title: Calcinosis is associated with digital ulcers and osteoporosis in patients with systemic sclerosis: A Scleroderma Clinical Trials Consortium study.
abstract: We sought to identify the clinical factors associated with calcinosis in an international multicenter collaborative effort with the Scleroderma Clinical Trials Consortium (SCTC).
  
  
  
  This is a retrospective cohort study of 5218 patients with systemic sclerosis (SSc). Logistic regression was used to obtain odds ratios (OR) relating calcinosis to various clinical features in multivariate analyses.
  
  
  
  A total of 1290 patients (24.7%) had calcinosis. In univariate analyses, patients with calcinosis were older than patients without calcinosis, more likely to be female, and had longer disease duration from the first non-Raynaud phenomenon symptom. Patients with calcinosis were more likely to have digital ulcers, telangiectasias, acro-osteolysis, cardiac disease, pulmonary hypertension, gastrointestinal involvement, arthritis, and osteoporosis, but less likely to have muscle disease. Anti-Scl-70, RNA-polymerase-III, and U1-RNP autoantibodies were significantly less common in patients with calcinosis, while anticentromere (ACA), anti-PM/Scl, and anticardiolipin antibodies were more frequent. In multivariate analysis, the strongest associations with calcinosis were digital ulcers (OR = 3.9; 95% CI: 2.7-5.5; p < 0.0001) and osteoporosis (OR = 4.2; 95% CI: 2.3-7.9; p < 0.0001).
  
  
  
  One quarter of patients with SSc have calcinosis at some time during their illness. Our data confirm a strong association of calcinosis with digital ulcers, and support a novel association with osteoporosis.
authors.affiliation: Department of Immunology and Rheumatology, Stanford University School of Medicine, 1000 Welch Road, Suite 203 MC 5755, Palo Alto, CA 94304.
authors.forename: Antonia
authors.initials: A
authors.lastname: Valenzuela
authors.affiliation: Department of Rheumatology, Jewish General Hospital McGill University, Montreal, Canada.
authors.forename: Murray
authors.initials: M
authors.lastname: Baron
authors.affiliation: Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
authors.forename: Ariane L
authors.initials: AL
authors.lastname: Herrick
authors.affiliation: Rheumatology Unit, Royal Adelaide Hospital, North Terrace, Australia; Discipline of Medicine, University of Adelaide, Adelaide, Australia; Department of Rheumatology, St. Vincent׳s Hospital Melbourne, Fitzroy, Australia.
authors.forename: Susanna
authors.initials: S
authors.lastname: Proudman
authors.affiliation: Discipline of Medicine, University of Adelaide, Adelaide, Australia; Department of Rheumatology, St. Vincent׳s Hospital Melbourne, Fitzroy, Australia.
authors.forename: Wendy
authors.initials: W
authors.lastname: Stevens
authors.affiliation: Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, DF, Mexico, Mexico.
authors.forename: Tatiana S
authors.initials: TS
authors.lastname: Rodriguez-Reyna
authors.affiliation: Unit and Chair of Rheumatology, University Hospital of Cagliari, Cagliari, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Vacca
authors.affiliation: Department of Medicine/Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Medsger
authors.affiliation: Department of Rheumatology, Northwestern University, Chicago, IL.
authors.forename: Monique
authors.initials: M
authors.lastname: Hinchcliff
authors.affiliation: Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: Vivien
authors.initials: V
authors.lastname: Hsu
authors.affiliation: Department of Endocrinology, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Joy Y
authors.initials: JY
authors.lastname: Wu
authors.affiliation: Department of Dermatology, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: David
authors.initials: D
authors.lastname: Fiorentino
authors.affiliation: Department of Immunology and Rheumatology, Stanford University School of Medicine, 1000 Welch Road, Suite 203 MC 5755, Palo Alto, CA 94304. Electronic address: shauwei@stanford.edu.
authors.forename: Lorinda
authors.initials: L
authors.lastname: Chung
mesh_terms: D030981:Acro-Osteolysis / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000974:Antibodies, Antinuclear / Q000276:immunology; D001323:Autoantibodies / Q000276:immunology; D002114:Calcinosis / Q000453:epidemiology* / Q000276:immunology; D015331:Cohort Studies; D004264:DNA Topoisomerases, Type I; D005260:Female; D005385:Fingers; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009687:Nuclear Proteins / Q000276:immunology; D016017:Odds Ratio; D010024:Osteoporosis / Q000453:epidemiology*; D012320:RNA Polymerase III / Q000276:immunology; D012189:Retrospective Studies; D017412:Ribonucleoprotein, U1 Small Nuclear / Q000276:immunology; D012595:Scleroderma, Systemic / Q000453:epidemiology* / Q000276:immunology; D012883:Skin Ulcer / Q000453:epidemiology* / Q000276:immunology; D013684:Telangiectasis / Q000453:epidemiology
chemical_list: D000974:Antibodies, Antinuclear; D001323:Autoantibodies; D009687:Nuclear Proteins; D017412:Ribonucleoprotein, U1 Small Nuclear; C048100:Scl 70 antigen, human; C538950:anticentromere antibody; D012320:RNA Polymerase III; D004264:DNA Topoisomerases, Type I
keywords: Calcinosis; Digital ulcers; Osteoporosis; Systemic sclerosis