Advertisement

Clinical Rheumatology

, Volume 38, Issue 11, pp 3189–3193 | Cite as

Acroosteolysis and bone metabolism parameters distinguish female patients with limited systemic sclerosis with and without calcinosis: a case control study

  • Marilia M. Sampaio-Barros
  • Lorena C. M. Castelo Branco
  • Liliam Takayama
  • Marco Antonio G. Pontes Filho
  • Percival D. Sampaio-Barros
  • Rosa Maria R. PereiraEmail author
Brief Report
Part of the following topical collections:
  1. Updates in Systemic Sclerosis

Abstract

Calcinosis usually represents a late manifestation of systemic sclerosis (SSc), inducing tissue damage and chronic calcifications. To analyze clinical and bone metabolism parameters associated with calcinosis in limited systemic sclerosis (lSSc), thirty-six female lSSc patients with calcinosis were compared with 36 female lSSc patients without calcinosis, matched by age, disease duration, and body mass index. Organ involvement, autoantibodies, bone density, and laboratory parameters were analyzed. Statistical significance was considered if p < 0.05. Calcinosis was significantly associated with acroosteolysis (69% vs. 22%, p < 0.001), higher modified Rodnan skin score (mRSS 4.28 ± 4.66 vs. 1.17 ± 2.50, p < 0.001), and higher 25-hydroxyvitamin D (25OHD) (24.46 ± 8.15 vs. 20.80 ± 6.60 ng/ml, p = 0.040) and phosphorus serum levels (3.81 ± 0.41 vs. 3.43 ± 0.45 mg/dl, p < 0.001). 25OHD levels > 30 ng/ml were also significantly more frequent in patients with calcinosis (p = 0.041). Regarding treatment, current use of corticosteroids was lower in patients with calcinosis compared with patients without calcinosis (8% vs. 28%, p = 0.032). On logistic regression analysis, acroosteolysis (OR = 12.04; 95% CI, 2.73–53.04; p = 0.001), mRSS (OR = 1.37; 95% CI, 1.11–1.69; p = 0.003), phosphorus serum levels (OR = 5.07; 95% CI, 1.06–24.23; p = 0.042), and lower glucocorticoid use (OR = 0.07; 95% CI, 0.007–0.66; p = 0.021) are independent risk factors for calcinosis. This study showed that limited SSc patients with calcinosis present a distinct clinic and biochemical profile when compared with a matched group without calcinosis, paired by disease duration, age and BMI.

Key Points

Calcinosis in patients with limited SSc was associated with acroosteolysis, higher mRSS and higher serum levels of phosphorus.

Keywords

Acroosteolysis Calcinosis Limited systemic sclerosis 

Notes

Support and grants

This work was supported by grants from Programa Nacional de Pós-Doutorado da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (PNPD/ CAPES) (no. 1412229 to M.M.S.B.) and Federico Foundation (to P.D.S.B. and R.M.R.P.).

Compliance with ethical standards

All patients gave their written informed consent, and the study was approved by the Ethics Research Committee of the University of São Paulo (Research protocol 0819/10).

Disclosures

None.

