Key result
History of digital ulcers in systemic sclerosis is linked to ~2.2-fold higher odds of carotid plaque.
Why the study?
The association between digital ulcers and carotid artery atherosclerosis in systemic sclerosis patients had not been analyzed.
Does a history of digital ulcers correlate with macrovascular impairment and subclinical carotid atherosclerotic plaques in patients with systemic sclerosis?
Cross-Sectional (n=107)
Outcome assessors blinded to patient characteristics
No
Does a history of digital ulcers correlate with macrovascular impairment and subclinical carotid atherosclerotic plaques in patients with systemic sclerosis?
Odds Ratio: 2.25
Absolute Event Rate: 58.1% vs 38.2%
p-value: p=0.015
Digital ulcers in systemic sclerosis not only signify severe microvascular damage but also represent an important clinical marker for an increased burden of subclinical carotid macrovascular atherosclerosis.
May flag systemic sclerosis patients for carotid evaluation; hypothesis-generating for macrovascular risk beyond microvascular disease.
Patients with systemic sclerosis (SSc) usually develop Raynaud's phenomenon, persistent digital ischemia and sometimes develop digital ulcers (DU). Several studies have reported an association of carotid artery atherosclerosis with SSc by evaluating carotid intima-media thickness (IMT) in SSc patients. However, none of those studies analyzed the association between DU and carotid artery atherosclerosis in SSc patients. We examined the association of carotid artery atherosclerosis with digital ulcers by comparing SSc patients with (n = 48, 29.5%) and without (n = 206, 70.5%) DU. The demographic and clinical features of the SSc patients showed that young age, male sex, anti-topoisomerase I antibody positivity, severe skin sclerosis, interstitial lung disease complication and cardiac involvements were significantly prevalent in patients with DU. In addition, diffuse cutaneous type, anti-RNA polymerase III antibody positivity and severe skin sclerosis are more frequent in SSc patients with DU at the extensor surface of joints than SSc patients with DU at the digital tip. There were no differences in serum lipid level, carotid IMT or plaque score between SSc patients with and without DU, suggesting that atherosclerotic changes are not primarily involved in the development of DU.
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Motegi et al. (2014) conducted a cross-sectional in Systemic sclerosis (n=107). History of digital ulcers vs. No history of digital ulcers was evaluated on Presence of atherosclerotic plaques at any site (adjusted OR 2.25, p=0.015). In patients with systemic sclerosis, a history of digital ulcers was independently associated with an increased risk of carotid atherosclerotic plaques (adjusted OR 2.25, p=0.015).
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