Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Medium and Large Vessel Involvements Contribute to Digital Ulcers in Systemic Sclerosis.

Meune1,  Christophe, Meunier2,  Marine, Avouac2,  Jérôme, Kahan2,  Andre, Allanore2,  Yannick

Paris Descartes University, Cardiology department, Cochin Hospital, Paris, France
Paris Descartes University, Rheumatology A department, Cochin Hospital, Paris, France


Digital ulcers are a burden in systemic sclerosis (SSc). Microangiopathy is a cardinal feature of SSc that has a critical role in the development of DU. However, whether injury of the medium or large vessels also contributes to DU in SSc has been poorly investigated. The importance of large artery stiffening has been highlighted by the observation that aortic pulse wave velocity (PWV), which is inversely related to distensibility, and central augmentation index (AIx), a composite measure that depends on the site and degree of wave reflection, are independent predictors of cardiovascular and total mortality in selected patient groups. In addition, previous reports suggested that Aix is a more sensitive marker of arterial stiffening and risk in younger individuals. Our aim was to measure PWV and Aix in SSc patients stratified according to the presence of digital ulcers.


Reflected waves assessed by radial applanation tonometry and PWV were measured and compared in a prospective cohort of consecutive SSc patients with and without active digital ulcers, recruited during a 6-month period.


63 consecutive SSc patients were included (male 14, age 57±12 years, diffuse cutaneous form 10, disease duration 9.7±7.1 years). Among these, 10 SSc patients (15.9%) had active digital ulcer. Systolic, diastolic aortic pressure, as well as aortic pulse pressure, were similar in patients with versus without active ulcers (p=0.104, 0.531 and 0.143 respectively). Regarding our primary criteria, when compared to patients without ulcer, SSc patients with active digital ulcer had increased AIx_75 (35%[28–38] versus 29%[21–34], p=0.048) without any significance difference in PWV (7.3 m/s [6.7–10.1] versus 7.6 m/s [6.7–8.6], p=0.913). By univariate analysis, age (p=0.002), the existence of active ulcer (p=0.048) and ESR (p=0.010) are the only associated factors with Aix_75. In bivariate analysis, after adjustment for age, the presence of active ulcer remained a strong determinant of AIx_75 (p=0.038). In addition, the AIx_75 of the reflected wave correlated with age (r=0.76, p=0.035) and NT-proBNP concentration (r=0.388, p=0.004), whereas PWV correlated only with age (r=0.520, p=0.001).


SSc patients with active ulcer have increased Aix_75 but similar PWV when compared to patients without active ulcer. These data suggest that patients with active ulcer have a different arteriolar site of reflection, possibly due to increased peripheral arteries vasoconstrictor tone. If confirmed this could suggest that this vascular component should be targeted by the drug regimen in SSc patients with active DU.

To cite this abstract, please use the following information:
Meune, Christophe, Meunier, Marine, Avouac, Jérôme, Kahan, Andre, Allanore, Yannick; Medium and Large Vessel Involvements Contribute to Digital Ulcers in Systemic Sclerosis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1464

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