Digital ulcers predict a worse disease course in patients with systemic sclerosis

Carina Mihai; R. Landewé; D. Van Der Heijde; Ulrich A. Walker; Paul I. Constantin; Ana Maria Gherghe; Ruxandra Maria Ionescu; Simona Rednic; Yannick Allanore; Jérôme Avouac; László Czirják; E. Hachulla; Gabriela Riemekasten; Franco Cozzi; Paolo Airo; Maurizio Cutolo; Ulf Mueller-Ladner; Marco Matucci-Cerinic; David Launay; Rucsandra Dobrota; Roxana Sfrent-Cornateanu; Stefania Zingarelli; Erika Pigatto; Giovanna Cuomo; Paola Caramaschi; Lidia P. Ananieva; Susanne Ullman; Line Iversen; Alexandra Balbir Gurman; Yolanda Braun-Moscovici; Patricia Carreira; Beatriz Joven; Tünde Minier; Serena Guiducci; Silvia Bellando-Randone; Raffaele Pellerito; Nicolas Hunzelmann; Ingo H. Tarner; Sebastião Cezar Radominski; Carolina De Souza Müller; Florenzo Iannone; Jörg Henes; Dominique Farge Bancel; Nemanja Damjanov; Predrag Ostojic; Maria R. Pozzi; Roger Hesselstrand; Christopher Denton; Dorota Krasowska; Mohammed Tikly; Valeria Riccieri; F. Cantatore; Ada Corrado; José Antonio Pereira Da Silva; Maria João Salvador; Alan Tyndall; Armando Gabrielli; Oliver Distler; Suzan Jordan; Stefan Heitmann; Harald Burkhardt; Andrea Himsel; Blaz Rozman; Vanessa Smith; Filip De Keyser; Dusanka Martinovic Kalitena; Mislav Radic; Ileana Filipescu; Ana Petcu; Panayiotis G. Vlachoyiannopoulos; Eugene Kucharz; Malgorzata Widuchowska; Magdalena Kopec-Medrek; Anna Kotulska; Gabriella Szücs; Aleksandra Stankovic; Bojana Stamenkovic; Carlo Francesco Selmi; Maria De Santis; Bianca Marasini; Bernard Coleiro; Vera Ortiz Santamaria; Rene Westhovens; Radim Becvar; Srdan Novak; Merete Engelhart; Pier Luigi Meroni; Francesca Ingegnoli; Silvana Zeni; Alberto Sulli; Jörg H W Distler; Sule Kurhan Yavuz; Carlomaurizio Montecucco; Kilian Eyerich; Brigitte Krummel-Lorenz; Thierry Zenone; Øyvind Midtvedt; Carlo Chizzolini; Matthias Seidel; Mara Oleszowsky; Maria Üprus; Daniela Opris; Laura Groseanu; Otylia Kowal Bielecka; Zea Mendoza Antonio; Jacek Szechinski; Jadranka Morovic-Vergles; Raffaella Scorza; Francesco Puppo; A. Mathieu; Branimir Anic; J. Stork; Simon Stebbings; M. Inanc; Paul Hasler; Carlos A. Von Mühlen; Martin Aringer; Sergei Popa; Mengtao Li; Edoardo Rosato

doi:10.1136/annrheumdis-2014-205897

Digital ulcers predict a worse disease course in patients with systemic sclerosis

