Prevalence and Risk Factors for Systemic Sclerosis Digital Ischemic Complications in the Collaborative National Quality and Efficacy Registry

Marissa Savoie¹, Monica Harding², Jessica Alvey², John VanBuren², Shervin Assassi³, Elana Bernstein⁴, Lorinda Chung⁵, Luke Evnin⁶, Tracy Frech⁷, Jessica Gordon⁸, Faye Hant⁹, Laura Hummers¹⁰, Dinesh Khanna¹¹, Kimberly Lakin⁸, Dorota Lebiedz-Odrobina¹², Yiming Luo¹³, Ashima Makol¹⁴, Jerry Molitor¹⁵, Duncan Moore¹⁶, Carrie Richardson¹⁷, Nora Sandorfi¹⁸, Ami Shah¹⁹, Ankoor Shah²⁰, Brian Skaug²¹, Virginia Steen²², Elizabeth Volkmann²³ and Flavia Castelino¹, ¹Massachusetts General Hospital, Boston, MA, ²University of Utah, Salt Lake City, UT, ³University of Texas McGovern Medical School at Houston, Houston, TX, ⁴Division of Rheumatology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, ⁵Department of Medicine, Division of Immunology and Rheumatology, Stanford University School of Medicine, Woodside, CA, ⁶Scleroderma Research Foundation, Brisbane, CA, ⁷Vanderbilt University Medical Center, Nashville, TN, ⁸Hospital for Special Surgery, New York, NY, ⁹Medical University of South Carolina, Charleston, SC, ¹⁰Johns Hopkins University, Baltimore, MD, ¹¹University of Michigan, Ann Arbor, MI, ¹²University of Utah, Cottonwood Heights, UT, ¹³Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, ¹⁴Mayo Clinic, Rochester, MN, Rochester, MN, ¹⁵University of Minnesota, Minneapolis, MN, ¹⁶Northwestern University, Department of Rheumatology, Chicago, IL, ¹⁷Northwestern University, Chicago, IL, ¹⁸University of Pennsylvania, Philadelphia, PA, ¹⁹Department of Medicine, Division of Rheumatology, Johns Hopkins University School of Medicine, Ellicott City, MD, ²⁰Duke University, Durham, NC, ²¹Division of Rheumatology, University of Texas McGovern Medical School, Houston, TX, ²²Georgetown University School of Medicine, Washington, DC, ²³University of California Los Angeles, Los Angeles, CA

Meeting: ACR Convergence 2023

Keywords: quality of life, Scleroderma, Scleroderma, Systemic, Systemic sclerosis, Ulcers

Session Information

Date: Sunday, November 12, 2023

Title: (0609–0672) Systemic Sclerosis & Related Disorders – Clinical Poster I: Research

Session Type: Poster Session A

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

Background/Purpose: Digital ischemic ulcers (DIU) develop in 36-44% of patients with systemic sclerosis (SSc).^1,2Prior international observational studies have evaluated characteristics of digital pitting and ulcers in their SSc patient populations; however, these studies do not necessarily reflect the US SSc patient population. We examined the prevalence of digital ischemic complications in a US-based longitudinal registry and evaluated clinical factors and patient reported outcomes associated with current digital pitting scars (DPS) and DIU.

Methods: We conducted a cross-sectional study utilizing the Collaborative National Quality and Efficacy Registry (CONQUER), a US-based, prospective, multi-center cohort of adults with SSc who meet 2013 ACR/EULAR Classification Criteria, with a disease duration ≤ 5 years from first non-Raynaud’s symptom at enrollment. At study enrollment, clinicians recorded the presence of DPS and DIU, and demographic, clinical, laboratory variables, and patient reported outcomes were collected. Multivariable-adjusted logistic regression models were designed using directed acyclic graphs.

Results: Among 772 eligible CONQUER participants, 166 (22%) had at least one DPS and 47 (6%) had active DIU at enrollment (Tables 1 and 2). Half of the participants with DPS were prescribed calcium channel blockers. Participants with DPS had worse PROMIS-29 v2.0 social function and pain scores, and participants with DIU had worse physical function, depression, social function, and pain scores. In our multivariable logistic regression model, younger age and male sex were associated with DPS (OR for female sex 0.50, 95% CI: 0.30 to 0.84 and OR for increased age by 5-year increments 0.90, 95% CI: 0.83 to 0.98, Figure). Race, tobacco use, abnormal nailfold capillaries, presence of telangiectasias, mRSS, disease subtype, disease duration, hypertension, and autoantibody status were not associated with DPS.

