Andreina Manfredi1, Marco Sebastiani1, Valeria Carraro2, Michele Iudici3, Mario Bocci4, Gentiana Vukatana5, Roberto Gerli6, Rossella De Angelis7, Patrizia Del Medico8, Emanuela Praino9, Andrea Lo Monaco10, Roberto D'Amico11, Cinzia Del Giovane11, Salvatore Mazzuca12, Michele Colaci1, Dilia Giuggioli1, Clodoveo Ferri1. 1. Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy. 2. Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy. 3. Department of Clinical and Experimental Medicine, Rheumatology Unit, Second University of Naples, Naples, Italy. 4. Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy. 5. Department of Internal Medicine, Rheumatology Unit, Policlinico S. Orsola Malpighi, Bologna, Italy. 6. Rheumatology Unit, Department of Clinical & Experimental Medicine, University of Perugia, Perugia, Italy. 7. Rheumatology Unit, Department of Molecular Pathology and Innovative Therapies, Università Politecnica delle Marche, Ancona, Italy. 8. Internal Medicine Unit - Civitanova Marche Hospital, Italy. 9. DiMIMP, Rheumatology Unit, University of Bari, Bari, Italy. 10. Department of Clinical and Experimental Medicine-Rheumatology Unit, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy. 11. Unit of Statistics in Medicine, Department of Public Health, Clinical and Diagnostic Medicine, University of Modena and Reggio Emilia, Modena, Italy. 12. Department of Internal Medicine, Pugliese-Ciaccio Hospital, Catanzaro, Italy.
Abstract
BACKGROUND: Digital ulcers (DU) affect 50% of systemic sclerosis (SSc) patients, representing a challenging clinical problem. Despite a high negative predictive value, capillaroscopic scores proposed to select patients at risk for DU show an inadequate positive predictive value, especially in patients without previous DU. AIM OF THIS STUDY: To increase the predictive value for DU development of capillaroscopy, through a predictive risk chart taking into account capillaroscopic, demographic, and clinico-serological parameters. PATIENTS AND METHODS: Two hundred and nineteen unselected SSc patients from 8 Italian Rheumatology Centers were consecutively enrolled during a 6-month period. Demographic, clinical, serological and instrumental data and capillaroscopy skin ulcers risk index (CSURI) were collected. RESULTS: A multivariate logistic regression analysis showed a significant positive association between DU appearance and male gender, DU history, altered CSURI, and ESR. A prediction risk chart of the development of DU within 6 months were built on the basis of the above parameters. According to the risk level, four risk classes were identified: low (≤19.3%); medium (>19.3%, ≤58.6%); high (>58.6%, ≤89.2%), and very high risk (>89.2%). CONCLUSIONS: The systematic evaluation of the above parameters can be helpful to identify patients at risk to develop DU optimizing preventive vasoactive therapy.
BACKGROUND: Digital ulcers (DU) affect 50% of systemic sclerosis (SSc) patients, representing a challenging clinical problem. Despite a high negative predictive value, capillaroscopic scores proposed to select patients at risk for DU show an inadequate positive predictive value, especially in patients without previous DU. AIM OF THIS STUDY: To increase the predictive value for DU development of capillaroscopy, through a predictive risk chart taking into account capillaroscopic, demographic, and clinico-serological parameters. PATIENTS AND METHODS: Two hundred and nineteen unselected SSc patients from 8 Italian Rheumatology Centers were consecutively enrolled during a 6-month period. Demographic, clinical, serological and instrumental data and capillaroscopy skin ulcers risk index (CSURI) were collected. RESULTS: A multivariate logistic regression analysis showed a significant positive association between DU appearance and male gender, DU history, altered CSURI, and ESR. A prediction risk chart of the development of DU within 6 months were built on the basis of the above parameters. According to the risk level, four risk classes were identified: low (≤19.3%); medium (>19.3%, ≤58.6%); high (>58.6%, ≤89.2%), and very high risk (>89.2%). CONCLUSIONS: The systematic evaluation of the above parameters can be helpful to identify patients at risk to develop DU optimizing preventive vasoactive therapy.
Entities:
Keywords:
capillaroscopy; digital ulcers; predictive risk chart; systemic sclerosis
Authors: S Friedrich; S Lüders; A M Glimm; S G Werner; G Schmittat; G R Burmester; M Backhaus; G Riemekasten; S Ohrndorf Journal: Arthritis Res Ther Date: 2019-04-15 Impact factor: 5.156
Authors: Maurizio Cutolo; Ariane L Herrick; Oliver Distler; Mike O Becker; Emma Beltran; Patrick Carpentier; Clodoveo Ferri; Murat Inanç; Panayiotis Vlachoyiannopoulos; Harbajan Chadha-Boreham; Emmanuelle Cottreel; Thomas Pfister; Daniel Rosenberg; Juan V Torres; Vanessa Smith Journal: Arthritis Rheumatol Date: 2016-10 Impact factor: 10.995