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Introduction Calcinosis cutis (CC) is a frequent symptom of systemic sclerosis (SSc) and it is associated with vascular involvement, although its actual relationship, direct manifestation or consequence, with the underlying disease remain unclear.This study aimed to evaluate the possible impact of CC on the vascular involvement and its association to other clinical, laboratory, or instrumental features in a large SSc patient cohort.Material and Methods Data from Italian Systemic Sclerosis Progression InvestiGation (SPRING) registry were retrospectively analyzed. SSc patients fulfilling the ACR/EULAR 2013 classification criteria were included, categorized based on the presence of CC, with at least 12 months follow up and without evidence of pulmonary arterial hypertension (PAH) and/or scleroderma renal crisis (SRC). Firstly, a cross-sectional analysis and a multiple logistic regression was performed to assess any characteristics associated with the presence of CC. A Cox regression analysis was performed to evaluate the impact of CC on any worsening features of vascular involvement, set as composite primary endpoint (onset of a digital ulcers (DU) and/or escalation of vasoactive therapy). In secondary Cox regression analyses each component of the composite primary endpoint was set as outcome separately.Results Among 951 eligible SSc patients, 191 had CC. In the multivariable regression models CC resulted positively associated with DU (OR 1.90, p<0.001), intestinal symptoms (OR 1.66, p=0.009), ‘late’ scleroderma pattern (OR 4.80, p=0.005), and negatively to puffy fingers (OR 0.60, p=0.005) and ATA positivity (OR 0.50, p<0.001)( table 1). Cox regression analysis, also when adjusted for covariates, revealed that the presence of CC was associated with almost twofold increased risk of worsening features of vascular involvement (HR 1.89, 95% CI: 1.21-2.95, p=0.004), during a 5-years follow-up (figure 1). It also emerged that the presence of CC was associated with an increasing use of Iloprost (H 3.73, 95% CI: 1.35-10.36, p=0.011), but not of ERA, PDE5i or onset of new DU.Conclusions Our data show that CC is related to a worsening of vascular involvement, particularly by increasing the need for treatment escalation. This result further supports the association between CC and vascular features of SSc, and suggests that CC might be considered as a clinical marker of a progressively severe vascular disease.Abstract P.203 Figure 1Kaplan-Meier survival estimate curve for primary end point. Calcinosis group (N=185), no calcinosis group (N=185)Abstract P.203 Table 1Odd ratios (OR) with 95% Confidental Interval (CI) resulting from the multivariate logistic regression analysis performed to identify clinical variables associated with the likelihood of presenting calcinosis