References

  1. 1.
    Vayssairat M, Hidouche D, Abdoucheli-Baudot N, Gaitz JP (1998) Clinical significance of subcutaneous calcinosis in patients with systemic sclerosis. Does diltiazem induce its regression? Ann Rheum Dis 57:252–254CrossRefGoogle Scholar
  2. 2.
    Valenzuela A, Baron M, Canadian Scleroderma Research Group, Herrick AL, Proudman S, Stevens W et al (2016) Calcinosis is associated with digital ulcers and osteoporosis in patients with systemic sclerosis: a Scleroderma Clinical Trials Consortium study. Semin Arthritis Rheum 46:344–349CrossRefGoogle Scholar
  3. 3.
    Boulman N, Slobodin G, Rozenbaum M, Rosner I (2005) Calcinosis in rheumatic diseases. Semin Arthritis Rheum 34:805–812CrossRefGoogle Scholar
  4. 4.
    Valenzuela A, Song P, Chung L (2018) Calcinosis in scleroderma. Curr Opin Rheumatol 30:554–561CrossRefGoogle Scholar
  5. 5.
    Braun-Moscovici Y, Furst DE, Markovits D, Rozin A, Clements PJ, Nahir AM et al (2008) Vitamin D, parathyroid hormone, and acroosteolysis in systemic sclerosis. J Rheumatol 35:2201–2205CrossRefGoogle Scholar
  6. 6.
    Serup J, Hagdrup HK (1984) Parathyroid hormone and calcium metabolism in generalized scleroderma. Increased PTH level and secondary hyperparathyroidism in patients with aberrant calcifications. Prophylactic treatment of calcinosis. Arch Dermatol Res 276:91–95CrossRefGoogle Scholar
  7. 7.
    Di Munno O, Mazzantini M, Massei P, Ferdeghini M, Pitaro N, Latorraca A et al (1995) Reduced bone mass and normal calcium metabolism in systemic sclerosis with and without calcinosis. Clin Rheumatol 14:407–412CrossRefGoogle Scholar
  8. 8.
    van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, Matucci-Cerinic M, Naden RP, Medsger TA Jr, Carreira PE, Riemekasten G, Clements PJ, Denton CP, Distler O, Allanore Y, Furst DE, Gabrielli A, Mayes MD, van Laar JM, Seibold JR, Czirjak L, Steen VD, Inanc M, Kowal-Bielecka O, Müller-Ladner U, Valentini G, Veale DJ, Vonk MC, Walker UA, Chung L, Collier DH, Csuka ME, Fessler BJ, Guiducci S, Herrick A, Hsu VM, Jimenez S, Kahaleh B, Merkel PA, Sierakowski S, Silver RM, Simms RW, Varga J, Pope JE (2013) 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 65:2737–2747CrossRefGoogle Scholar
  9. 9.
    LeRoy EC, Black C, Fleischmajer R, Jablonska S, Krieg T, Medsger TA Jr et al (1988) Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol 15:202–205Google Scholar
  10. 10.
    Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R (2005) Estimates of optimal vitamin D status. Osteoporos Int 16:713–716CrossRefGoogle Scholar
  11. 11.
    Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281CrossRefGoogle Scholar
  12. 12.
    Koutaissoff S, Vanthuyne M, Smith V, De Langhe E, Depresseux G, Westhoven R et al (2011) Hand radiological damage in systemic sclerosis: comparison with a control group and clinical and functional correlations. Semin Arthritis Rheum 40:455–460CrossRefGoogle Scholar
  13. 13.
    Johnstone EM, Hutchinson CE, Vail A, Chevance A, Herrick AL (2012) Acro-osteolysis in systemic sclerosis is associated with digital ischaemia and severe calcinosis. Rheumatology (Oxford) 51:2234–2238CrossRefGoogle Scholar
  14. 14.
    Pai S, Hsu V (2018) Are there risk factors for scleroderma-related calcinosis? Mod Rheumatol 28:518–522CrossRefGoogle Scholar
  15. 15.
    Park JK, Fava A, Carrino J, Del Grande F, Rosen A, Boin F (2016) Association of acroosteolysis with enhanced osteoclastogenesis and higher blood levels of vascular endothelial growth factor in systemic sclerosis. Arthritis Rheumatol 68:201–209CrossRefGoogle Scholar
  16. 16.
    Rios-Fernández R, Callejas-Rubio JL, Fernández-Roldán C, Simeón-Aznar CP, García-Hernández F, Castillo-García MJ, Fonollosa Pla V, Barnosi Marín AC, González-Gay MÁ, Ortego-Centeno N (2012) Bone mass and vitamin D in patients with systemic sclerosis from two Spanish regions. Clin Exp Rheumatol 30:905–911PubMedGoogle Scholar
  17. 17.
    Atteritano M, Sorbara S, Bagnato G, Miceli G, Sangari D, Morgante S, Visalli E, Bagnato G (2013) Bone mineral density, bone turnover markers and fractures in patients with systemic sclerosis: a case control study. PLoS One 8:e66991CrossRefGoogle Scholar
  18. 18.
    Quarles LD (2012) Role of FGF23 in vitamin D and phosphate metabolism: implications in chronic kidney disease. Exp Cell Res 318:1040–1048CrossRefGoogle Scholar
  19. 19.
    Sheridan K, Logomarsino JV (2017) Effects of serum phosphorus on vascular calcification in a healthy, adult population: a systematic review. J Vasc Nurs 35:157–169CrossRefGoogle Scholar
  20. 20.
    Baron M, Pope J, Robinson D, Jones N, Khalidi N, Docherty P, Kaminska E, Masetto A, Sutton E, Mathieu JP, Ligier S, Grodzicky T, LeClercq S, Thorne C, Gyger G, Smith D, Fortin PR, Larché M, Abu-Hakima M, Rodriguez-Reyna TS, Cabral-Castaneda AR, Fritzler MJ, Wang M, Hudson M (2016) Calcinosis is associated with digital ischaemia in systemic sclerosis-a longitudinal study. Rheumatology (Oxford) 55:2148–2155CrossRefGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  • Marilia M. Sampaio-Barros
    • 1
  • Lorena C. M. Castelo Branco
    • 1
  • Liliam Takayama
    • 1
  • Marco Antonio G. Pontes Filho
    • 1
  • Percival D. Sampaio-Barros
    • 1
  • Rosa Maria R. Pereira
    • 1
    • 2
    Email author
  1. 1.Division of RheumatologyHospital das Clinicas HCFMUSP Faculdade de Medicina da Universidade de Sao PauloSao PauloBrazil
  2. 2.Disciplina de ReumatologiaFaculdade Medicina da Universidade de Sao PauloSao PauloBrazil

Personalised recommendations