AB0712 Digital Ischemic Complications in Systemic sclerosis associated Raynaud’s: Prevalence, Risk factors and Treatment patterns from a Single Center Cohort

Abstract

BackgroundA significant number of Systemic sclerosis (SSc) patients with Raynaud’s phenomenon (RP) experience digital ischemic complications (DICs-digital ulcers, digital pitting/scars, gangrene and/or amputation).ObjectivesWe reviewed the prevalence & risk factors for DICs in SSc-RP and compared treatment patterns among patients with & without DICs.MethodsSSc patients meeting ACR/EULAR 2013 classification criteria that underwent an upper extremity arterial study between 2001-2018 were included. Clinical characteristics, treatment for RP, use of antiplatelet (aspirin 81 mg), statin therapy & occurrence of DICs, digital occlusive arterial disease (DOAD) on laser doppler flowmetry (LDF) and macrovascular disease (MVD) on duplex US were abstracted. Risk factors for DICs and their associations with therapy were evaluated.ResultsWe identified 273 SSc patients (mean age 57±13 y, 81% F, 93% Caucasian, mean disease duration 4.8 ± 7.1 y). Cohort characteristics are described in Table 1. 79% (217/273) patients experienced DICs (digital ulcers 203, digital pitting/scar 138, digital gangrene 76). Patients with DICs had a higher prevalence of DOAD (89% vs 54%, p <0.001), MVD (32% vs 9%, p <0.001), ILD (41% vs. 27%, p=0.04), calcinosis (95/192 (49%) vs. 7/44 (16%), p<0.001), and pericardial effusion (25% vs. 12%, p=0.047), compared to those without DICs. No difference was noted between the 2 groups in regard to skin severity, smoking, BMI, hypertension, hyperlipidemia, diabetes, coronary artery disease, telangiectasias, pulmonary hypertension, renal crisis, GI dysmotility or myositis.Treatment patterns are described in Figure 1. Calcium channel blocker (CCB) and phosphodiesterase 5 inhibitor (PDE5I) use was higher among SSc patients with DICs than in those without DICs (CCBs: 53% vs. 34%, p=0.01; PDE5: 29% vs. 2%, p=0.01) likely due to confounding by indication. The use of aspirin or statins was not associated with DICs, even after adjusting for CV risk factors (ASA: OR 0.83, 95% CI 0.45-1.54; statin OR 0.67, 95% CI 0.28-1.62).ConclusionOur study confirms a high prevalence of DICs in SSc, with digital ulcers occurring in nearly 75% patients. A higher risk of DICs is associated with DOAD, MVD, ILD, calcinosis and pericardial effusion. While there is a significantly higher utilization of vasodilators among patients with DICs, the utilization of antiplatelet therapy and statins was not different among these groups. Whether this suggests a lack of evidence supporting their use in clinical practice, or inefficacy in preventing DICs remains unclear and warrants further study.Table 1.Overall (N=273)DICs (N=217)No DICs (N=56)p-valueDemographicsAge at procedure(y); mean (SD)57.5 (13.3)56.9 (13.6)59.4 (11.8)0.25Sex (Female)220 (81%)173 (80%)47 (84%)0.48Race (White)253 (93%)199 (92%)54 (96%)0.73BMI (kg/m2) at study; mean (SD)26.6 (6.1)26.3 (6.1)27.4 (6.1)0.14Smoking statusNever154 (56%)120 (55%)34 (61%)0.76Former102 (37%)83 (38%)19 (34%)Current17 (6%)14 (6%)3 (5%)Disease characteristicsSSc subtype:Limited211 (77%)166 (76%)45 (80%)0.18Diffuse59 (22%)49 (23%)10 (18%)Time from SSc diagnosis to duplex US (months) mean (SD)57.9 (85.7)63.5 (91.5)36.1 (52.9)0.04Digital occlusive arterial disease223 (82%)193 (89%)30 (54%)<0.001Macrovascular disease74 (27%)69 (32%)5 (9%)<0.001Ulnar Occlusive disease68 (25%)63 (29%)5 (9%)0.002Telangiectasias239 (88%)192 (89%)47 (84%)0.27Calcinosis102 (43%)95 (49%)7 (16%)<0.001Interstitial lung disease105 (38%)90 (41%)15 (27%)0.04Pulmonary hypertension50 (18%)43 (20%)7 (12%)0.21Pericardial effusion61 (22%)54 (25%)7 (12%)0.047Gastrointestinal dysmotility194 (71%)159 (73%)35 (62%)0.11Renal crisis17 (6%)12 (6%)5 (9%)0.35SSc specific antibodies:175 (68%)138 (67%)38 (69%)0.77Centromere116 (63%)95 (63%)21 (64%)0.97Scl-7048 (19%)36 (18%)12 (22%)0.57RNA-Polymerase19 (20%)14 (19%)5 (22%)0.79Figure 1.Disclosure of InterestsNone declared