Ulnar Artery Occlusion and Severity Markers of Vasculopathy in Systemic Sclerosis: A Multicenter Cross‐Sectional Study

Abstract

Objective. To evaluate the association of ulnar artery occlusion (UAO) assessed using Doppler ultrasound (DUS) with the severity markers of systemic sclerosis (SSc).Methods. Two hundred four unselected patients fulfilling the American College of Rheumatology/European League Against Rheumatism 2013 classification criteria for SSc were included in this cross-sectional multicenter study. All patients underwent bilateral hand DUS to evaluate the presence of UAO and clinical/paraclinical visceral evaluation according to current guidelines. Univariable and multivariable ordinal regression models were applied, grading the severity of UAO as "no UAO," "only one UAO," and "UAO on both hands," and assessing its association with clinical features of SSc. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated.Results. UAO was found in 76 patients (37.3%) and was bilateral in 49 patients (24%). UAO as an ordinal event was significantly associated with disease duration, history of fingertip ulcers, telangiectasia, higher modified Rodnan skin thickness score (MRSS), worse diffusing capacity for carbon monoxide (DLco) values, higher tricuspid jet velocity, late capillaroscopic pattern, and positivity for anticentromere antibodies (ACAs) (univariable analysis). In the adjusted multivariable ordinal model, UAO was less frequent in women (OR 0.35 [95% CI 0.15-0.83], P = 0.017) and in patients receiving steroids (OR 0.24 [95% CI 0.09-0.62], P = 0.0034). In multivariable analyses, significant association with UAO was retained for history of fingertip ulcers ], P = 0.011), higher MRSS (OR 1.65 [95% CI 1.06-2.56], P =0.025), lower DLco values (OR 0.85 [95% CI 0.78-0.94], P = 0.0015), and ACA positivity (OR 2.89 [95% CI 1.36-6.11], P = 0.0056).Conclusion. UAO may represent a relevant severity marker of vasculopathy in SSc. Its predictive value for the onset of severe vascular manifestations such as pulmonary arterial hypertension, and its association with mortality, remain to be determined in longitudinal studies.

Systemic Sclerosis Patients With Negative Antinuclear Antibodies Have Distinctive Clinical Manifestations: a Multicenter CRDC Cohort in China

“…Therefore, in general, skin brosis in ANA-negative SSc patients tend to be less severe. In addition to the skin, brosis commonly occurs in the lung in systemic sclerosis, leading to aggravations of respiratory dysfunctions and consequently mortality [18,19]. In this study, a lower incidence of ILD was observed in the ANAnegative group, which agreed with data from Hamaguchi et al [9] based on 203 Japanese SSc patients.…”

“…A hallmark of systemic sclerosis is vascular dysfunction, which is thought to occur early and play a central role in disease pathogenesis [18,22]. In this study, we observed that clinical manifestations of widely recognized microvasculopathy, such as Raynaud's phenomenon, digital pits and PAH, were remarkably less common in ANA-negative patients but that digital ulcers tended to be less prevalent in these patients, though with no signi cant differences.…”

Correlation between the infrared thermogram and microvascular abnormalities of the nailfold in patients with systemic sclerosis

“…A stronger correlation between temperature and capillary density was seen in fingers IV–V, and weaker in fingers II–III. A potential explanation is an occlusion of the ulnar artery which develops in some of SSc patients [ 39 – 41 ]. This would make blood circulation in fingers IV–V more dependent on the palmar arch supplied by the radial artery.…”

Ultrasound Detection of Calcinosis and Association With Ulnar Artery Occlusion in Patients With Systemic Sclerosis

“…The dramatic vascular and fibrotic changes associated with SSc are particularly amenable to evaluation by ultrasound (US), which has the benefits of being a noninvasive, low‐cost, nonionizing, point‐of‐care imaging modality. Conveniently, US provides tissue imaging capabilities for vasculopathy‐related disease manifestations and has been used to evaluate digital ulcers, calcinosis, and acro‐osteolysis (7–13), making it a promising tool for both research and clinical SSc evaluation and management. Ulnar artery occlusion (UAO) and pathologic finger pulp blood flow (FPBF) are vascular features detectable by US and may be helpful for screening patients with SSc at risk for digital vascular complications.…”