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Clinical burden of digital vasculopathy in limited and diffuse cutaneous systemic sclerosis
  1. S I Nihtyanova,
  2. G M Brough,
  3. C M Black,
  4. C P Denton
  1. Centre for Rheumatology, Royal Free Hospital, Pond Street, London, UK
  1. Professor C P Denton, Centre for Rheumatology, Royal Free Hospital, Pond Street, London NW3 2QG, UK; c.denton{at}medsch.ucl.ac.uk

Abstract

Background: Vascular damage is a key pathological process in systemic sclerosis (SSc) and accounts for significant disease-related morbidity. To determine the clinical burden of severe digital vasculopathy (SDV), we have reviewed hospital-based treatment for this important complication of SSc in a large single centre cohort.

Methods: Cases were identified from a cohort of 1168 patients with a diagnosis of SSc who were reviewed during an 18-month period. Patients with recorded episodes of SDV-related complications (digital ulceration, critical digital ischaemia or digital gangrene), requiring surgical amputation, digital sympathectomy or admissions for intravenous prostacyclin or calcitonin gene related peptide (CGRP) and/or intravenous antibiotic treatment were identified.

Results: From this large SSc cohort, 17.4% had SDV-related complications. Contrary to expectation, their frequency was significantly higher among the patients with the diffuse cutaneous subset of SSc (27.5%) compared with 13% among the patients with limited cutaneous SSc (p<0.0001). 16.6% had at least one recorded episode of digital ulcers, and 12% required at least one hospitalisation during the 18 months for treatment with intravenous prostacyclin/CGRP. Overall, there were 242 admissions with a mean duration of 6 days.

Conclusions: Digital vasculopathy is a serious complication of SSc contributing significant morbidity and often requiring hospital-based management.

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Footnotes

  • Competing interests: None declared.

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