Risk factors for incident digital ischemic complications in systemic sclerosis in the Collaborative National Quality and Efficacy Registry (CONQUER)

Marissa Savoie¹, Monica Harding², John VanBuren², Shervin Assassi³, Elana Bernstein⁴, Lorinda Chung⁵, Luke Evnin⁶, Tracy Frech⁷, Jessica Gordon¹, Faye Hant⁸, Laura Hummers⁹, Dinesh Khanna¹⁰, Kimberly Lakin¹, Dorota Lebiedz-Odrobina², Yiming Luo⁴, Ashima Makol¹¹, Maureen Mayes¹², Zsuzsanna McMahan¹³, Jerry Molitor¹⁴, Duncan Moore¹⁵, Carrie Richardson¹⁶, Nora Sandorfi¹⁷, Ami Shah⁹, Ankoor Shah¹⁸, Brian Skaug¹⁹, Virginia Steen²⁰, Elizabeth Volkmann²¹, Carleigh Zahn¹⁰ and Flavia Castelino²², ¹Hospital for Special Surgery, New York, NY, ²University of Utah, Salt Lake City, UT, ³Division of Rheumatology, UTHealth Houston, Houston, Texas, USA, Houston, TX, ⁴Columbia University, New York, NY, ⁵Stanford University, Stanford, CA, ⁶Scleroderma Research Foundation, Brisbane, CA, ⁷Vanderbilt University Medical Center, Nashville, TN, ⁸Medical University of South Carolina, Charleston, SC, ⁹Johns Hopkins Rheumatology, Baltimore, MD, ¹⁰University of Michigan, Ann Arbor, MI, ¹¹Mayo Clinic, Rochester, MN, ¹²UT Health Houston Division of Rheumatology, Houston, TX, ¹³UT Health Houston, Houston, TX, ¹⁴University of Minnesota, Minneapolis, MN, ¹⁵Northwestern Memorial Hospital, Chicago, IL, ¹⁶Northwestern University, Chicago, IL, ¹⁷University of Pennsylvania, Philadelphia, PA, ¹⁸Duke University, Durham, NC, ¹⁹UTHealth Houston Division of Rheumatology, Houston, TX, ²⁰Georgetown University School of Medicine, Washington, DC, ²¹Division of Rheumatology, Department of Medicine, University of California, David Geffen School of Medicine, Los Angeles, CA, USA, Los Angeles, CA, ²²Massachusetts General Hospital, Boston, MA

Meeting: ACR Convergence 2025

Keywords: Raynaud's Disease, Raynaud's phenomenon, Scleroderma, Systemic sclerosis, Ulcers

Session Information

Date: Monday, October 27, 2025

Title: (1553–1591) Systemic Sclerosis & Related Disorders – Clinical Poster II

Session Type: Poster Session B

Session Time: 10:30AM-12:30PM

Background/Purpose: There have not been large US-based studies of digital pitting scars (DPS) and digital ischemic ulcers (DIU) in systemic sclerosis. Utilizing the Collaborative National Quality and Efficacy Registry (CONQUER) cohort, we describe the prevalence, incidence, and quality of life impact of DPS and DIU and determine factors associated with the development of DPS or DIU.

Methods: CONQUER is a US-based, prospective, multi-center cohort of adults (age ≥18) with SSc who meet 2013 ACR/EULAR Classification Criteria and have a disease duration ≤5 years from first non-Raynaud’s symptom at enrollment. As of December 31st, 2024, 1113 participants with mean follow-up of 24 months were enrolled. At each visit, investigators noted the presence of DPS and DIU and collected demographic, clinical and laboratory variables. Multivariable logistic regression models were designed using directed acyclic graphs.

Results: The mean age at study entry was 52.5 years, 83% were female, 65% had diffuse cutaneous SSc and 64% had interstitial lung disease. At baseline, 20% had current DPS and 5% had DIU. Younger age at baseline, non-Hispanic Black or African American race, telangiectasias of face or lips, and positive Scl-70 antibody were associated with DPS at baseline (Table 1). Younger age was associated with DIU at baseline (Table 1). In contrast to the variables associated with DPS, positive Scl-70 antibody was associated with lower odds of DIU at baseline. During the first year in CONQUER, 14% developed new DPS and 15% developed new DIU. Analyses of demographic and SSc-related factors did not reveal significant predictors for time to development of first DPS or DIU (Figures 1 and 2). The presence of DIU, but not DPS, was associated with higher PROMIS-29 scales (worse symptom burden) from anxiety (OR 1.38, 95% CI 1.05 to 1.81), depression (OR 1.57, 95% CI 1.18 to 2.10), and pain (OR 1.40, 95% CI 1.04 to 1.89).

Conclusion: In this large, prospective US cohort of participants with early SSc, 14% developed DPS and 15% developed DIU in the first year of study. Non-Hispanic Black or African American race and younger age were associated with DPS, while younger age was associated with DIU. Although we did not identify significant predictors of incident DPS or DIU, DIU were associated with worse symptom burden. These findings underscore the importance of early vascular assessment in SSc and support further study to reduce ischemic complications and improve patient outcomes.

