ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 830

Calcinosis Is Associated with Digital Ulcers and Osteoporosis in Patients with Systemic Sclerosis

Antonia Valenzuela1, Murray Baron2, Ariane L. Herrick3, Susana Proudman4, Wendy Stevens5, Tatiana Sofia Rodriguez-Reyna6, Alessandra Vacca7, Thomas A. Medsger Jr.8, Monique Hinchcliff9, Vivien Hsu10, David Fiorentino11, Lorinda Chung12 and the Canadian Scleroderma Research Group, and the ASIG rubric, 1Stanford University School of Medicine, Stanford, CA, 2Rheumatology, McGill University, Jewish General Hospital, Montreal, QC, Canada, 3Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom, 4Rheumatology Unit, Royal Adelaide Hospital North Terrace, Adelaide, Australia, 5Department of Rheumatology, St. Vincent’s Hospital Melbourne, Melbourne, Australia, 6Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, 7University Hospital of Cagliari, Rheumatology Unit, Monserrato, Italy, 8Department of Medicine/Rheumatology, University of Pittsburgh, Pittsburgh, PA, 9Rheumatology, Northwestern University, Chicago, IL, 10Rheumatology, RWJ Med Schl Scleroderma Prog, New Brunswick, NJ, 11Department of Dermatology, Stanford University School of Medicine, Palo Alto, CA, 12Stanford University, Palo Alto, CA

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: , ,

Session Information

Date: Sunday, November 8, 2015

Title: Systemic Sclerosis, Fibrosing Syndromes and Raynaud's - Clinical Aspects and Therapeutics Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Calcinosis is a
debilitating complication of systemic sclerosis (SSc). We sought to determine
the clinical factors associated with calcinosis in an international
multi-center collaborative effort with the Scleroderma Clinical Trials
Consortium (SCTC).

Methods: This is a retrospective
cohort study of 5180 patients with SSc from 9 centers within the US, Australia,
Canada, United Kingdom, Italy, and Mexico. Calcinosis was determined by
physical examination and/or radiography. Logistic regression was used to obtain
odds ratios (OR) relating calcinosis to various clinical features in
multivariate analyses adjusted for disease duration, gender, and modified
Rodnan skin score (mRSS).

Results: A total of 1290 patients
(24.4%) had calcinosis. In univariate analyses (Table), not correcting for
multiple comparisons, patients with calcinosis were older than patients without
calcinosis, more likely to be female, and had longer disease duration from
first non-Raynaud symptom. Patients with calcinosis were more likely to have
digital ulcers, telangiectasias, and acro-osteolysis, cardiac disease,
pulmonary hypertension, gastrointestinal involvement, and arthritis, but less
likely to have myositis. Osteoporosis was much more common in patients who had
calcinosis. Scl-70, RNA-polymerase-III, and RNP autoantibodies were
significantly less common in patients with calcinosis, while anticentromere
(ACA), PM-1, and anticardiolipin were more frequent. In multivariate analysis,
the strongest associations with calcinosis were digital ulcers (OR 3.7, 95%CI
2.6-5.3, p<0.0001), and
osteoporosis (OR 3.9, 95%CI 2.1-7.4, p<0.0001).
After controlling for steroid use and body mass index in the model, the
association with osteoporosis persisted in stratified analyses in non-obese
patients (OR 6.5, 95%CI 1.8-23.8, p=0.004).

Conclusion: Almost one quarter of
patients with SSc have calcinosis. Our data support a strong association of
calcinosis with digital ulcers and osteoporosis in non-obese patients. We were
successfully able to gather data from many sources, which markedly increased
the power of our study in this rare disease. Our study sets a precedent for
future studies of calcinosis in SSc and our results may guide the development
of future therapies.

