Article type: Research Article
Authors: Manfredi, Andreina | Sebastiani, Marco | Carraro, Valeria | Iudici, Michele | Bocci, Mario | Vukatana, Gentiana | Gerli, Roberto | De Angelis, Rossella | Del Medico, Patrizia | Praino, Emanuela | Lo Monaco, Andrea | D'Amico, Roberto | Del Giovane, Cinzia | Mazzuca, Salvatore | Colaci, Michele | Giuggioli, Dilia | Ferri, Clodoveo
Affiliations: Rheumatology Unit, University of Modena and Reggio Emilia, Modena, Italy | Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy | Department of Clinical and Experimental Medicine, Rheumatology Unit, Second University of Naples, Naples, Italy | Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy | Department of Internal Medicine, Rheumatology Unit, Policlinico S. Orsola Malpighi, Bologna, Italy | Rheumatology Unit, Department of Clinical & Experimental Medicine, University of Perugia, Perugia, Italy | Rheumatology Unit, Department of Molecular Pathology and Innovative Therapies, Università Politecnica delle Marche, Ancona, Italy | Internal Medicine Unit - Civitanova Marche Hospital, Italy | DiMIMP, Rheumatology Unit, University of Bari, Bari, Italy | Department of Clinical and Experimental Medicine-Rheumatology Unit, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy | Unit of Statistics in Medicine, Department of Public Health, Clinical and Diagnostic Medicine, University of Modena and Reggio Emilia, Modena, Italy | Department of Internal Medicine, Pugliese-Ciaccio Hospital, Catanzaro, Italy
Note: [] Corresponding author: Dr. Marco Sebastiani, MD, Rheumatology Unit, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41121, Modena, Italy. Tel.: +39 059 4222595; Fax: +39 059 4223007; E-mail: [email protected]
Abstract: BACKGROUND: Digital ulcers (DU) affect 50% of systemic sclerosis (SSc) patients, representing a challenging clinical problem. Despite a high negative predictive value, capillaroscopic scores proposed to select patients at risk for DU show an inadequate positive predictive value, especially in patients without previous DU. AIM OF THIS STUDY: To increase the predictive value for DU development of capillaroscopy, through a predictive risk chart taking into account capillaroscopic, demographic, and clinico-serological parameters. PATIENTS AND METHODS: Two hundred and nineteen unselected SSc patients from 8 Italian Rheumatology Centers were consecutively enrolled during a 6-month period. Demographic, clinical, serological and instrumental data and capillaroscopy skin ulcers risk index (CSURI) were collected. RESULTS: A multivariate logistic regression analysis showed a significant positive association between DU appearance and male gender, DU history, altered CSURI, and ESR. A prediction risk chart of the development of DU within 6 months were built on the basis of the above parameters. According to the risk level, four risk classes were identified: low (≤19.3%); medium (>19.3%, ≤58.6%); high (>58.6%, ≤89.2%), and very high risk (>89.2%). CONCLUSIONS: The systematic evaluation of the above parameters can be helpful to identify patients at risk to develop DU optimizing preventive vasoactive therapy.
Keywords: capillaroscopy, digital ulcers, systemic sclerosis, predictive risk chart
DOI: 10.3233/CH-141809
Journal: Clinical Hemorheology and Microcirculation, vol. 59, no. 2, pp. 133-143, 2015