Carina Mihai, R. Landewé, D. Van Der Heijde, Ulrich A. Walker, Paul I. Constantin, Ana Maria Gherghe, Ruxandra Maria Ionescu, Simona Rednic, Yannick Allanore, Jérôme Avouac, László Czirják, E. Hachulla, Gabriela Riemekasten, Franco Cozzi, Paolo Airo, Maurizio Cutolo, Ulf Mueller-Ladner, Marco Matucci-Cerinic, David Launay, Rucsandra DobrotaRoxana Sfrent-Cornateanu, Stefania Zingarelli, Erika Pigatto, Giovanna Cuomo, Paola Caramaschi, Lidia P. Ananieva, Susanne Ullman, Line Iversen, Alexandra Balbir Gurman, Yolanda Braun-Moscovici, Patricia Carreira, Beatriz Joven, Tünde Minier, Serena Guiducci, Silvia Bellando-Randone, Raffaele Pellerito, Nicolas Hunzelmann, Ingo H. Tarner, Sebastião Cezar Radominski, Carolina De Souza Müller, Florenzo Iannone, Jörg Henes, Dominique Farge Bancel, Nemanja Damjanov, Predrag Ostojic, Maria R. Pozzi, Roger Hesselstrand, Christopher Denton, Dorota Krasowska, Mohammed Tikly, Valeria Riccieri, F. Cantatore, Ada Corrado, José Antonio Pereira Da Silva, Maria João Salvador, Alan Tyndall, Armando Gabrielli, Oliver Distler, Suzan Jordan, Stefan Heitmann, Harald Burkhardt, Andrea Himsel, Blaz Rozman, Vanessa Smith, Filip De Keyser, Dusanka Martinovic Kalitena, Mislav Radic, Ileana Filipescu, Ana Petcu, Panayiotis G. Vlachoyiannopoulos, Eugene Kucharz, Malgorzata Widuchowska, Magdalena Kopec-Medrek, Anna Kotulska, Gabriella Szücs, Aleksandra Stankovic, Bojana Stamenkovic, Carlo Francesco Selmi, Maria De Santis, Bianca Marasini, Bernard Coleiro, Vera Ortiz Santamaria, Rene Westhovens, Radim Becvar, Srdan Novak, Merete Engelhart, Pier Luigi Meroni, Francesca Ingegnoli, Silvana Zeni, Alberto Sulli, Jörg H W Distler, Sule Kurhan Yavuz, Carlomaurizio Montecucco, Kilian Eyerich, Brigitte Krummel-Lorenz, Thierry Zenone, Øyvind Midtvedt, Carlo Chizzolini, Matthias Seidel, Mara Oleszowsky, Maria Üprus, Daniela Opris, Laura Groseanu, Otylia Kowal Bielecka, Zea Mendoza Antonio, Jacek Szechinski, Jadranka Morovic-Vergles, Raffaella Scorza, Francesco Puppo, A. Mathieu, Branimir Anic, J. Stork, Simon Stebbings, M. Inanc, Paul Hasler, Carlos A. Von Mühlen, Martin Aringer, Sergei Popa, Mengtao Li, Edoardo Rosato

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: Systemic sclerosis (SSc) is a systemic autoimmune disease with high morbidity and significant mortality. There is a great need of predictors that would allow risk stratification of patients with SSc and ultimately initiation of treatment early enough to ensure optimal clinical results. In this study, we evaluated whether a history of digital ulcers (HDU) at presentation may be a predictor of vascular outcomes and of overall clinical worsening and death in patients with SSc. Methods: Patients from the EULAR Scleroderma Trials and Research (EUSTAR) database, satisfying at inclusion the 1980 American College of Rheumatology classification criteria for SSc, who had a follow-up of at least 3 years since baseline or who have died, were included in the analysis. HDU at presentation as a predictor of disease worsening or death was evaluated by Cox proportional hazards regression analysis. Results :3196 patients matched the inclusion criteria (male sex 13.2%, 33.4% diffuse subset). At presentation, 1092/3196 patients had an HDU (34.1%). In multivariable analysis adjusting for age, gender and all parameters considered potentially significant, HDU was predictive for the presence of active digital ulcers (DUs) at prospective visits (HR (95% CI)): 2.41(1.91 to 3.03), p

Original language	English
Pages (from-to)	681-686
Number of pages	6
Journal	Annals of the Rheumatic Diseases
Volume	75
Issue number	4
DOIs	https://doi.org/10.1136/annrheumdis-2014-205897
Publication status	Published - Apr 1 2016

