Background/Purpose: Among the cutaneous manifestations of SLE, critical peripheral ischemia (CPI) including digital infarcts and gangrene are considered rare, gangrene occurring only in about 0.2% as initial presentation and in 1.2% in the longest longitudinal cohort with a follow up of 44 years¹. Whether vasculitis or thrombosis or both contribute to these remains debated. We report the incidence, associations and outcome of digital infarcts and gangrene in the Indian Systemic Lupus Erythematosus(SLE) Cohort.

Methods: From the ongoing prospective INdian SLE inception cohort For Research (INSPIRE), baseline data on CPI was accessed with key terms: ‘Digital Infarct’ and ‘Digital gangrene’ in May 2023. Association with other clinical domains and autoantibodies including antiphospholipid antibodies were analysed between cases and controls (all others without digital infarcts or gangrene). Adjusted odds ratios were reported using multivariable logistic regression analysis to identify the factors associated with gangrene and or digital infarcts

Results: Of 2503 patients in the INSPIRE cohort, 79 (3.2%) patients had CPI at initial presentation. Their mean age was 28.7±9.5 years including 9 (11.3%) children and 76(96.2%) women. There were 92 events (gangrene 47, digital infarcts 45 and with both gangrene and infarcts in 13). The duration of CPI symptoms was 7.0 ±11.9 days. None of the CPI patients were smokers.

The presence of coexistent thrombosis AOR[10.2(3.91,24.5)](p< 0.001), Raynaud’s phenomenon AOR[6.41(1.83,17.4)] (p< 0.006) and longer disease duration prior to diagnosis AOR[1.01(1.00,1.02)] (p< 0.007) were significantly associated with the presence of CPI in SLE patients. The presence of anti Scl-70 antibody AOR[5.34(1.78,13) (p< 0.008) and the antiphospholipid antibodies including lupus anticoagulant {AOR for triple positivity [3.75(1.10,9.70)](p< 0.05)} were significantly associated with higher odds of CPI positivity.(Table 1) None of Scl-70 positive patients had features of scleroderma. The disease activity as measured by SLEDAI and the proportion of early mortality were similar in those with and without CPI.

Conclusion: Critical peripheral ischemia occurred in a higher proportion (3.2%) of SLE patients in the INSPIRE cohort as compared to earlier reports. Both prothrombotic state and vasculopathy contribute to its occurrence.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/associations-and-outcomes-of-critical-peripheral-ischemia-in-systemic-lupus-erythematosus-sle-data-from-indian-sle-inception-cohort-for-research-inspire/