Background Currently there's no clear understanding of the clinical course and outcomes of panniculitis with predominant involvement of subcutaneous adipose tissue (SAT), which is often associated with the involvement of locomotor system and viscera. Consistent elaboration of both is of paramount importance, as it may give a deeper insight into clinical and curative factors which may have impact on the disease prognosis.
Objectives To assess clinical outcomes of panniculitis (risk factors for recurrence and predictors of slow regression of indurations).
Methods 186 pts (172 females, 14 males) aged 43,5±14,5 years with different types of Pn, who were at the record of V. A. Nasonova Research Institute of Rheumatology during 2009–2015 yy. Disease duration varied from 1 week to 20 years. General clinical examination and lab tests (serum levels of α1-antitrypsin, amylase, lipase, ferritin, creatine phosphokinase (CPK), rheumatoid factor) (RF), ANF, anti-DNA, ANCA), bacteriological and serological tests, radiological examination (chest CT scan), ultrasound examinations of skin and subcutaneous fat (SF) around the nodules, tuberculin skin test and histopathology of nodular skin samples were performed at baseline. Patients were re-tested during the follow up (FUP) when necessary.
Results Female middle-aged patients prevailed in the study group with the disease duration from 1 week to 25 years. Saucer-like depressions as a Pn - specific phenomenon was documented in 28,5% cases. The estimated risk of saucer-like depressions was higher in patients who manifested Pn at the age of >40 years (OR 4,9, 95% CI 2,3–10,4; p<0,0001); this subgroup also showed lesion proneness to confluence and forming of irregular shape conglomerates (OR 2,9, 95% CI 1,45–5,7; p=0,002), tendency to forming large size >3 cm lesions (OR 4,96, 95% CI 2,2–10,97; p<0,0001), and the disease lasting over 3 months (OR 24,9, 95% CI 9,2–67,4; p<0,0001). All pts were re-examined within 1–6 years. Median time to onset of nodules regression was 2 [1;6] months. Recurrences were documented in 66 (35,5%) pts during the follow up. Logistic regression was used for multivariate statistical analysis in order to identify the potential predictors of delayed (>3 months) nodules regression and recurrence risk factors. Used model identified the following predictors of delayed nodules regression (i.e., disease regression): age >40 years (OR 2,58; CI 1,02–6,5; p=0,04), and presence of saucer-like depressions (OR 5,05; CI 1,2–21,7; p=0,03). The sensitivity of used statistical model was 70%, specificity – 71%, positive predictive value - 74%. Disease duration >3 months (OR 4,7; CI 2,0–10,6; p=0,0002) was identified by our model as the predictor of recurrences with 60% sensitivity, 78% specificity, and 59% positive predictive value.
Conclusions Pn tends to regress more slowly in pts aged over 40 and in pts having saucer-like depressions. Trend to recurrences is not so evident in Pn, although probability of recurrence increases in pts with longer disease duration at the time of initiation of therapy.
Disclosure of Interest None declared