Table. Non-stratified univariate
and multivariate analyses (calcinosis is the dependent variable).

n (%)

 Univariate analysis

 Multivariate analysis
OR

 95%CI

 p-value

 OR

 95%CI

 p-value
Age at last visit

4929 (93.4)

 1.02

 1.01 – 1.02

 <0.0001
Disease duration

5052 (95.7)

 1.05

 1.04 – 1.05

 <0.0001

 –

 –

 –
Female

 5218 (98.8)

 1.6

 1.3 – 1.9

 <0.0001

 2.8

 1.4 – 5.7

 0.0038
Obese

3473 (65.8)

 0.8

 0.6 – 0.9

 0.0133
Steroids use ever

3503 (66.3)

 0.7

 0.6 – 0.8

 <0.0001
mRSS >11

 4978 (94.3)

 1.1

 0.98 – 1.3

 0.0759

 –

 –

 –
Raynaud’s phenomenon

 5199 (98.5)

 2.9

 1.7-  4.9

 <0.0001
Digital ulcers

 4992 (94.5)

 3.6

 3.2 – 4.2

 <0.0001

 3.7

 2.6-  5.3

 <0.0001
Digital pitting scars

 5182 (98.1)

 3.0

 2.7 – 3.5

 <0.0001
Loss of digital pulp

 3452 (65.4)

 2.9

 2.5 – 3.4

 <0.0001
Nailfold capillary changes

 3826 (72.5)

 2.7

 2.3-  3.2

 <0.0001
Puffy fingers

 4922 (93.2)

 0.8

 0.7 – 0.9

 0.0232

 0.6

 0.4 – 0.9

 0.0179
Sclerodactyly

 5204 (98.6)

 1.6

 1.3 – 2.0

 <0.0001
Acroosteolysis

 1156 (21.9)

 3.5

 2.5 – 4.9

 <0.0001
Telangiectasias

 4888 (92.6)

 4.1

 3.4 – 4.9

 <0.0001

 3.5

 2.1 – 5.7

 <0.0001
Osteoporosis

 2127 (40.3)

 10.2

 6.9 – 15.0

 <0.0001

 3.9

 2.1 – 7.4

 <0.0001
Cardiac disease

 4907 (92.9)

 1.6

 1.3 – 1.9

 <0.0001

 1.9

 1.1 – 3.0

 0.0136
PAH

 4990 (94.5)

 1.2

 1.0 – 1.5

 0.0231
GI disease

 5179 (98.1)

 1.7

 1.4 – 1.96

 <0.0001

 1.9

 1.1 – 2.5

 0.0265
Myositis

 4580 (86.7)

 0.7

 0.6 – 0.9

 0.001

 –

 –

 –
Arthritis

 4606 (87.2)

 1.2

 1.0 – 1.4

 0.0416

 1.5

 1.0 – 2.2

 0.0323
Positive Scl-70

 4578 (86.7)

 0.6

 0.5 – 0.8

 <0.0001
Positive anticentromere

 3370 (63.8)

 1.7

 1.4 – 2.0

 <0.0001

 2.4

 1.6 – 3.5

 <0.0001
Positive PM-1

 1825 (34.6)

 1.8

 1.2 – 2.5

 0.0028
Positive RNA polymerase III

 2414 (45.7)

 0.8

 0.6 – 0.9

 0.0159
Positive RNP

 4286 (81.2)

 0.5

 0.4 – 0.8

 0.0002
Positive Anticardiolipin

 949 (18.0)

 1.7

 1.2 – 2.2

 0.0005
Abbreviations: mRSS=modified
Rodnan skin score, PAH=pulmonary artery hypertension, GI=gastrointestinal,
ACA=anticentromere, RNP= Ribonucleoprotein

Multivariate model included:
disease duration from first non-Raynaud symptoms, gender, modified Rodnan skin
score (mRSS), digital ulcers, puffy fingers, telangiectasias, osteoporosis,
cardiac disease, GI disease, myositis, arthritis, and anticentromere antibody.

Disclosure: A. Valenzuela, None; M. Baron, None; A. L. Herrick, None; S. Proudman, None; W. Stevens, None; T. S. Rodriguez-Reyna, None; A. Vacca, None; T. A. Medsger Jr., None; M. Hinchcliff, None; V. Hsu, None; D. Fiorentino, None; L. Chung, Gilead, 4.

To cite this abstract in AMA style:

Valenzuela A, Baron M, Herrick AL, Proudman S, Stevens W, Rodriguez-Reyna TS, Vacca A, Medsger TA Jr., Hinchcliff M, Hsu V, Fiorentino D, Chung L. Calcinosis Is Associated with Digital Ulcers and Osteoporosis in Patients with Systemic Sclerosis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/calcinosis-is-associated-with-digital-ulcers-and-osteoporosis-in-patients-with-systemic-sclerosis/. Accessed .

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