Peripheral blood eosinophilia is associated with the presence of skin ulcers in patients with systemic sclerosis

Abstract

The role of eosinophil in systemic sclerosis (SSc) is still controversial. In the present study, the relationship between skin ulcers and peripheral blood eosinophilia were analyzed in patients with SSc. We retrospectively investigated the clinical records of all patients who were diagnosed with SSc on the basis of American College of Rheumatology/European League Against Rheumatism 2013 criteria, and were followed up for more than 2 years at Wakayama Medical University. As a result, maximum eosinophil counts during the 2‐year follow‐up period were 20–983/mm3 (median, 270), whereas maximum eosinophil percentages were 0.5–14.1% (median, 5.3%) in peripheral blood of 47 SSc patients. On the other hand, patients with skin ulcers during the 2‐year follow up showed significantly increased maximum eosinophil counts compared with those without (median, 520 vs 228/mm3; P = 0.0001). Maximum eosinophil percentage was also significantly higher in patients with skin ulcers (median, 9.7% vs 4.6%; P = 0.00001). To note, in four of the nine patients with skin ulcers, the timing of emerging of the maximum eosinophil counts was associated with the ulcer development during the 2‐year follow up. These results suggest that eosinophils are involved in the pathogenesis of vascular dysfunction of SSc. Larger studies should be performed to clarify the exact mechanism of ulcer formation caused by eosinophilia in SSc patients in the future.

Detection of IgE-autoantibodies to nuclear antigens in patients with systemic sclerosis and analysis of their clinical relevance

“…Th2 cells support activation of eosinophils and B cells producing IgE immunoglobulins. In this respect it is of interest that SSc patients with skin ulcers showed significantly increased eosinophil counts compared with those without (20), and that eosinophils play an important role in the development of fibrosis in SSc (33,34). However, in the present series we did not find a correlation between eosinophil counts and presence of ulcers or IgE-anti-CENP-A/B reactivity which may be due to selection criteria or low number of patients.…”

“…Since it had been reported that the presence of skin ulcers in SSc is correlated with blood eosinophilia (20) we also analysed IgE-anti-CENP-A/B reactivity in relation to eosinophil counts (Supplemental Table S2). However, there was no significant difference between patients with eosinophils >300/ mm 3 as compared to patients with eosinophil counts < 300/mm 3 (p=0.45 for IgE-anti-CENP-A and p=0.78 for IgE-anti-CENP-B), and there was also no significant correlation between absolute eosinophil counts and IgE-anti-CENP-A/B reactivity (r=0.09 and r=-0.07, respectively).…”

Therapeutic Options for Systemic Sclerosis: Current and Future Perspectives in Tackling Immune-Mediated Fibrosis

“…Furthermore, eosinophil counts were significantly correlated with severe interstitial lung disease (ILD) and an increased skin thickness in patients with SSc, but not in patients with other collagen diseases [ 32 ]. In addition, the presence of skin ulcers in SSc has been associated with elevated counts of peripheral blood eosinophils [ 33 ]. Collectively, these results implicate eosinophils in the pathogenesis of SSc including the hallmarks of inflammation and vascular dysfunction.…”

The importance of skin manifestations, serology and nailfold (video)capillaroscopy in morphea and systemic sclerosis: current understanding and new insights

“…Also, recently, an international prospective study identified the mean number of capillaries per millimetre in the middle finger of the dominant hand, the number of DU at enrolment and the presence of critical digital ischaemia at enrolment as risk factors for the development of new DU in SSc patients 24 . Furthermore, peripheral blood eosinophilia is shown to be associated with the presence of DU in SSc patients 25 . Moreover, a new clinical score for SSc‐related DU is proposed.…”