Document resource
Introduction Peripheral arterial disease (PAD) of the lower limbs has been poorly investigated in systemic sclerosis (SSc), despite its potential relevance for functional impairment, pain, and ulcer development. This study aimed to evaluate PAD in SSc patients through Doppler waveform analysis and to explore its relationship with other vascular assessments, clinical manifestations, and patient-reported outcomes.Material and Methods A cross-sectional observational study enrolled 116 SSc patients (87.9% female, mean age 57.1 years) and 51 age- and gender-matched healthy controls (HC) ( table 1). For each participant, the dorsalis pedis (DP) and posterior tibial (PT) arteries were assessed bilaterally by continuous-wave Doppler ultrasound. Pathological waveforms were defined as monophasic or absent. Ankle-brachial pressure index (ABPI) and foot X-rays were also performed. Clinical data, comorbidities, history of digital ulcers (DUs), and patient-reported symptoms (including the Manchester Foot Pain and Disability Index, MFPDI) were collected.Results Pathological Doppler waveforms were observed in 88 of 464 arteries (19%) in SSc patients, compared with 6 of 204 arteries (3%) in healthy controls (p < 0.001). At least one pathological artery was found in 37.1% of SSc vs 5.9% of HC (OR 9.42, 95%CI 3.19–40.4; p<0.001). Bilateral involvement occurred in 24.1% vs 5.9% (OR 6.13; p<0.001), and 12.1% of SSc had both arteries affected in a single leg (OR 14.6; p=0.006). Five patients (5.8%) had all four arteries pathological.In contrast, pathological ABPI values were not significantly different between groups (11.2% vs 5.9%). Arterial calcifications on X-rays were detected only in SSc (7%), but differences from HC did not reach significance. ABPI values were significantly lower in legs with Doppler-detected PAD (p=0.02 right; p=0.002 left).Pathological Doppler findings were independently associated with current smoking (p=0.05), history of DUs (p=0.03), and absence of immunosuppressive therapy (p=0.05). Double-artery involvement in a single leg was linked to longer disease duration (p=0.02), lower BMI (p=0.01), and DUs (p=0.02). Bilateral PAD was associated with current smoking (p=0.04) and DUs (p=0.01).From a patient perspective, rest pain was strongly associated with Doppler-detected PAD (p=0.01), whereas intermittent claudication and MFPDI score were not. However, SSc patients with rest pain reported higher MFPDI scores (22.9 vs 10.7; p<0.001).Conclusions Doppler ultrasound reveals a high prevalence of subclinical PAD in SSc, largely undetected by ABPI or X-ray. Doppler abnormalities are closely linked to smoking, DUs and rest pain, suggesting clinical relevance for vascular risk stratification. Routine Doppler assessment may provide added value in the vascular evaluation of SSc patients.Abstract OC.08 Table 1Epidemiological and clinical characteristics of the cohort