Osteitis in Systemic Sclerosis: A Nationwide Case–Control Retrospective Study

• Main Authors: Agard, C. (Author), Berthier, S. (Author), Bertolino, J. (Author), Cerles, O. (Author), Chaigne, B. (Author), Cosse, C. (Author), Dion, J. (Author), Diot, E. (Author), Fagedet, D. (Author), Giret, C. (Author), Granel, B. (Author), Jourde, W. (Author), Kernéis, S. (Author), Le Jeunne, C. (Author), Lescoat, A. (Author), Luque Paz, D. (Author), Martin, M. (Author), Maurier, F. (Author), Mouthon, L. (Author), Nguyen, C. (Author), Priollet, P. (Author), Pugnet, G. (Author), Raffray, L. (Author), Toquet, S. (Author), Truchetet, M.-E (Author), Viallard, J.F (Author), Watelet, B. (Author)
• Format: Article
• Language: English
• Published: John Wiley and Sons Inc 2022
• Online Access: View Fulltext in Publisher
• ISBN: 2151464X (ISSN)
• DOI: 10.1002/acr.24530

Objective: Systemic sclerosis (SSc) is an autoimmune connective tissue disorder characterized by skin fibrosis, vasculopathy, and dysimmunity. Data regarding osteitis in SSc are scarce. Methods: We performed a nationwide multicenter, retrospective, case–control study including patients with SSc, according to the 2013 American College of Rheumatology/European Alliance of Associations for Rheumatology classification, with a diagnosis of osteitis. The objectives of the study were to describe, to characterize, and to identify associated factors for osteitis in patients with SSc. Results: Forty-eight patients were included. Twenty-six patients (54.1%) had osteitis beneath digital tip ulcers. Physical symptoms included pain (36 of 48, 75%), erythema (35 of 48, 73%), and local warmth (35 of 48, 73%). Thirty-one (65%) patients had median (interquartile range) C-reactive protein levels >2 mg/liter of 8 (2.7–44.3) mg/liter. On radiography, computed tomography, or magnetic resonance imaging, osteitis was characterized by swelling or abscess of soft tissues, with acro-osteolysis or lysis in 28 patients (58%). Microbiological sampling was performed in 45 (94%) patients. Most pathogens were Staphylococcus aureus (43.8%), anaerobes and Enterobacteriaceae (29.1%), and Pseudomonas aeruginosa (10.4%). Management comprised antibiotics in 37 (77.1%) patients and/or surgery in 26 (54.2%). Fluoroquinolones were used in 22 (45.8%) patients, and amoxicillin plus β-lactamase inhibitor in 7 (14.6%). Six (12.6%) patients relapsed, 6 (12.6%) patients had osteitis recurrence, 15 (32%) sequelae, and 2 patients had septic shock and died. Conclusion: This study confirmed digital tip ulcers as an associated factor for osteitis and revealed a high rate of functional sequelae. Antimicrobial therapy with oral fluoroquinolone or intravenous amoxicillin and β-lactamase inhibitor are used as first-line antibiotic therapy in SSc patients with osteitis. © 2020 American College of Rheumatology.