ; Keyser, Filip De ; Kalitena, Dusanka Martinovic ; Radic, Mislav ; Filipescu, Ileana ; Petcu, Ana ; Vlachoyiannopoulos, Panayiotis ; Kucharz, Eugene J. ; Widuchowska, Malgorzata ; Kopec-Medrek, Magdalena ; Kotulska, Anna ; Szücs, Gabriella ; Stankovic, Aleksandra ; Stamenkovic, Bojana ; Selmi, Carlo Francesco ; Santis, Maria De ; Marasini, Bianca ; Coleiro, Bernard ; Santamaria, Vera Ortiz ; Westhovens, René ; Becvár, Radim ; Novak, Srdan ; Engelhart, Merete ; Meroni, Pierluigi ; Ingegnoli, Francesca ; Zeni, Silvana ; Sulli, Alberto ; Distler, Jörg ; Yavuz, Sule ; Montecucco, Carlomaurizio ; Eyerich, Kilian ; Krummel-Lorenz, Brigitte ; Zenone, Thierry ; Midtvedt, Øyvind ; Chizzolini, Carlo ; Seidel, Matthias ; Oleszowsky, Mara ; Üprus, Maria ; Opriş, Daniela ; Groseanu, Laura ; Bielecka, Otylia Kowal ; Antonio, Zea Mendoza ; Szechinski, Jacek ; Morovic-Vergles, Jadranka ; Scorza, Raffaella ; Puppo, Francesco ; Mathieu, Alessandro ; Anic, Branimir ; Stork, Jiri ; Stebbings, Simon ; Inanc, Murat ; Hasler, Paul ; Von Mühlen, Carlos Alberto ; Aringer, Martin ; Popa, Sergei ; Li, Mengtao ; Rosato, Edoardo. / Digital ulcers predict a worse disease course in patients with systemic sclerosis. In: Annals of the Rheumatic Diseases. 2016 ; Vol. 75, No. 4. pp. 681-686.
@article{83ebcc3075fb4953afd925b65970a391,
title = "Digital ulcers predict a worse disease course in patients with systemic sclerosis",
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.",
author = "Carina Mihai and Robert Landew{\'e} and {Van Der Heijde}, D{\'e}sir{\'e}e and Walker, {Ulrich A.} and Constantin, {Paul I.} and Gherghe, {Ana Maria} and Ruxandra Ionescu and Simona Rednic and Yannick Allanore and J{\'e}roˆme Avouac and L{\'a}szl{\'o} Czirj{\'a}k and Eric Hachulla and Gabriela Riemekasten and Franco Cozzi and Paolo Air{\`o} and Maurizio Cutolo and Ulf Mueller-Ladner and Marco Matucci-Cerinic and David Launay and Rucsandra Dobrota and Roxana Sfrent-Cornateanu and Stefania Zingarelli and Erika Pigatto and Giovanna Cuomo and Paola Caramaschi and Lidia Ananieva and Susanne Ullman and Line Iversen and Gurman, {Alexandra Balbir} and Yolanda Braun-Moscovici and Carreira, {Patricia E.} and Joven, {Beatriz E.} and T{\"u}nde Minier and Serena Guiducci and Silvia Bellando-Randone and Raffaele Pellerito and Nicolas Hunzelmann and Tarner, {Ingo H.} and Radominski, {Sebasti{\~a}o Cezar} and {De Souza M{\"u}ller}, Carolina and Florenzo Iannone and J{\"o}rg Henes and Bancel, {Dominique Farge} and Nemanja Damjanov and Predrag Ostojic and Pozzi, {Maria Rosa} and Roger Hesselstrand and Christopher Denton and Dorota Krasowska and Mohammed Tikly and Valeria Riccieri and Cantatore, {Francesco Paolo} and Ada Corrado and {Da Silva}, {Jos{\'e} Antonio Pereira} and Salvador, {Maria Jo{\~a}o} and Alan Tyndall and Armando Gabrielli and Oliver Distler and Suzan Jordan and Stefan Heitmann and Harald Burkhardt and Andrea Himsel and Blaz Rozman and Vanessa Smith and Keyser, {Filip De} and Kalitena, {Dusanka Martinovic} and Mislav Radic and Ileana Filipescu and Ana Petcu and Panayiotis Vlachoyiannopoulos and Kucharz, {Eugene J.} and Malgorzata Widuchowska and Magdalena Kopec-Medrek and Anna Kotulska and Gabriella Sz{\"u}cs and Aleksandra Stankovic and Bojana Stamenkovic and Selmi, {Carlo Francesco} and Santis, {Maria De} and Bianca Marasini and Bernard Coleiro and Santamaria, {Vera Ortiz} and Ren{\'e} Westhovens and Radim Becv{\'a}r and Srdan Novak and Merete Engelhart and Pierluigi Meroni and Francesca Ingegnoli and Silvana Zeni and Alberto Sulli and J{\"o}rg Distler and Sule Yavuz and Carlomaurizio Montecucco and Kilian Eyerich and Brigitte Krummel-Lorenz and Thierry Zenone and {\O}yvind Midtvedt and Carlo Chizzolini and Matthias Seidel and Mara Oleszowsky and Maria {\"U}prus and Daniela Opriş and Laura Groseanu and Bielecka, {Otylia Kowal} and Antonio, {Zea Mendoza} and Jacek Szechinski and Jadranka Morovic-Vergles and Raffaella Scorza and Francesco Puppo and Alessandro Mathieu and Branimir Anic and Jiri Stork and Simon Stebbings and Murat Inanc and Paul Hasler and {Von M{\"u}hlen}, {Carlos Alberto} and Martin Aringer and Sergei Popa and Mengtao Li and Edoardo Rosato",
year = "2016",
month = "4",
day = "1",
doi = "10.1136/annrheumdis-2014-205897",
language = "English (US)",
volume = "75",
pages = "681--686",
journal = "Annals of the Rheumatic Diseases",
issn = "0003-4967",
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}

