{
  "abstract": "Introduction Microvascular damage contributes to various cutaneous manifestations in systemic sclerosis (SSc). Concomitant macroangiopathy may also occur, potentially leading to severe lower limb ischemia, foot ulcers, and gangrene. However, the clinical risk factors for lower limb ulcers in SSc remain poorly understood.Material and Methods We conducted retrospective chart reviews of 239 patients diagnosed with SSc at Yokohama City University Hospital from January 2018 to March 2025. Clinical characteristics, laboratory data, and autoantibody profiles were collected and analysed to assess their association with lower limb ulcers using multivariable logistic regression analysis. In addition, lower limb CT angiography was reviewed to evaluate the presence and site of vascular stenosis, and to assess their association with lower limb gangrene and ulcer severity.Results The cohort included 31 males and 208 females, with a median age at SSc onset of 53.0 years. Of these, 70 patients (29.3%) were classified as dcSSc and 169 (70.7%) as lcSSc. The most frequent autoantibody was anticentromere (44.1%), followed by anti-topoisomerase I (22.2%), and anti-RNA polymerase III (8.8%). Lower limb ulcers were observed in 29 patients (12.1%), and 6 patients (2.5%) lastly required lower extremity amputation. Multivariable logistic regression analysis revealed that the development of lower limb ulcers was statistically associated with interstitial lung disease (ILD) (OR=4.84; 95% CI, 1.49-6.30; P = 0.009), pulmonary arterial hypertension (PAH) (OR=5.29; 95% CI, 1.84-14.94; P = 0.002), anticentromere antibody positivity (OR=5.60; 95% CI, 1.66-20.85; P = 0.005), and anti-SS-A antibody positivity (OR=4.17; 95% CI, 1.72-10.24; P = 0.002). No significant associations were observed with skin thickness severity or smoking status. CT angiography performed in 21 patients with lower limb ulcers revealed that the most frequent site of stenosis was the posterior tibial artery in 15 patients (71.4%), followed by the anterior tibial artery (14 patients, 66.7%) and the fibular artery (10 patients, 47.6%). Notably, all 6 patients requiring amputation had posterior tibial artery stenosis, whereas only 2 of these patients (33.3%) had stenosis in the iliac and femoral artery, which are the predominant sites of lower extremity artery disease caused by atherosclerosis.Conclusions Our analysis suggested that the onset of lower limb ulcers may be primarily associated with ILD, PAH, and the presence of specific autoantibodies, while lifestyle-related factors seem to play only a limited role. Furthermore, severe tibial artery stenosis may be associated with progression from lower limb ulcers to amputation.Abstract P.186 Table 1Comparison of clinical characteristics between SSc patients with and without lower limb ulcersAbstract P.186 Table 2Logistic regression analysis for the risk of SSc patients with lower limb ulcers",
  "authors": [
    {
      "affiliations": [
        "Yokohama City University Graduate School of Medicin, Department of Environmental Immuno-Dermatology, Yokohama, Japan"
      ],
      "name": "Tomoya Watanabe"
    },
    {
      "affiliations": [
        "Yokohama City University Graduate School of Medicin, Department of Environmental Immuno-Dermatology, Yokohama, Japan"
      ],
      "name": "Izumi Moteki"
    },
    {
      "affiliations": [
        "Yokohama City University Graduate School of Medicin, Department of Environmental Immuno-Dermatology, Yokohama, Japan"
      ],
      "name": "Yukari Hamamura"
    },
    {
      "affiliations": [
        "Yokohama City University Graduate School of Medicin, Department of Environmental Immuno-Dermatology, Yokohama, Japan"
      ],
      "name": "Haruka"
    },
    {
      "affiliations": [
        "Yokohama City University Graduate School of Medicin, Department of Environmental Immuno-Dermatology, Yokohama, Japan"
      ],
      "name": "Arakawa"
    },
    {
      "affiliations": [
        "Yokohama City University Graduate School of Medicin, Department of Environmental Immuno-Dermatology, Yokohama, Japan"
      ],
      "name": "Hisho Kawamura"
    },
    {
      "affiliations": [
        "Yokohama City University Graduate School of Medicin, Department of Environmental Immuno-Dermatology, Yokohama, Japan"
      ],
      "name": "Yasushi Ototake"
    },
    {
      "affiliations": [
        "Yokohama City University Graduate School of Medicin, Department of Environmental Immuno-Dermatology, Yokohama, Japan"
      ],
      "name": "Miwa Kanaoka"
    },
    {
      "affiliations": [
        "Yokohama City University Graduate School of Medicin, Department of Environmental Immuno-Dermatology, Yokohama, Japan"
      ],
      "name": "Yukie Yamaguchi"
    }
  ],
  "title": "P.186 Clinical risk factors for the development of lower limb ulcers in patients with systemic sclerosis: a cohort study of 239 patients",
  "uid": "d00a7ea7-bb9f-5932-9f03-fbceb004c96a"
}