Calcinosis is associated with digital ischaemia in systemic sclerosis-a longitudinal study

Area of Science:

• Rheumatology
• Vascular Medicine
• Dermatology

Background:

• Calcinosis is a common complication in systemic sclerosis (SSc).
• The underlying mechanisms driving calcinosis in SSc remain incompletely understood.
• Investigating potential contributing factors like ischemia is crucial for SSc management.

Purpose of the Study:

• To investigate the potential causal role of digital ischemia in the development of calcinosis among patients with SSc.
• To identify associations between digital ischemia, nailfold capillary abnormalities, and calcinosis in SSc.
• To explore predictors for calcinosis development over time in an SSc cohort.

Main Methods:

• Longitudinal assessment of 1305 SSc patients over a median of 4 years.
• Systematic recording of calcinosis, digital ischemia (ulcers, necrosis, amputation), and nailfold capillary dropout.
• Statistical analysis using logistic regression and Cox proportional hazards models to determine associations.

Main Results:

• Calcinosis at baseline was significantly associated with digital ischemia (OR=2.37) and capillary dropout (OR=1.41).
• Digital ischemia (HR=1.82) and capillary dropout (HR=1.46) were significant predictors for new-onset calcinosis during follow-up.
• Specific SSc autoantibodies, including anti-centromere antibodies (ACA) and anti-RNA polymerase III, were also associated with calcinosis.

Conclusions:

• Digital ischemia appears to be a significant contributing factor in the pathogenesis of calcinosis in SSc.
• Nailfold capillary abnormalities and specific autoantibodies further correlate with calcinosis development.
• These findings highlight the importance of monitoring and managing vascular complications in SSc to potentially mitigate calcinosis risk.