Incidence of Systemic Vasculitis and Clinical Outcomes in Systemic Sclerosis: 2-Years Follow-Up of Asymptomatic Positive for Anti-Neutrophilic Cytoplasmic Antibody

Raiwin Suwannamajo, Ajanee Mahakkanukrauh, Siraphop Suwannaroj, Chingching Foocharoen Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, ThailandCorrespondence: Chingching Foocharoen, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand, Tel +6643363746, Email [email protected]: Anti-neutrophilic cytoplasmic antibody (ANCA)-associated vasculitis (AAV) overlap with systemic sclerosis (SSc) is uncommon. We aimed to determine the incidence of AAV and define clinical outcomes relevant to asymptomatic screening positive for ANCA in SSc after 2 years of follow-up.Patients and Methods: The study was a cohort study of 185 Thai adult SSc patients testing for ANCA and having a 2-year follow-up at the Scleroderma Clinic, Khon Kaen University, Thailand. The incidence of AAV and outcomes of those who tested positive for ANCA were evaluated.Results: A total of 185 SSc patients were tested for ANCA, of whom 21.6% were positive for either cytoplasmic ANCA, perinuclear ANCA (p-ANCA), anti-myeloperoxidase (anti-MPO), or anti-proteinase3 antibody. Only one 52-year-old female patient with dcSSc, negative for initial ANCA test, developed AAV (microscopic polyangiitis) 7 months after the first ANCA test for an incidence of AAV of 0.27 per 100-person-years (95% CI 0.01– 1.5). She was positive for p-ANCA and anti-MPO. Eight of those who had an initial test were positive for ANCA and underwent a repeated test. Only two cases persisted as positive for ANCA (1 anti-MPO and 1 anti-PR3) and had no clinicals suspicious of vasculitis. Four cases that had ANCA turned to a negative result.Conclusion: AAV is a rare complication in SSc, so ANCA may not have any role as a screening test for AAV as it cannot predict the development of AAV in SSc. We suggest testing for ANCA only in SSc patients with clinicals suspicious of AAV.Keywords: systemic sclerosis, scleroderma, anti-neutrophilic cytoplasmic antibody, ANCA- associated vasculitis, vasculiti

The prevalence and clinical features associated of hypothyroidism among Thai systemic sclerosis patients

Thyroid disease, particularly hypothyroidism, has been reported in systemic sclerosis (SSc). Some clinical features of SSc can also present in hypothyroidism. Our aims were to determine the prevalence of, and describe clinical features associated with, hypothyroidism in SSc patients. We conducted a historical cohort study of adult SSc patients who underwent screening thyroid function tests at the Scleroderma Clinic, Khon Kaen University, Thailand, between 2009 and 2018. The patients who had any thyroid disorders before the onset of SSc and were diagnosed as an overlap syndrome were excluded. A total of 200 SSc were included according to sample size calculation, among whom the female to male ratio was 2:1. The majority of cases (137; 69.5%) were diffuse cutaneous SSc subset. The mean age was 55.8 ± 10.7 years and the median duration of disease 4.9 (IQR 1.6–9.9) years. Of the total, 9 had primary hypothyroidism (prevalence 4.5%; 95%CI 2.1–8.4) and 22 had subclinical hypothyroidism (prevalence 11%; 95%CI 7.0–16.2). Of the latter 22, 71% had dcSSc. Logistic regression analysis indicated that unexplained anemia was significantly associated with either subclinical hypothyroid or hypothyroidism (OR 2.74; 95% CI 1.17–6.47), whereas Raynaud’s phenomenon had a negative association (OR 0.28; 95% CI 0.11–0.66). Neither severity of skin tightness nor internal organ involvement were associated with hypothyroidism among SSc patients. Clinical-subclinical hypothyroidism is uncommon among SSc patients, it is frequently associated with anemia, and less so Raynaud’s phenomenon. Clinical-subclinical hypothyroidism should thus be considered in cases of unexplained anemia in SSc patients

An international, large-scale multi-center study assessing the role of facet joint angulation and tropism with the development of lumbar degenerative spondylolisthesis - A study from the AOSAP Research Collaboration Consortium

Session: Free Papers Lumbar Spine 2: abstract no. 39935INTRODUCTION: Degenerative spondylolisthesis (DS) mainly occurs at L4-L5. The phenotype and critical values of facet joint (FJ) angulation and tropism (FJs angulation asymmetry) in relation to DS remain controversial. The study addressed the role of FJ angulation and tropism in relation to L4-L5 DS in the Asia Pacific region. METHODS: An international cross-sectional study was performed in 33 institutions of single level DS. Imaging assessment consisted of identifying the DS level and left/right L4-L5 FJ angulations. Patients were stratified to those without (Group A) or with L4-L5 DS (Group B). ROC and multivariate analyses were performed, assessing the FJ angulation profile and tropism in relation to DS. RESULTS: The study included 349 patients (63% females; mean age: 61.8 years). Group B had greater sagittal FJ angulation than Group A (p<0.001). 58 degrees or greater significantly increased the risk of DS (unilateral FJ: OR:2.5; 95% CI:1.2-5.5; bilateral FJ: OR:5.9; 95% CI:2.7-13.2; p<0.001). FJ tropism was found to be relevant between 16-24 degrees angulation difference (OR:5.6; 95% CI:1.2-26.1). CONCLUSIONS: To the authors’ knowledge, this is one of the largest studies to address the role of FJ angulation and tropism in relation to L4-L5 DS. Greater FJ angulation was associated with DS, with a critical value of ≥58 degrees increasing DS risk for unilateral and bilateral facet involvement. Specific FJT ranges were related to DS. This study further broadens the understanding of the phenotype of facet joint orientation in relation to DS

Nailfold capillary abnormalities in erectile dysfunction of systemic sclerosis: a EUSTAR group analysis

Objective. The objective of this study was to analyse an association between nailfold capillary abnormalities and the presence and severity of erectile dysfunction (ED) in men with SSc.Methods. A cross-sectional analysis of the prospective European League Against Rheumatism (EULAR) Scleroderma Trial and Research database was performed. Men with SSc were included if they had undergone nailfold capillaroscopy and simultaneous ED assessment with the 5-item International Index for Erectile Function (IIEF-5).Results. Eighty-six men met the inclusion criteria. Eight men (9.3%) had not had sexual intercourse and could not be assigned an IIEF-5 score. Sixty-nine of the 78 men (88.5%) with an IIEF-5 score had nailfold capillary abnormalities, of whom 54 (78.3%) suffered from ED. Nine men (11.5%) had no nailfold capillary abnormalities, of whom six (66.7%) had ED (P = 0.44). ED was more frequent in older men (P = 0.002) and in men with diffuse disease (P = 0.06). Men with abnormal capillaroscopy had a higher median EULAR disease activity than men without (P = 0.02), a lower diffusing capacity of the lung (P = 0.001) and a higher modified Rodnan skin score (P = 0.04), but mean IIEF-5 scores did not differ [15.7 (s.d. 6.2) vs 15.7 (s.d. 6.3)]. IIEF-5 scores did not differ between men with early (n = 12), active (n = 27) or late (n = 27) patterns (IIEF-5 scores of 17.9, 16.3 and 14.7, respectively). There were no differences in the prevalence of early, active and late capillaroscopy patterns between men with or without ED.Conclusion. Neither the presence or absence of abnormal capillaroscopy findings nor the subdivision into early, active and late patterns is associated with coexistent ED in SSc