ASJC Scopus subject areas

Rheumatology
Immunology
Biochemistry, Genetics and Molecular Biology(all)
Immunology and Allergy

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10.1136/annrheumdis-2014-205897

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Mihai, C., Landewé, R., Van Der Heijde, D., Walker, U. A., Constantin, P. I., Gherghe, A. M., Ionescu, R. M., Rednic, S., Allanore, Y., Avouac, J., Czirják, L., Hachulla, E., Riemekasten, G., Cozzi, F., Airo, P., Cutolo, M., Mueller-Ladner, U., Matucci-Cerinic, M., Launay, D., ... Rosato, E. (2016). Digital ulcers predict a worse disease course in patients with systemic sclerosis. Annals of the Rheumatic Diseases, 75(4), 681-686. https://doi.org/10.1136/annrheumdis-2014-205897

Mihai, C, Landewé, R, Van Der Heijde, D, Walker, UA, Constantin, PI, Gherghe, AM, Ionescu, RM, Rednic, S, Allanore, Y, Avouac, J, Czirják, L, Hachulla, E, Riemekasten, G, Cozzi, F, Airo, P, Cutolo, M, Mueller-Ladner, U, Matucci-Cerinic, M, Launay, D, Dobrota, R, Sfrent-Cornateanu, R, Zingarelli, S, Pigatto, E, Cuomo, G, Caramaschi, P, Ananieva, LP, Ullman, S, Iversen, L, Gurman, AB, Braun-Moscovici, Y, Carreira, P, Joven, B, Minier, T, Guiducci, S, Bellando-Randone, S, Pellerito, R, Hunzelmann, N, Tarner, IH, Radominski, SC, De Souza Müller, C, Iannone, F, Henes, J, Bancel, DF, Damjanov, N, Ostojic, P, Pozzi, MR, Hesselstrand, R, Denton, C, Krasowska, D, Tikly, M, Riccieri, V, Cantatore, F, Corrado, A, Da Silva, JAP, Salvador, MJ, Tyndall, A, Gabrielli, A, Distler, O, Jordan, S, Heitmann, S, Burkhardt, H, Himsel, A, Rozman, B, Smith, V, Keyser, FD, Kalitena, DM, Radic, M, Filipescu, I, Petcu, A, Vlachoyiannopoulos, PG, Kucharz, E, Widuchowska, M, Kopec-Medrek, M, Kotulska, A, Szücs, G, Stankovic, A, Stamenkovic, B, Selmi, CF , De Santis, M, Marasini, B, Coleiro, B, Santamaria, VO, Westhovens, R, Becvar, R, Novak, S, Engelhart, M, Meroni, PL, Ingegnoli, F, Zeni, S, Sulli, A, Distler, JHW, Yavuz, SK, Montecucco, C, Eyerich, K, Krummel-Lorenz, B, Zenone, T, Midtvedt, Ø, Chizzolini, C, Seidel, M, Oleszowsky, M, Üprus, M, Opris, D, Groseanu, L, Bielecka, OK, Antonio, ZM, Szechinski, J, Morovic-Vergles, J, Scorza, R, Puppo, F, Mathieu, A, Anic, B, Stork, J, Stebbings, S, Inanc, M, Hasler, P, Von Mühlen, CA, Aringer, M, Popa, S, Li, M & Rosato, E 2016, 'Digital ulcers predict a worse disease course in patients with systemic sclerosis', Annals of the Rheumatic Diseases, vol. 75, no. 4, pp. 681-686. https://doi.org/10.1136/annrheumdis-2014-205897

