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Incidence and risk factors for gangrene in patients with systemic sclerosis from the EUSTAR cohort

2019; Oxford University Press; Volume: 59; Issue: 8 Linguagem: Inglês

10.1093/rheumatology/kez558

1462-0332

Carina Mihai, Oliver Distler, Ana Maria Gheorghiu, Paul I Constantin, Rucsandra Dobrota, Suzana Jordan, Vanessa Smith, É. Hachulla, Jörg Henes, Elise Siegert, Serena Vettori, Ulf Müller-Ladner, Marco Matucci‐Cerinic, Yannick Allanore, Gemma Lepri, Veronika K. Jaeger, Ulrich A. Walker, Florenzo Iannone, Fabio Cacciapaglia, Michal Tomčík, Radim Bečvář, Simona Rednic, Ana Petcu, Iulia Szabo, Veronica Codullo, Roberto Caporali, Carlomaurizio Montecucco, Patrícia Carreira, Beatriz Ioven, Tünde Minier, László Czirják, Carlo Chizzolini, Danièle Allali, Elisabetta Zanatta, Andrea Doria, Tianlu Li, Paolo Airò, Maria Grazia Lazzaroni, Mislav Radić, Duška Martinović, Yolanda Braun‐Moscovici, Alexandra Balbir‐Gurman, Nicolas Hunzelmann, Paola Caramaschi, Jadranka Morović‐Vergles, Christopher Denton, Vera Ortiz-Santamaría, Stefan Heitmann, Dorota Krasowska, Małgorzata Michalska‐Jakubus, Matthias F. Seidel, Ivan Foeldvari, Nicola Helmus, Maria João Salvador, Bojana Stamenković, Aleksandra Stanković, L. Ananieva, Ariane L. Herrick, Merete Engelhart, Carlos de la Puente, Anna‐Maria Hoffmann‐Vold, Øyvind Midtvedt, David Launay, Vincent Sobanski, Valeria Riccieri, Daniela Opriş-Belinski, L. Groşeanu, Ruxandra Ionescu, Mihai Bojinca, Cord Sunderkötter, Jörg H. W. Distler, Francesca Ingegnoli, Amber van der Haecke, Susanne Ullman, Maria Rosa Pozzi, Kilian Eyerich, Marie Vanthuyne, A. Erler, Martin Aringer, Ellen De Langhe, Marko Barešić, Miroslav Mayer, Branimir Anić, Şule Yavuz, B. Granel, Serghei Popa, Svetlana Agachi, Thierry Zénone, Alessandro Mathieu, Alessandra Vacca, Kamal Solanki, Douglas J. Veale, Esthela Loyo, Carmen Tineo, Antonetta Gigante, Edoardo Rosato, Fahrettin Öksel, Figen Yagurcu, Cristina-Mihaela Tănăseanu, Elisa Visalli, Alessia Benenati, Rosario Foti, Codrina Ancuța, Diana Dan, Sabine Adler, Peter M. Villiger, Nihal Fathi, Paloma García de la Peña Lefebvre, Jorge Juan González Martín, Emmanuel Chatelus, Jean Sibilia, Ira Litinsky, Francesco Del Galdo, Lesley Ann Sakettkoo, Eduardo Kerzberg, Washington A. Bianchi, Breno Valdetaro Bianchi, I. Castellví, Massimiliano Limonta, Doron Rimar, Maura Couto, Camillo Ribi, François Spertini, Sarah Kahl, Vivien Hsu, Vincent Poindron, Kilifa Meghit, Thierry Martin, Kathleen D. Kolstad, Leland W.K. Chung, Astrid Thiele, Tim Schmeiser, Zbigniew Zdrojewski, Gabriela Riemekasten, Yair Levy, Anca Cardoneanu, Alexandra Burlui, Elena Rezuş, Ömer Nurı Pamuk, Rossella Talotta, Sara Bongiovanni, Piercarlo Sarzi‐Puttini,

Skin Diseases and Diabetes

In patients with SSc, peripheral vasculopathy can promote critical ischaemia and gangrene. The aim of this study was to investigate the prevalence, incidence and risk factors for gangrene in the EUSTAR cohort.We included patients from the EUSTAR database fulfilling the ACR 1980 or the ACR/EULAR 2013 classification criteria for SSc, with at least one visit recording data on gangrene. Centres were asked for supplementary data on traditional cardiovascular risk factors. We analysed the cross-sectional relationship between gangrene and its potential risk factors by univariable and multivariable logistic regression. Longitudinal data were analysed by Cox proportional hazards regression.1757 patients were analysed (age 55.9 [14.5] years, disease duration 7.9 [10.3] years, male sex 16.7%, 24.6% diffuse cutaneous subset [dcSSc]). At inclusion, 8.9% of patients had current or previous digital gangrene, 16.1% had current digital ulcers (DUs) and 42.7% had ever had DUs (current or previous). Older age, DUs ever and dcSSc were statistically significant risk factors for gangrene in the cross-sectional multivariable model. During a median follow-up of 13.1 months, 16/771 (0.9%) patients developed gangrene. All 16 patients who developed gangrene had previously had DUs and gangrene. Further risk factors for incident gangrene were the dcSSc subset and longer disease duration.In unselected SSc patients, gangrene occurs in about 9% of SSc patients. DUs ever and, to a lesser extent, the dcSSc subset are strongly and independently associated with gangrene, while traditional cardiovascular risk factors could not be identified as risk factors.