Whole-body distribution and clinical association of telangiectases in systemic sclerosis

Abstract

IMPORTANCE In systemic sclerosis (SSc), to date, no study has precisely described the total number and fine distribution of telangiectases (TAs), their clinical association with the disease, and the biological mechanisms causing their development. OBJECTIVES To describe the whole-body distribution of TAs and assess the association between the whole-body TA number and the characteristics of patients with SSc. DESIGN, SETTING, AND PARTICIPANTS A single-center, cross-sectional studywas conducted between July 11, 2016, and March 15, 2017, at the National Referral Centre for Rare Systemic and Autoimmune Diseases in France. A population-based sample of 106 adults who fulfilled the 2013 American College of Rheumatology/European League Against Rheumatism criteria for SSc were included; 8 patients who had previously received laser treatment for TAs were excluded. MAIN OUTCOMES AND MEASURES The number of TAs on the whole body (total and those >5 mm) and TA distribution in different areas were recorded. The association with clinical and biological data was studied using univariate and multivariate linear regression. RESULTS A total of 106 patients (83 [78.3%] women) were enrolled, including 12 with precapillary pulmonary hypertension (PH). Mean (SD) age was 60.6 (13.5) years. Telangiectasia distribution was 37.2%on the face, 33.2%on the upper limbs, including 26.4% on the hands, 28.1%on the trunk, including 17.1% for the upper part of the trunk, and 1.5%on the lower limbs. In analysis using the multivariate linear regression model, the whole-body TA number was independently associated with male sex (percentage change, 144.4%; 95%CI, 7.5%to 455.9%; P = .03), PH (162.8%; 95%CI, 5.6%to 553.8%; P = .04), history of pulmonary embolism (336.4%; 95%CI, 39.0%to 1270.1%; P = .01), glomerular filtration rate (-1.6%; 95%CI, -3.2%to -0.1% per 1-mL/min/1.73m2 increase; P = .04), and soluble endoglin level (28.2%; 95%CI, 1.2%to 62.5%per 1-ng/mL increase; P = .04). Receiver operating characteristic analyses assessing the ability of TAs to identify the presence of PH revealed that the area under the curve was significant for the TA number on the whole body (0.77; 95%CI, 0.57 to 0.88), on the hands and face (0.81; 95%CI, 0.57 to 0.91), and on the hands (95%CI, 0.77; 95%CI, 0.57 to 0.89). CONCLUSIONS AND RELEVANCE In the patients in this study with SSc, TAs were predominantly located on the face, hands, and the upper part of the trunk. Telangiectases appeared to be associated with vasculopathy features of SSc, particularly with PH and soluble endoglin levels.