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title = "Digital ulcers predict a worse disease course in patients with systemic sclerosis",

abstract = "Objective: Systemic sclerosis (SSc) is a systemic autoimmune disease with high morbidity and significant mortality. There is a great need of predictors that would allow risk stratification of patients with SSc and ultimately initiation of treatment early enough to ensure optimal clinical results. In this study, we evaluated whether a history of digital ulcers (HDU) at presentation may be a predictor of vascular outcomes and of overall clinical worsening and death in patients with SSc. Methods: Patients from the EULAR Scleroderma Trials and Research (EUSTAR) database, satisfying at inclusion the 1980 American College of Rheumatology classification criteria for SSc, who had a follow-up of at least 3 years since baseline or who have died, were included in the analysis. HDU at presentation as a predictor of disease worsening or death was evaluated by Cox proportional hazards regression analysis. Results :3196 patients matched the inclusion criteria (male sex 13.2%, 33.4% diffuse subset). At presentation, 1092/3196 patients had an HDU (34.1%). In multivariable analysis adjusting for age, gender and all parameters considered potentially significant, HDU was predictive for the presence of active digital ulcers (DUs) at prospective visits (HR (95% CI)): 2.41(1.91 to 3.03), p",

author = "Carina Mihai and R. Landew{\'e} and {Van Der Heijde}, D. and Walker, {Ulrich A.} and Constantin, {Paul I.} and Gherghe, {Ana Maria} and Ionescu, {Ruxandra Maria} and Simona Rednic and Yannick Allanore and J{\'e}r{\^o}me Avouac and L{\'a}szl{\'o} Czirj{\'a}k and E. Hachulla and Gabriela Riemekasten and Franco Cozzi and Paolo Airo and Maurizio Cutolo and Ulf Mueller-Ladner and Marco Matucci-Cerinic and David Launay and Rucsandra Dobrota and Roxana Sfrent-Cornateanu and Stefania Zingarelli and Erika Pigatto and Giovanna Cuomo and Paola Caramaschi and Ananieva, {Lidia P.} and Susanne Ullman and Line Iversen and Gurman, {Alexandra Balbir} and Yolanda Braun-Moscovici and Patricia Carreira and Beatriz Joven and T{\"u}nde Minier and Serena Guiducci and Silvia Bellando-Randone and Raffaele Pellerito and Nicolas Hunzelmann and Tarner, {Ingo H.} and Radominski, {Sebasti{\~a}o Cezar} and {De Souza M{\"u}ller}, Carolina and Florenzo Iannone and J{\"o}rg Henes and Bancel, {Dominique Farge} and Nemanja Damjanov and Predrag Ostojic and Pozzi, {Maria R.} and Roger Hesselstrand and Christopher Denton and Dorota Krasowska and Mohammed Tikly and Valeria Riccieri and F. Cantatore and Ada Corrado and {Da Silva}, {Jos{\'e} Antonio Pereira} and Salvador, {Maria Jo{\~a}o} and Alan Tyndall and Armando Gabrielli and Oliver Distler and Suzan Jordan and Stefan Heitmann and Harald Burkhardt and Andrea Himsel and Blaz Rozman and Vanessa Smith and Keyser, {Filip De} and Kalitena, {Dusanka Martinovic} and Mislav Radic and Ileana Filipescu and Ana Petcu and Vlachoyiannopoulos, {Panayiotis G.} and Eugene Kucharz and Malgorzata Widuchowska and Magdalena Kopec-Medrek and Anna Kotulska and Gabriella Sz{\"u}cs and Aleksandra Stankovic and Bojana Stamenkovic and Selmi, {Carlo Francesco} and {De Santis}, Maria and Bianca Marasini and Bernard Coleiro and Santamaria, {Vera Ortiz} and Rene Westhovens and Radim Becvar and Srdan Novak and Merete Engelhart and Meroni, {Pier Luigi} and Francesca Ingegnoli and Silvana Zeni and Alberto Sulli and Distler, {J{\"o}rg H W} and Yavuz, {Sule Kurhan} and Carlomaurizio Montecucco and Kilian Eyerich and Brigitte Krummel-Lorenz and Thierry Zenone and {\O}yvind Midtvedt and Carlo Chizzolini and Matthias Seidel and Mara Oleszowsky and Maria {\"U}prus and Daniela Opris and Laura Groseanu and Bielecka, {Otylia Kowal} and Antonio, {Zea Mendoza} and Jacek Szechinski and Jadranka Morovic-Vergles and Raffaella Scorza and Francesco Puppo and A. Mathieu and Branimir Anic and J. Stork and Simon Stebbings and M. Inanc and Paul Hasler and {Von M{\"u}hlen}, {Carlos A.} and Martin Aringer and Sergei Popa and Mengtao Li and Edoardo Rosato",