TY - JOUR

T1 - Digital ulcers predict a worse disease course in patients with systemic sclerosis

AU - Mihai, Carina

AU - Landewé, Robert

AU - Van Der Heijde, Désirée

AU - Walker, Ulrich A.

AU - Constantin, Paul I.

AU - Gherghe, Ana Maria

AU - Ionescu, Ruxandra

AU - Rednic, Simona

AU - Allanore, Yannick

AU - Avouac, Jéroˆme

AU - Czirják, László

AU - Hachulla, Eric

AU - Riemekasten, Gabriela

AU - Cozzi, Franco

AU - Airò, Paolo

AU - Cutolo, Maurizio

AU - Mueller-Ladner, Ulf

AU - Matucci-Cerinic, Marco

AU - Launay, David

AU - Dobrota, Rucsandra

AU - Sfrent-Cornateanu, Roxana

AU - Zingarelli, Stefania

AU - Pigatto, Erika

AU - Cuomo, Giovanna

AU - Caramaschi, Paola

AU - Ananieva, Lidia

AU - Ullman, Susanne

AU - Iversen, Line

AU - Gurman, Alexandra Balbir

AU - Braun-Moscovici, Yolanda

AU - Carreira, Patricia E.

AU - Joven, Beatriz E.

AU - Minier, Tünde

AU - Guiducci, Serena

AU - Bellando-Randone, Silvia

AU - Pellerito, Raffaele

AU - Hunzelmann, Nicolas

AU - Tarner, Ingo H.

AU - Radominski, Sebastião Cezar

AU - De Souza Müller, Carolina

AU - Iannone, Florenzo

AU - Henes, Jörg

AU - Bancel, Dominique Farge

AU - Damjanov, Nemanja

AU - Ostojic, Predrag

AU - Pozzi, Maria Rosa

AU - Hesselstrand, Roger

AU - Denton, Christopher

AU - Krasowska, Dorota

AU - Tikly, Mohammed

AU - Riccieri, Valeria

AU - Cantatore, Francesco Paolo

AU - Corrado, Ada

AU - Da Silva, José Antonio Pereira

AU - Salvador, Maria João

AU - Tyndall, Alan

AU - Gabrielli, Armando

AU - Distler, Oliver

AU - Jordan, Suzan

AU - Heitmann, Stefan

AU - Burkhardt, Harald

AU - Himsel, Andrea

AU - Rozman, Blaz

AU - Smith, Vanessa

AU - Keyser, Filip De

AU - Kalitena, Dusanka Martinovic

AU - Radic, Mislav

AU - Filipescu, Ileana

AU - Petcu, Ana

AU - Vlachoyiannopoulos, Panayiotis

AU - Kucharz, Eugene J.

AU - Widuchowska, Malgorzata

AU - Kopec-Medrek, Magdalena

AU - Kotulska, Anna

AU - Szücs, Gabriella

AU - Stankovic, Aleksandra

AU - Stamenkovic, Bojana

AU - Selmi, Carlo Francesco

AU - Santis, Maria De

AU - Marasini, Bianca

AU - Coleiro, Bernard

AU - Santamaria, Vera Ortiz

AU - Westhovens, René

AU - Becvár, Radim

AU - Novak, Srdan

AU - Engelhart, Merete

AU - Meroni, Pierluigi

AU - Ingegnoli, Francesca

AU - Zeni, Silvana

AU - Sulli, Alberto

AU - Distler, Jörg

AU - Yavuz, Sule

AU - Montecucco, Carlomaurizio

AU - Eyerich, Kilian

AU - Krummel-Lorenz, Brigitte

AU - Zenone, Thierry

AU - Midtvedt, Øyvind

AU - Chizzolini, Carlo

AU - Seidel, Matthias

AU - Oleszowsky, Mara

AU - Üprus, Maria

AU - Opriş, Daniela

AU - Groseanu, Laura

AU - Bielecka, Otylia Kowal

AU - Antonio, Zea Mendoza

AU - Szechinski, Jacek

AU - Morovic-Vergles, Jadranka

AU - Scorza, Raffaella

AU - Puppo, Francesco

AU - Mathieu, Alessandro

AU - Anic, Branimir

AU - Stork, Jiri

AU - Stebbings, Simon

AU - Inanc, Murat

AU - Hasler, Paul

AU - Von Mühlen, Carlos Alberto

AU - Aringer, Martin

AU - Popa, Sergei

AU - Li, Mengtao

AU - Rosato, Edoardo

PY - 2016/4/1

Y1 - 2016/4/1

N2 - 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.

AB - 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.

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U2 - 10.1136/annrheumdis-2014-205897

DO - 10.1136/annrheumdis-2014-205897

M3 - Article

VL - 75

SP - 681

EP - 686

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

SN - 0003-4967

IS - 4

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