Calcinosis is associated with digital ulcers and osteoporosis in patients with systemic sclerosis: A Scleroderma Clinical Trials Consortium study

Abstract

Objectives We sought to identify the clinical factors associated with calcinosis in an international multicenter collaborative effort with the Scleroderma Clinical Trials Consortium (SCTC). Methods This is a retrospective cohort study of 5218 patients with systemic sclerosis (SSc). Logistic regression was used to obtain odds ratios (OR) relating calcinosis to various clinical features in multivariate analyses. Results A total of 1290 patients (24.7%) had calcinosis. In univariate analyses, patients with calcinosis were older than patients without calcinosis, more likely to be female, and had longer disease duration from the first non-Raynaud phenomenon symptom. Patients with calcinosis were more likely to have digital ulcers, telangiectasias, acro-osteolysis, cardiac disease, pulmonary hypertension, gastrointestinal involvement, arthritis, and osteoporosis, but less likely to have muscle disease. Anti-Scl-70, RNA-polymerase-III, and U1-RNP autoantibodies were significantly less common in patients with calcinosis, while anticentromere (ACA), anti-PM/Scl, and anticardiolipin antibodies were more frequent. In multivariate analysis, the strongest associations with calcinosis were digital ulcers (OR = 3.9; 95% CI: 2.7–5.5; p < 0.0001) and osteoporosis (OR = 4.2; 95% CI: 2.3–7.9; p < 0.0001). Conclusion One quarter of patients with SSc have calcinosis at some time during their illness. Our data confirm a strong association of calcinosis with digital ulcers, and support a novel association with osteoporosis.

Scleroderma in Cairns: an epidemiological study

“…On the other hand, the higher prevalence of calcinosis in the Cairns cohort, also thought to be a long‐term consequence of digital ischemia, argues against the possibility that the lower prevalence of digital ulcers is due to shorter disease duration or less cold‐induced ischaemia in the Cairns cohort . This is also out of keeping with the findings of a previous multi‐centre cohort study, which found a strong association of calcinosis with digital ulcers, in cohorts from temperate areas around the world, including Canada and the United Kingdom . Hence, while some disease features may be ameliorated by living in the tropics, the prevalence of other features, such as calcinosis, is not affected by the warmer climate.…”

Validation of a Novel Radiographic Scoring System for Calcinosis Affecting the Hands of Patients With Systemic Sclerosis

“…We previously reported in a multicenter international cohort of 7,056 SSc patients an overall frequency of calcinosis of 22%. We also demonstrated that patients with calcinosis had longer mean disease duration from the first non–Raynaud's phenomenon symptom than those without .…”

Acroosteolysis of distal phalanges in patient with systemic sclerosis – case report

“…Valenzuela i wsp. zaobserwowali u tych pacjentów zwiększone ryzyko wystąpienia owrzodzeń opuszek palców, a także zajęcia układu krążenia oraz układu pokarmowego i oddechowego [7]. Wyniki badań kohortowych potwierdzają również statystycznie częst-sze występowanie zaburzeń kostnych i wapnienia tkanek u osób, u których stwierdzono przeciwciała antycentromerowe (ACA), niż u osób z przeciwciałami przeciwko topoizomerazie I (Scl-70) [7].…”

“…trzeszczenie stawów, które spowodowane jest zmianami w obrębie ścięgien (objaw tarcia ścięgien). Ponadto u większości osób z SSc w badaniu rentgenograficznym (RTG) kość-ca opisuje się odkładanie złogów wapnia zarówno w okolicach okołostawowych, jak i w innych lokalizacjach [5][6][7]. Resorpcja kostna dystalnych paliczków dłoni opisywana jest rzadko, jednak uważa się, że może występować nawet u ponad 25% chorych na SSc [6], co przyczynia się do stopniowego zaniku kostnego, a w przypadkach skrajnych nawet do cał-kowitej resorpcji kości.…”