year = "2016",

month = apr,

day = "1",

doi = "10.1136/annrheumdis-2014-205897",

language = "English",

volume = "75",

pages = "681--686",

journal = "Annals of the Rheumatic Diseases",

issn = "0003-4967",

publisher = "BMJ Publishing Group",

number = "4",

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TY - JOUR

T1 - Digital ulcers predict a worse disease course in patients with systemic sclerosis

AU - Mihai, Carina

AU - Landewé, R.

AU - Van Der Heijde, D.

AU - Walker, Ulrich A.

AU - Constantin, Paul I.

AU - Gherghe, Ana Maria

AU - Ionescu, Ruxandra Maria

AU - Rednic, Simona

AU - Allanore, Yannick

AU - Avouac, Jérôme

AU - Czirják, László

AU - Hachulla, E.

AU - Riemekasten, Gabriela

AU - Cozzi, Franco

AU - Airo, Paolo

AU - Cutolo, Maurizio

AU - Mueller-Ladner, Ulf

AU - Matucci-Cerinic, Marco

AU - Launay, David

AU - Dobrota, Rucsandra

AU - Sfrent-Cornateanu, Roxana

AU - Zingarelli, Stefania

AU - Pigatto, Erika

AU - Cuomo, Giovanna

AU - Caramaschi, Paola

AU - Ananieva, Lidia P.

AU - Ullman, Susanne

AU - Iversen, Line

AU - Gurman, Alexandra Balbir

AU - Braun-Moscovici, Yolanda

AU - Carreira, Patricia

AU - Joven, Beatriz

AU - Minier, Tünde

AU - Guiducci, Serena

AU - Bellando-Randone, Silvia

AU - Pellerito, Raffaele

AU - Hunzelmann, Nicolas

AU - Tarner, Ingo H.

AU - Radominski, Sebastião Cezar

AU - De Souza Müller, Carolina

AU - Iannone, Florenzo

AU - Henes, Jörg

AU - Bancel, Dominique Farge

AU - Damjanov, Nemanja

AU - Ostojic, Predrag

AU - Pozzi, Maria R.

AU - Hesselstrand, Roger

AU - Denton, Christopher

AU - Krasowska, Dorota

AU - Tikly, Mohammed

AU - Riccieri, Valeria

AU - Cantatore, F.

AU - Corrado, Ada

AU - Da Silva, José Antonio Pereira

AU - Salvador, Maria João

AU - Tyndall, Alan

AU - Gabrielli, Armando

AU - Distler, Oliver

AU - Jordan, Suzan

AU - Heitmann, Stefan

AU - Burkhardt, Harald

AU - Himsel, Andrea

AU - Rozman, Blaz

AU - Smith, Vanessa

AU - Keyser, Filip De

AU - Kalitena, Dusanka Martinovic

AU - Radic, Mislav

AU - Filipescu, Ileana

AU - Petcu, Ana

AU - Vlachoyiannopoulos, Panayiotis G.

