Peripheral arterial disease in rheumatology

Objective: to assess the frequency of thromboangiitis obliterans (TAO) vascular lesions and its association with clinical and laboratory manifestations in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS).

Material and methods. The study included 172 patients (30 men and 142 women): 22 (13%) with isolated “primary” APS (pAPS), 66 (38%) with SLE, and 84 (49%) with SLE + APS. The median age was 36 [30; 46] years. Disease duration in the SLE + APS group was longer than in the pAPS and SLE groups (median 17 [9; 21], 5 [2; 13], and 7 [3; 12] years, respectively; p<0.05). All patients were hospitalized at the V.A. Nasonova Research Institute of Rheumatology due to exacerbation of the underlying disease and underwent a comprehensive examination.

Results and discussion. Vascular lesions of the TAO type were recorded in 17 (10%) of 172 patients: 1 with pAPS, 13 with SLE + APS, and 3 with SLE. The development of TAO in patients with SLE + APS was influenced by the following factors: dyslipidemia (odds ratio, OR 10.74; 95% confidence interval, CI 3.29–34.99; p<0.01), arterial hypertension (OR 7.19; 95% CI 1.98–26.07; p<0.01), and Raynaud’s syndrome (OR 7.72; 95% CI 2.61–22.82; p<0.01). As a result of multivariate analysis, a prognostic model was obtained, according to which the number of aseptic bone necroses, the number of lower leg ulcers over the entire disease course, the type of thrombosis, APS duration, disease onset with APS manifestations, livedo reticularis, elevated levels of IgG antibodies to cardiolipin, to β₂-glycoprotein 1, total cholesterol, C-reactive protein (CRP), and an increase in leukocyte count are associated with a higher probability of TAO development in patients with SLE and/or APS.

Conclusion. Risk factors for the development of TAO in patients with SLE and APS are aseptic bone necroses, trophic ulcers of the lower legs, APS duration, livedo reticularis, elevated levels of IgG antibodies to cardiolipin, to β₂-glycoprotein 1, total cholesterol, CRP, and an increased leukocyte count.

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