Risk of digital ulcers occurrence in systemic sclerosis: a cross-sectional study

Horimoto, Alex Magno Coelho; Souza, Albert Schiaveto de; Rodrigues, Sílvia Helena; Kayser, Cristiane

doi:10.1186/s42358-019-0057-9

Cited by 7 publications

(5 citation statements)

References 36 publications

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“…Given these, we constructed a DU cohort to confirm the effect of IGU. We compared most of the known clinical risk factors for the new DUs, including the onset of the disease at a younger age (41)(42)(43), dcSSc (42,44,45), DU(s) ever (44,45), elevated ESR (46), anti-TOPO (41,47), presence of ILD (42), certain capillaroscopic phenotype (47,48), and heavy smoking (>25 pack-years) (49), as well as some risk factors with conflicting results, such as sex (41,46,50), disease duration (42,51), and presence of PH (42,43). None of these factors was statistically different between patients with and without IGU therapy.…”

Section: Discussionmentioning

confidence: 99%

Iguratimod as an alternative therapy for systemic sclerosis and prevention of the occurrence of ischemic digital ulcer

Yan,

Liu,

Wang

et al. 2023

Front. Med.

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ObjectivesThis study aimed to assess the effectiveness of iguratimod (IGU) as an alternative treatment for systemic sclerosis (SSc), especially in the prevention of ischemic digital ulcers (DUs).MethodsWe constructed two cohorts from the Renji SSc registry. In the first cohort, SSc patients receiving IGU were observed prospectively with effectiveness and safety. In the second cohort, we picked up all the DU patients with at least a 3-month follow-up to investigate the prevention of IGU on ischemic DU.ResultsFrom 2017 to 2021, 182 SSc patients were enrolled in our SSc registry. A total of 23 patients received IGU. With a median follow-up of 61 weeks (IQR: 15–82 weeks), the drug persistence was 13/23. In total, 91.3% of the patients (21/23) became free of deterioration in the last visit with IGU. Of note, 10 patients withdrew from the study due to the following reasons: two patients withdrew due to deterioration, three due to incompliance, and five due to mild-to-moderate side effects. All the patients with side effects recovered fully after stopping IGU. Of note, 11 patients had ischemic DU, and 8 out of 11 (72.7%) patients had no new occurrence of DU during the follow-up. In the second cohort of 31 DU patients receiving a combination of vasoactive agents with a median follow-up of 47 weeks (IQR, 16–107 weeks), IGU treatment was protective of new DU occurrence (adjusted risk ratio = 0.25; 95% CI, 0.05–0.94; adjusted odds ratio = 0.07; and 95% CI, 0.01–0.49).ConclusionOur study for the first time describes the potential of IGU possibly as an alternative treatment for SSc. To our surprise, this study provides a hint that IGU treatment can be used for the prevention of the occurrence of ischemic DU and merits further investigation.

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Section: Discussionmentioning

confidence: 99%

Iguratimod as an alternative therapy for systemic sclerosis and prevention of the occurrence of ischemic digital ulcer

Yan,

Liu,

Wang

et al. 2023

Front. Med.

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“…Pitting scars of the fingertips are observed in 40-70% of patients with SSc [10,11] (Figure 4(a)). Probably because they are highly specific to SSc in comparison with Raynaud's phenomenon and nailfold bleeding, fingertip pitting scars is included in the Japanese diagnostic criteria [4] and 2013 ACR/ EULAR criteria for the classification [12].…”

