SAT0209 The Risk for Initial Digital Ulcer Involvement in SSC Patients Decreases with Disease Duration Since the Beginning of Raynaud Phenomenon

Background Digital ulcers (DU) constitute an important component of disease burden in SSc. Among patients with SSc it has been reported that 15 to 25 % have active digital ulcers and 35 % have or have had DUs in the past. The natural history, including risk as well as protective factors for the development of DU are only partially understood. Objectives To identify new clinical parameters as risk factors for the development of DU. Methods In a prospective study, patients with definite SSc were included in three groups: i) group 1 for patients with active DU; ii) group 2 for patients, who have no active DU at baseline, but had reliably documented SSc-related DU in the past; iii) group 3 for patients, who neither have active DU at inclusion nor had DU in their past. Patients in group 3 are followed on months 6, 12, 24 for the development of DU. Results 87 patients were included in group 1, 148 patients in group 2. 420 patients were recruited for group 3. Mean disease duration at enrolment as determined by first non-Raynaud organ involvement was 10.6 years in group 1, 2 and 8.8 in group 3. Patients in group 3 with no history of DU were significantly (p< 0.001) older (median 60 years vs. 55 years in group 1, 2), had lower mRSS (median 6 vs. 9), a lower frequency of lung fibrosis (38.4% vs. 54.2%) and a lower frequency of Scl-70 autoantibody (18.5% vs 40.9%). In group 3 after a mean follow up of 1.6 years, only 17/420 (4.0%) patients developed a DU, with decreasing frequency over the observation time. The risk to develop DU was highest within 3 years after beginning of raynaud phenomenon (RP). Risk for DU was significantly reduced for patients within 3-6 years after beginning of RP (OR=0,114 95%>KI (0,014;0,952)) and >6 years ((OR = 0,337, 95%>KI (0,121;0,943)). Conclusions In addition to well known risk factors for DU, including diffuse disease, high mRSS, Scl-70 antibody, this study indicates that a) a substantial number of SSc patients do not develop DU and b) disease duration is inversely correlated with the risk to develop DU for the first time. Disclosure of Interest P. Moinzadeh Grant/research support from: This study was financially supported by Actelion Pharmaceuticals Germany., N. Hunzelmann Grant/research support from: This study was financially supported by Actelion Pharmaceuticals Germany., U. Mueller-Ladner Grant/research support from: This study was financially supported by Actelion Pharmaceuticals Germany., F. Meier Grant/research support from: