Diabetic ulcer ups PAH risk in SSc patients

Patients with systemic sclerosis (SSc) who have diabetic ulcer (DU) are at an increased risk for developing pulmonary arterial hypertension (PAH), reports a study. However, the use of bosentan for preventing DU may reduce such risk. 

Overall, 727 eligible patients with SSc were followed for a median of 2.0 years. Of these, 54 (7.4 percent) developed PAH (incidence rate [IR], 3.71 per 100 patient-years). 

Patients with DU who did not receive treatment with bosentan showed a higher incidence of PAH (IR, 4.90 per 100 patient-years) than those with bosentan exposure, whose rates were similar to individuals without DU and who were never exposed to bosentan. 

PAH development was associated independently with the following factors: DU (hazard ratio [HR], 1.86), age (HR, 1.05), modified Rodnan skin score >4 (HR, 2.07), interstitial lung disease (HR, 2.29), and acetylsalicylic acid treatment (HR, 1.78). 

“Only patients with DU who were not using bosentan had an increased PAH incidence,” the investigators said.  

This study included SSc patients from the SPRING registry who met the 2013 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria with data on PAH onset, DU status, bosentan exposure, and at least 1 year of follow-up between 2015 and 2020, and had no known PAH at baseline. 

PAH was diagnosed with right heart catheterization during follow-up. The investigators then calculated its IR, determined the Kaplan-Meier curves, and identified PAH risk factors via multivariate regression. 

“Bosentan is approved for treating PAH and preventing DU in SSc,” according to the investigators.