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Digital gangrene in systemic sclerosis patients: not only due to the microvascular disease

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A LETTER TO THE EDITOR to this article was published on 20 February 2024

Abstract

Objective

This study aims to investigate the characteristics, risk factors, and outcomes of digital gangrenes in SSc patients, and to identify whether vasculitis is one of the causes for digital gangrene.

Methods

A retrospective case–control study was performed from February 2003 to April 2021. Forty-three SSc patients with digital gangrene admitted to Peking Union Medical College Hospital were included. One-hundred forty-six age- and sex-matched SSc patients without gangrene were selected as controls during the same period. Univariate and multivariate logistic regression analysis was used to determine risk factors.

Results

Among 43 SSc patients with gangrene, 93.0% had Raynaud’s phenomenon (RP) and 32.6% had current or previous digital ulcers (DU). SSc patients with digital gangrene had more ESR elevation (54.8% vs. 34.9%, p = 0.020) and higher level of high-sensitive C reactive protein (median 7.2 mg/L vs. 1.8 mg/L, p = 0.045) compared with controls. In the multivariable logistic regression analysis, smoking history (OR 4.119, p = 0.037), anti-centromere antibody positivity (OR 3.542, p = 0.016), anti-neutrophil cytoplasmic antibody positivity (OR 22.605, p = 0.037), and anti-phospholipid antibody positivity (OR 16.563, p = 0.001), as well as elevated ESR (OR 2.524, p = 0.038) were identified as independent risk factors for gangrenes. Most (79.1%) cases were treated with combination of immunosuppressive and vasodilating therapy, and four cases also got remised after treatment of only glucocorticoid and immunosuppressive agent.

Conclusion

Smoking history; positive-ACA, ANCA, and anti-phospholipid antibodies; and increased ESR were independent risk factors for digital gangrenes in SSc. Vasculitis and macrovascular disease may contribute to the progression of digital gangrenes.

Key Points

•18.6% of SSc patients with digital gangrene had macrovascular stenosis.

•Smoking, positive-ACA, ANCA, aPL, and increased ESR were indicators for digital gangrenes in SSc.

•Vasculitis and macrovascular disease may involve in the pathogenesis.

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Data availability

All data generated or analyzed during this study are included in the article.

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Acknowledgements

We thank CRDC multi-center co-authors as above for assistance with case collections.

Funding

This study was supported by CAMS Innovation Fund for Medical Sciences (CIFMS) (2021-I2M-1–005).

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Author notes

  1. Min Hui and Jiaxin Zhou contributed equally to this study.

Authors and Affiliations

  1. Department of Rheumatology and Clinical Immunology National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology State Key Laboratory of Complex Severe and Rare Diseases Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China

    Min Hui, Jiaxin Zhou, Mengtao Li, Qian Wang, Jiuliang Zhao, Yong Hou, Dong Xu & Xiaofeng Zeng

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  1. Min Hui
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Contributions

Min Hui and Jiaxin Zhou: data curation, writing—original draft preparation.

Mengtao Li: visualization, investigation.

Jiuliang Zhao and Qian Wang: conceptualization, methodology, software.

Yong Hou: validation and writing—reviewing.

Dong Xu and Xiaofeng Zeng: writing—reviewing and editing.

Corresponding author

Correspondence to Dong Xu.

Ethics declarations

Ethical approval and consent to participate

This study was approved by Chinese Rheumatism Data Center (CRDC) with number S-478 and ethics committee of PUMCH with number S-191. Informed consent was obtained from CRDC.

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The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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Hui, M., Zhou, J., Li, M. et al. Digital gangrene in systemic sclerosis patients: not only due to the microvascular disease. Clin Rheumatol 43, 1083–1092 (2024). https://doi.org/10.1007/s10067-024-06886-8

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