Table 1: Multivariable logistic regression of systemic sclerosis (SSc) characteristics and vascular risk factors with the presence of digital pitting scars and digital ischemic ulcers at baseline

Figure 1: Survival analysis of demographic and systemic sclerosis-related factors in association

with time to digital pitting scar

Figure 2: Survival analysis of demographic and systemic sclerosis-related factors in association

with time to ischemic digital ulcers

Disclosures: M. Savoie: None; M. Harding: None; J. VanBuren: None; S. Assassi: AbbVie, 2, AstraZeneca, 2, aTyr, 2, 5, Boehringer Ingelheim, 2, 5, 6, 12, Medical writing support provided by Fleishman Hillard, CSL Behring, 2, Janssen, 5, Merck, 2, Mitsubishi Tanabe, 2, PeerView Institute for Medical Education, 6, Scleroderma Research Foundation, 5, 6, Takeda, 2, TeneoFour, 2; E. Bernstein: AstraZeneca, 5, aTyr, 5, Boehringer-Ingelheim, 2, 5, Bristol-Myers Squibb(BMS), 5, Cabaletta Bio, 5, Synthekine, 2; L. Chung: AbbVie/Abbott, 1, Boehringer-Ingelheim, 1, CRISPR Therpeutics, 2, Cure Ventures, 2, jade, 2, Kyverna, 6, Mediar, 1, 2; L. Evnin: None; T. Frech: None; J. Gordon: Cumberland, 5, Prometheus/Merck, 5; F. Hant: None; L. Hummers: AbbVie/Abbott, 1, AstraZeneca, 5, Biotest, 2, Boehringer-Ingelheim, 1, 5, Cumberland Pharmaceuticals, 5, GlaxoSmithKlein(GSK), 5, Horizon Pharma, 5, Merck/MSD, 5, Mitsubishi Tanabe, 5; D. Khanna: Argenx, 2, AstraZeneca, 2, Boehringer-Ingelheim, 2, Bristol-Myers Squibb(BMS), 2, Cabaletta, 2, Novartis, 2, UCB, 2, Zura Bio, 2; K. Lakin: None; D. Lebiedz-Odrobina: None; Y. Luo: None; A. Makol: Amgen, 12, Site PI for Clinical trial, AstraZeneca, 12, Site PI for Clinical trial, Boehringer-Ingelheim, 1, 12, Site PI for Clinical trial, Sanofi Genzyme, 12, Site PI for Clinical trial; M. Mayes: Argenx, 2, AstraZeneca, 5, atyr, 5, Boehringer-Ingelheim, 5, Bristol-Myers Squibb(BMS), 1, 5, h, 5, Novartis, 2, prometheus merck, 5; Z. McMahan: Aera Therapeutics, 2, Allogene, 2, Boehringer-Ingelheim, 2, guidepoint, 2; J. Molitor: None; D. Moore: AstraZeneca, 5; C. Richardson: Cabaletta Bio, 2; N. Sandorfi: Bristol-Myers Squibb(BMS), 2, Immunovant, 2, Janssen, 2, Novartis, 1; A. Shah: None; A. Shah: Adtium Bio, 2, Cabaletta Bio, 5, Horizon Therapeuatics, 5, Mitsubishi, 2; B. Skaug: None; V. Steen: None; E. Volkmann: AbbVie, 2, Boehringer-Ingelheim, 2, 5, 6, 12, Medical writing support provided by Fleishman Hillard, Bristol-Myers Squibb(BMS), 2, GlaxoSmithKleine, 2, 5, Horizon, 5, Kadmon, 5, Prometheus, 5, The National Heart, Lung and Blood Institute, 5; C. Zahn: None; F. Castelino: Boehringer-Ingelheim, 2, Genentech, 5, Horizon, 5, Mediar Therapeutics, 1, Takeda, 1.

To cite this abstract in AMA style:

Savoie M, Harding M, VanBuren J, Assassi S, Bernstein E, Chung L, Evnin L, Frech T, Gordon J, Hant F, Hummers L, Khanna D, Lakin K, Lebiedz-Odrobina D, Luo Y, Makol A, Mayes M, McMahan Z, Molitor J, Moore D, Richardson C, Sandorfi N, Shah A, Shah A, Skaug B, Steen V, Volkmann E, Zahn C, Castelino F. Risk factors for incident digital ischemic complications in systemic sclerosis in the Collaborative National Quality and Efficacy Registry (CONQUER) [abstract]. Arthritis Rheumatol. 2025; 77 (suppl 9). https://acrabstracts.org/abstract/risk-factors-for-incident-digital-ischemic-complications-in-systemic-sclerosis-in-the-collaborative-national-quality-and-efficacy-registry-conquer/. Accessed .

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