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Prevalence and clinical association with acro-osteolysis in early systemic sclerosis


1, 2, 3, 4

 

  1. Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
  2. Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
  3. Division of Rheumatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
  4. Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. wpunth@kku.ac.th

CER13878
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PMID: 33427611 [PubMed]

Received: 31/07/2020
Accepted : 23/11/2020
In Press: 06/01/2021

Abstract

OBJECTIVES:
Acro-osteolysis is often associated with systemic sclerosis (SSc). However, the severity of acro-osteolysis and its clinical association among SSc patients is limited. Our aims were to assess the prevalence of acro-osteolysis and the clinical association with acro-osteolysis among SSc patients at early onset of the disease.
METHODS:
A cross-sectional study of 120 newly diagnosed SSc patients with the onset of less than 4 years were evaluated on clinical characteristics and hand radiographs. Acro-osteolysis was graded on a 0–4-point scale based on the severity and the patients were subdivided into mild, moderate and severe.
RESULTS:
Among all SSc patients enrolled, 62.5% were females, 56.1% dcSSc and the vast majority of them (84.1%) were positive for anti-topoisomerase I antibody (anti-topo I). The mean disease duration was 2.0±1.3 years. Acro-osteolysis was noted in 77 patients with a prevalence of 64.1% (95%CI 54.9–72.7), of which 16.7% were defined as severe acro-osteolysis. Logistic regression analysis revealed that acro-osteolysis was positively associated with anti-topo I (OR 13.96), hand deformity (OR 3.81) and dysphagia (OR 6.66), but negatively associated with oedematous skin (OR 0.05). Analysis stratified by severity of acro-osteolysis showed significant differences between subgroup in terms of the presence of digital gangrene (p=0.02), ischaemic ulcer (p=0.001), oedematous skin (p=0.001), and hand deformities (p=0.01).
CONCLUSIONS:
Acro-osteolysis was common in SSc at the early onset of disease. While the presence of anti-topo I, hand deformity and esophageal involvement were strongly associated with acro-osteolysis, oedematous skin was the protective factor for acro-osteolysis.

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