Prevalence, risk factors and outcome of digital gangrene in 2684 lupus patients

Abstract

The aim of the study is to assess the clinical characteristics, risk factors and outcome of patients with systemic lupus erythematosus (SLE) complicated with digital gangrene. In all, 2684 consecutive SLE inpatients admitted to Peking Union Medical College Hospital from December 1997 to August 2007 were studied. Demographic data, clinical features, laboratory findings as well as therapeutic regimens were systematically reviewed and a database was established. Cases with digital gangrene were identified and followed up. 1) Eighteen patients with SLE were complicated with digital gangrene, the average age at event was 33.1 +/- 11.8 years and the average disease duration was 99.1 +/- 60.1 months. 2) Patients with SLE, with long disease duration (> or =4 years), Raynaud's phenomenon and elevated serum C-reactive protein (CRP) were more likely to develop digital gangrene, P = 0.006, 0.001, and 0.031, respectively, OR = 1.03 (95% CI 1.01, 1.04), 35.76 (95% CI 4.67, 273.83) and 9.93 (95% CI 1.23, 80.30), respectively. 3) Fifteen gangrene patients started prednisone > or =1 mg/kg/d, and 18 were treated with cyclophosphamide, although 8 cases failed and ultimately received digital amputation. Prompt corticosteroid treatment (prednisone > or = mg/kg/d started within 3 weeks) decreased the hazard of amputation, P = 0.073, HR = 0.13 (95% CI 0.01, 1.21). Long disease duration, Raynaud's phenomenon and elevated serum CRP were independent predictive factors for SLE to develop digital gangrene. Early and aggressive corticosteroid treatment prevented gangrene from progression and improved prognosis.

Digital gangrene as the initial presentation of systemic lupus erythematosus

“…Treatment with corticosteroids decrease the hazard of amputation 9. Our patients had pulse methylprednisolone, cyclophosphamide, while the patients with APS also had anticoagulation with warfarin and aspirin.…”

“…Liu et al 9 have also suggested other contributory factors such as disease duration, Raynaud's phenomenon, elevated CRP and dyslipidaemia. Plasma cholesterol and triglycerides were normal in both patients and only one patient had elevated CRP.…”

“…Asherson et al 8 had reported only 27 cases of this association as of 1996. Eighteen cases of lupus digital gangrene had also been reported among the Chinese population as of 2009,9 while 20 cases were reported among a cohort of 344 Indian SLE patients 10. There have been few reported cases of digital gangrene among the black African population.…”

Digital Ulcers as an Initial Manifestation of Systemic Lupus Erythematosus

“…In SLE patients, RP is frequently present and it is associated with pulmonary hypertension (10). Long disease duration, RP and elevated serum CRP were independent predictive factors for SLE to develop digital gangrene (11). In addition lupus nephritis and RP are significant risk factors for vascular thrombosis in SLE patients with positive antiphospholipid antibodies (12).…”

Digital Ulcer as a Rare Complication of Systemic Lupus Erythematosus: A Case Report

“…3 Several risk factors have been identified with digital ulcers in SLE, including duration of lupus, male gender, atherosclerosis, vasculitis, and AAS. 4 Liu et al 5 demonstrated that duration of disease, the presence of Raynaud's phenomenon, and high serum CRP levels were determinants of digital ulcer development in a cohort of 2,600 lupus patients. When we looked at the risk factors in our patient, she had a 10-year history of lupus, but her disease activity was under control with small oral doses of corticosteroids.…”