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Digital gangrene in systemic sclerosis patients: not only due to the microvascular disease

Min Hui1, Jiaxin Zhou1, Mengtao Li1

  • 1Department of Rheumatology and Clinical Immunology National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology State Key Laboratory of Complex Severe and Rare Diseases Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.

Clinical Rheumatology
|February 1, 2024
PubMed

Insights

Smoking, certain antibodies (ACA, ANCA, anti-phospholipid), and elevated ESR are key risk factors for digital gangrene in Scleroderma (SSc) patients. Vasculitis and macrovascular issues may also drive this condition.

Area of Science:

  • Rheumatology
  • Immunology
  • Vascular Medicine

Background:

  • Digital gangrene is a severe complication in Systemic Sclerosis (SSc).
  • Understanding its risk factors and underlying mechanisms is crucial for patient management.

Purpose of the Study:

  • To investigate the characteristics, risk factors, and outcomes of digital gangrene in SSc patients.
  • To determine if vasculitis contributes to digital gangrene in SSc.

Main Methods:

  • Retrospective case-control study from February 2003 to April 2021.
  • Included 43 SSc patients with digital gangrene and 146 SSc controls without gangrene.
  • Utilized univariate and multivariate logistic regression to identify risk factors.

Main Results:

  • SSc patients with digital gangrene showed higher rates of Raynaud's phenomenon and digital ulcers.
  • Independent risk factors identified include smoking history, anti-centromere antibody (ACA), anti-neutrophil cytoplasmic antibody (ANCA), anti-phospholipid antibody (aPL) positivity, and elevated erythrocyte sedimentation rate (ESR).
  • 18.6% of cases had macrovascular stenosis; treatment often involved immunosuppressive and vasodilating therapies.

Conclusions:

  • Smoking, ACA, ANCA, aPL positivity, and elevated ESR are significant independent risk factors for digital gangrene in SSc.
  • Vasculitis and macrovascular disease are implicated in the pathogenesis and progression of digital gangrene in SSc patients.
Abstract

Keywords:
AutoantibodiesCase–control studyRisk factorsSystemic sclerosisVasculitis

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