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Digital Tip Ulcers Are Associated With Osteitis in Systemic Sclerosis
Findings from a new study confirm that digital tip ulcers are an associated factor for osteitis among patients with systemic sclerosis (SSc).
This determination comes after more than half of the patients with SSc with a diagnosis of osteitis who were included in the study had bone inflammation occur beneath digital tip ulcers.
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The researchers aimed to describe, characterize, and identify associated factors for osteitis among patients with SSc. The retrospective, multicenter study included 48 patients with SSc and osteitis.
In all, 54.1% of patients had osteitis underneath ulcers on digital tips. In terms of physical symptoms, 75% of patients had pain, 73% had erythema, and 73% had local warmth. Meanwhile, 65% of patients had C-reactive protein levels greater than 2 mg/L. Osteitis was characterized on x-ray, computerized tomography scan, or magnetic resonance imaging scan by swelling or abscess of soft tissues with acro-osteolysis or lysis in 58% of patients.
Among 94% of patients who underwent microbiological sampling, 43.8% had Staphylococcus aureus, 29.1% had anaerobes and Enterobacteriaceae, and 10.4% had Pseudomonas aeruginosa. For management, antibiotics were used among 77.1% of patients and surgery was performed among 54.2% of patients. Meanwhile, 45.8% of patients received fluoroquinolones and 14.6% of patients received amoxicillin plus beta-lactamase inhibitor.
Of the 48 patients in the study, 6 relapsed, 6 experienced osteitis recurrence, and 2 had septic shock and died.
“This study confirmed digital tip ulcers as an associated factor for osteitis and revealed a high rate of functional sequelae,” the researchers concluded. “Antimicrobial therapy with oral fluoroquinolone or intravenous amoxicillin and beta‐lactamase inhibitor are used as first‐line antibiotherapy in SSc patients with osteitis.”
—Jolynn Tumolo
Reference:
Cosse C, Kernéis S, Lescoat A, et al. Osteitis in systemic sclerosis: a nationwide case-control retrospective study (SCLEROS Study). Arthritis Care Res. Published online December 5, 2020. doi:10.1002/acr.24530