Conclusion: Digital ischemic complications were associated with impaired quality of life among patients with SSc, specifically in the domains of social function and pain. Younger age and male sex were associated with presence of digital pitting scars.

References

Khimdas S, Harding S, Bonner A, et al. Associations with digital ulcers in a large cohort of systemic sclerosis: results from the Canadian Scleroderma Research Group registry. Arthritis Care Res (Hoboken) 2011;63(1):142–149.
Meier FMP, Frommer KW, Dinser R, et al. Update on the profile of the EUSTAR cohort: an analysis of the EULAR Scleroderma Trials and Research group database. Ann Rheum Dis 2012;71(8):1355–1360.

Table 1: Demographics and baseline characteristics by digital pitting status

Table 2: Demographics and baseline characteristics by presence of digital ischemic ulcers

Figure: Multiple logistic regression of systemic sclerosis characteristics and vascular risk factors with the presence of digital pitting scars at baseline

Disclosures: M. Savoie: None; M. Harding: None; J. Alvey: None; J. VanBuren: None; S. Assassi: AstraZeneca, 2, aTyr, 2, Boehringer Ingelheim, 2, 5, CSL Behring, 2, Janssen, 5, Merck, 2, Momenta, 5, TeneoFour, 2; E. Bernstein: Boehringer Ingelheim, 2, 5, Kadmon, 5, Pfizer, 5; L. Chung: Eicos Science, 1, 2, Eli Lilly, 1, 2, Genentech, 1, 2, IgM biosciences, 1, 2, Janssen, 1, 2, Kyverna, 1, 2, Mitsubishi Tanabe, 1, 2; L. Evnin: None; T. Frech: None; J. Gordon: Cumberland Pharmaceuticals, 5, Prometheus Pharmaceuticals, 5; F. Hant: None; L. Hummers: AbbVie/Abbott, 1, Biotest, 2, Boehringer-Ingelheim, 1, 5, CSL Behring, 1, Cumberland Pharmaceuticals, 5, GlaxoSmithKlein(GSK), 5, Kadmon Corporation, 5, Medpace, 5, Mitsubishi Tanabe, 5, Prometheus, 5; D. Khanna: AbbVie, 12, DSMB, AstraZeneca, 2, Boehringer-Ingelheim, 2, Bristol-Myers Squibb, 2, 5, CSL Behring, 2, Genentech, 2, Horizon Therapeutics, 2, 5, Janssen, 2, 6, Pfizer, 5, Prometheus, 2; K. Lakin: None; D. Lebiedz-Odrobina: None; Y. Luo: None; A. Makol: Boehringer-Ingelheim, 1, Sanofi-Genzyme, 1; J. Molitor: None; D. Moore: None; C. Richardson: None; N. Sandorfi: None; A. Shah: Arena Pharmaceuticals, 5, Eicos Sciences, 5, Kadmon Corporation, 5, Medpace LLC, 5; A. Shah: None; B. Skaug: None; V. Steen: None; E. Volkmann: Boehringer-Ingelheim, 2, 5, 6, CSL Behring, 2, GlaxoSmithKline, 2, Horizon, 5, Prometheus, 5, Roche, 2; F. Castelino: Boehringer-Ingelheim, 2, Genentech, 5, Prometheus, 5.

To cite this abstract in AMA style:

Savoie M, Harding M, Alvey J, 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, Molitor J, Moore D, Richardson C, Sandorfi N, Shah A, Shah A, Skaug B, Steen V, Volkmann E, Castelino F. Prevalence and Risk Factors for Systemic Sclerosis Digital Ischemic Complications in the Collaborative National Quality and Efficacy Registry [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/prevalence-and-risk-factors-for-systemic-sclerosis-digital-ischemic-complications-in-the-collaborative-national-quality-and-efficacy-registry/. Accessed .

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