Digital ulcers predict a worse disease course in patients with systemic sclerosis. Issue 4 (16th February 2015)

• Record Type: Journal Article
• Authors: Mihai, Carina; Landewé, Robert; van der Heijde, Désirée; Walker, Ulrich A; Constantin, Paul I; Gherghe, Ana Maria; Ionescu, Ruxandra; Rednic, Simona; Allanore, Yannick; Avouac, Jérôme; Czirják, László; Hachulla, Eric; Riemekasten, Gabriela; Cozzi, Franco; Airò, Paolo; Cutolo, Maurizio; Mueller-Ladner, Ulf; Matucci-Cerinic, Marco
• Other Names: author non-byline.; Launay David author non-byline.; Dobrotă Rucsandra author non-byline.; Sfrenţ-Cornăţeanu Roxana author non-byline.; Zingarelli Stefania author non-byline.; Pigatto Erika author non-byline.; Cuomo Giovanna author non-byline.; Caramaschi Paola author non-byline.; Ananieva Lidia author non-byline.; Ullman Susanne author non-byline.; Iversen Line author non-byline.; Gurman Alexandra Balbir author non-byline.; Braun-Moscovici Yolanda author non-byline.; Carreira Patricia E. author non-byline.; Joven Beatriz E author non-byline.; Minier Tünde author non-byline.; Guiducci Serena author non-byline.; Bellando-Randone Silvia author non-byline.; Pellerito Raffaele author non-byline.; Hunzelmann Nicolas author non-byline.; Tarner Ingo H. author non-byline.; Radominski Sebastião Cezar author non-byline.; de Souza Müller Carolina author non-byline.; Iannone Florenzo author non-byline.; Henes Jörg author non-byline.; Bancel Dominique Farge author non-byline.; Damjanov Nemanja author non-byline.; Ostojić Predrag author non-byline.; Pozzi Maria Rosa author non-byline.; Hesselstrand Roger author non-byline.; Denton Christopher author non-byline.; Krasowska Dorota author non-byline.; Tikly Mohammed author non-byline.; Riccieri Valeria author non-byline.; Cantatore Francesco Paolo author non-byline.; Corrado Ada author non-byline.; Da Silva José Antonio Pereira author non-byline.; Salvador Maria João author non-byline.; Tyndall Alan author non-byline.; Gabrielli Armando author non-byline.; Distler Oliver author non-byline.; Jordan Suzan author non-byline.; Heitmann Stefan author non-byline.; Burkhardt Harald author non-byline.; Himsel Andrea author non-byline.; Rozman Blaz author non-byline.; Smith Vanessa author non-byline.; De Keyser Filip author non-byline.; Kalitena Dusanka Martinovic author non-byline.; Radic Mislav author non-byline.; Filipescu Ileana author non-byline.; Petcu Ana author non-byline.; Vlachoyiannopoulos Panayiotis author non-byline.; Kucharz Eugene J. author non-byline.; Widuchowska Malgorzata author non-byline.; Kopec-Medrek Magdalena author non-byline.; Kotulska Anna author non-byline.; Szücs Gabriella author non-byline.; Stankovic Aleksandra author non-byline.; Stamenkovic Bojana author non-byline.; Selmi Carlo Francesco author non-byline.; De Santis Maria author non-byline.; Marasini Bianca author non-byline.; Coleiro Bernard author non-byline.; Santamaria Vera Ortiz author non-byline.; Westhovens René author non-byline.; Bečvář Radim author non-byline.; Novak Srdan author non-byline.; Engelhart Merete author non-byline.; Meroni Pierluigi author non-byline.; Ingegnoli Francesca author non-byline.; Zeni Silvana author non-byline.; Sulli Alberto author non-byline.; Distler Jörg author non-byline.; Yavuz Sule author non-byline.; Montecucco Carlomaurizio author non-byline.; Eyerich Kilian author non-byline.; Krummel-Lorenz Brigitte author non-byline.; Zenone Thierry author non-byline.; Midtvedt Øyvind author non-byline.; Chizzolini Carlo author non-byline.; Seidel Matthias author non-byline.; Oleszowsky Mara author non-byline.; Üprus Maria author non-byline.; Opriş Daniela author non-byline.; Groşeanu Laura author non-byline.; Bielecka Otylia Kowal author non-byline.; Antonio Zea Mendoza author non-byline.; Szechinski Jacek author non-byline.; Morović-Vergles Jadranka author non-byline.; Scorza Raffaella author non-byline.; Puppo Francesco author non-byline.; Mathieu Alessandro author non-byline.; Anic Branimir author non-byline.; Stork Jiri author non-byline.; Stebbings Simon author non-byline.; Inanc Murat author non-byline.; Hasler Paul author non-byline.; von Mühlen Carlos Alberto author non-byline.; Aringer Martin author non-byline.; Popa Sergei author non-byline.; Li Mengtao author non-byline.; Rosato Edoardo author non-byline.;
• Is Part Of: Annals of the rheumatic diseases. Volume 75:Issue 4(2016)
• Page Start: 681
• Page End: 686
• Publication Date: 2015-02-16
• Subjects: Systemic Sclerosis -- Cardiovascular Disease -- Epidemiology; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2014-205897
• Languages: English
• ISSNs: 0003-4967

Abstract

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.