Section: Pitting Scarsmentioning

confidence: 99%

‘Narrow-sense’ and ‘broad-sense’ vascular abnormalities of systemic sclerosis

Jinnin

2020

Immunological Medicine

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Systemic sclerosis (SSc) induces skin thickening and numerous symptoms involving the entire body. Collagen deposition, immune disorder, and vascular abnormalities is currently estimated to be three major causal factors involved in the respective conditions. Vascular abnormalities usually develop in the initial phase of this disease, and may exist in all phases; therefore, they markedly influence the patient's quality of life. This article reviews recent findings about 'narrow-sense' vascular lesions (including Raynaud's phenomenon, skin ulcers, nailfold bleedings, pitting scars, telangiectasia, and pulmonary hypertension) and 'broadsense' vascular lesions (such as calcinosis or erectile dysfunction). Affected blood vessels can be classified into arteriole/small artery and capillary blood vessels. Furthermore, pathological changes include the proliferation of the vascular endothelial or smooth muscle cells, lumen stenosis by collagen accumulation of the vascular intima, vasodilation or fragility, and apoptosis. There may be interaction between vascular lesions, autoimmune disorder, and collagen deposition. Thus, various symptoms of this disease may be controlled through the treatment of vascular lesions.

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“…In this prospective observational cohort study, 70 patients with SSc attending the Rheumatology Division of the University Hospital Maria Aparecida Pedrossian of the Federal University of Mato Grosso do Sul (UFMS) and of the Federal University of São Paulo (UNIFESP) were consecutively selected from March 2016 to April 2017 (baseline data published in Advances in Rheumatology DOI: https://doi.org/10.1186/s42358-019-0057-9) [16]. All patients were evaluated in four visits: at baseline and after 6, 12 and 24 months of follow-up.…”

Section: Study Design and Patientsmentioning

confidence: 99%

Anti-annexin V autoantibodies and vascular abnormalities in systemic sclerosis: a longitudinal study

et al. 2020

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Background: Annexins are a group of conserved proteins which exert several regulatory functions on various cellular activities. Increased frequency and levels of antibodies against annexin V have already been observed in several autoimmune diseases including systemic sclerosis (SSc), but their role as a vascular biomarker is unknown. The aim of this study was to determine the serum levels and the dynamical behavior of anti-annexin V antibodies over a 24 months follow-up in patients with SSc. Methods: In this bicentric cross-sectional study, 70 patients with SSc were consecutively selected from March 2016 to April 2017. Demographic and clinical features, including the presence of active DUs, were collected. Serum antiannexin V IgG and IgM antibodies were measured at baseline and after 6, 12 and 24 months of follow-up. Videocapillaroscopy was performed in all patients. Results: Among the 70 SSc patients included anti-annexin V IgG was found in 11 patients (15.7%) (range of 15.88-39.48 U/mL) and anti-annexin V IgM in 10 patients (14.3%) (range of 14.16-22.69 U/mL) at baseline. During followup, the number of patients who were positive for anti-annexin V IgG and IgM remained stable over 24 months. Among the patients with positive anti-annexin V IgG at baseline the frequency of patients with necrosis or amputation of extremities, forced vital capacity less than 70% and pulmonary arterial hypertension (PAH) was significantly higher than in patients with negative anti-annexin V IgG antibodies. Patients with anti-annexin V IgG had also a higher Raynaud's Condition Score and a higher Health Assessment Questionnaire Disability Index (HAQ-DI) than patients without these antibodies at baseline. Patients with positive anti-annexin V IgM at baseline presented a higher frequency of PAH, compared to those with negative anti-annexin V IgM at baseline. Conclusions: Anti-annexin V antibodies are stable and do not change their positivity during a 24 month follow-up in SSc patients. Anti-annexin V IgG was associated with more severe interstitial lung involvement and digital microangiopathy, and patients with anti-annexin V IgG or IgM had a higher occurrence of PAH indicating an association of these biomarker with more severe disease.

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Risk of digital ulcers occurrence in systemic sclerosis: a cross-sectional study

Cited by 7 publications

References 36 publications

Iguratimod as an alternative therapy for systemic sclerosis and prevention of the occurrence of ischemic digital ulcer

Iguratimod as an alternative therapy for systemic sclerosis and prevention of the occurrence of ischemic digital ulcer

‘Narrow-sense’ and ‘broad-sense’ vascular abnormalities of systemic sclerosis

Anti-annexin V autoantibodies and vascular abnormalities in systemic sclerosis: a longitudinal study

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