AU - Kucharz, Eugene

AU - Widuchowska, Malgorzata

AU - Kopec-Medrek, Magdalena

AU - Kotulska, Anna

AU - Szücs, Gabriella

AU - Stankovic, Aleksandra

AU - Stamenkovic, Bojana

AU - Selmi, Carlo Francesco

AU - De Santis, Maria

AU - Marasini, Bianca

AU - Coleiro, Bernard

AU - Santamaria, Vera Ortiz

AU - Westhovens, Rene

AU - Becvar, Radim

AU - Novak, Srdan

AU - Engelhart, Merete

AU - Meroni, Pier Luigi

AU - Ingegnoli, Francesca

AU - Zeni, Silvana

AU - Sulli, Alberto

AU - Distler, Jörg H W

AU - Yavuz, Sule Kurhan

AU - Montecucco, Carlomaurizio

AU - Eyerich, Kilian

AU - Krummel-Lorenz, Brigitte

AU - Zenone, Thierry

AU - Midtvedt, Øyvind

AU - Chizzolini, Carlo

AU - Seidel, Matthias

AU - Oleszowsky, Mara

AU - Üprus, Maria

AU - Opris, Daniela

AU - Groseanu, Laura

AU - Bielecka, Otylia Kowal

AU - Antonio, Zea Mendoza

AU - Szechinski, Jacek

AU - Morovic-Vergles, Jadranka

AU - Scorza, Raffaella

AU - Puppo, Francesco

AU - Mathieu, A.

AU - Anic, Branimir

AU - Stork, J.

AU - Stebbings, Simon

AU - Inanc, M.

AU - Hasler, Paul

AU - Von Mühlen, Carlos A.

AU - Aringer, Martin

AU - Popa, Sergei

AU - Li, Mengtao

AU - Rosato, Edoardo

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Objective: Systemic sclerosis (SSc) is a systemic autoimmune disease with high morbidity and significant mortality. There is a great need of predictors that would allow risk stratification of patients with SSc and ultimately initiation of treatment early enough to ensure optimal clinical results. In this study, we evaluated whether a history of digital ulcers (HDU) at presentation may be a predictor of vascular outcomes and of overall clinical worsening and death in patients with SSc. Methods: Patients from the EULAR Scleroderma Trials and Research (EUSTAR) database, satisfying at inclusion the 1980 American College of Rheumatology classification criteria for SSc, who had a follow-up of at least 3 years since baseline or who have died, were included in the analysis. HDU at presentation as a predictor of disease worsening or death was evaluated by Cox proportional hazards regression analysis. Results :3196 patients matched the inclusion criteria (male sex 13.2%, 33.4% diffuse subset). At presentation, 1092/3196 patients had an HDU (34.1%). In multivariable analysis adjusting for age, gender and all parameters considered potentially significant, HDU was predictive for the presence of active digital ulcers (DUs) at prospective visits (HR (95% CI)): 2.41(1.91 to 3.03), p

AB - Objective: Systemic sclerosis (SSc) is a systemic autoimmune disease with high morbidity and significant mortality. There is a great need of predictors that would allow risk stratification of patients with SSc and ultimately initiation of treatment early enough to ensure optimal clinical results. In this study, we evaluated whether a history of digital ulcers (HDU) at presentation may be a predictor of vascular outcomes and of overall clinical worsening and death in patients with SSc. Methods: Patients from the EULAR Scleroderma Trials and Research (EUSTAR) database, satisfying at inclusion the 1980 American College of Rheumatology classification criteria for SSc, who had a follow-up of at least 3 years since baseline or who have died, were included in the analysis. HDU at presentation as a predictor of disease worsening or death was evaluated by Cox proportional hazards regression analysis. Results :3196 patients matched the inclusion criteria (male sex 13.2%, 33.4% diffuse subset). At presentation, 1092/3196 patients had an HDU (34.1%). In multivariable analysis adjusting for age, gender and all parameters considered potentially significant, HDU was predictive for the presence of active digital ulcers (DUs) at prospective visits (HR (95% CI)): 2.41(1.91 to 3.03), p

UR - http://www.scopus.com/inward/record.url?scp=84930163748&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84930163748&partnerID=8YFLogxK

U2 - 10.1136/annrheumdis-2014-205897

DO - 10.1136/annrheumdis-2014-205897

M3 - Article

SN - 0003-4967

VL - 75

SP - 681

EP - 686

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

IS - 4

ER -

Digital ulcers predict a worse disease course in patients with systemic sclerosis

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