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Prediction and primary prevention of major vascular complications in systemic sclerosis
- Source :
- European Journal of Internal Medicine. 87:51-58
- Publication Year :
- 2021
- Publisher :
- Elsevier BV, 2021.
-
Abstract
- Objective In Systemic Sclerosis (SSc), vasculopathy is the background of major vascular complications (MVCs), like digital ulcers (DUs), pulmonary arterial hypertension (PAH) and scleroderma renal crisis (SRC). We aimed to identify the predictors and to test the primary preventive effect of vasoactive/vasodilating drugs (VVD) for the development of MVCs in SSc MVCs-naive patients. Methods patients fulfilling the ACR/EULAR 2013 classification criteria for SSc without history of MVCs were eligible. Data about clinical manifestations, laboratory and instrumental assessments and treatments were retrospectively collected at baseline and latest available follow-up. Results 134 SSc patients were enrolled (mean age 56.5 years ± 14.2, females 88.1%, limited subset 61.9%, ACA positivity 60.4%). In a mean of 43 ± 19 months of follow-up 12 (9.0%) patients developed at least 1 MVC (10 DU, 2 PAH and 1 SRC). Dyspnoea and arthritis at baseline were independent predictors for MVCs development (p = 0.012, and p = 0.002 respectively). No primary preventive effect of VVD on MVCs development was found. However, sildenafil reduced the renal resistive index increase (p = 0.042) and alprostadil slowed the DLco decline (p = 0.029). Both iloprost and angiotensin-receptor blockers (ARBs) delayed MVCs development, while angiotensin converting enzyme inhibitors (ACEi) determined an earlier onset of such MCVs. Conclusions in SSc patients, our data confirm the role of arthritis and dyspnea as independent predictors of major vascular complications, in particular in MVCs-naive patients. Prostanoids, sildenafil and ARBs, even in absence of a primary preventive action, might help in slowing disease progression and postponing the onset of MVCs.
- Subjects :
- medicine.medical_specialty
Sildenafil
Scleroderma Renal Crisis
Arthritis
Vasculopathy
Angiotensin-Converting Enzyme Inhibitors
Vasodilation
030204 cardiovascular system & hematology
Scleroderma
Angiotensin Receptor Antagonists
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
DLCO
Primary prevention
Internal medicine
Internal Medicine
medicine
Humans
030212 general & internal medicine
Prediction
Prevention
Systemic sclerosis
Female
Middle Aged
Primary Prevention
Retrospective Studies
Scleroderma, Systemic
biology
business.industry
Systemic
Angiotensin-converting enzyme
medicine.disease
chemistry
biology.protein
business
Iloprost
medicine.drug
Subjects
Details
- ISSN :
- 09536205
- Volume :
- 87
- Database :
- OpenAIRE
- Journal :
- European Journal of Internal Medicine
- Accession number :
- edsair.doi.dedup.....9b3bd5aed037fc5ab2f1356693c611cb