Assessment of calcinosis in Portuguese patients with systemic sclerosis — a multicenter study

Beatriz Samões, Diogo Guimarães da Fonseca, Tiago Beirão, Flávio Costa, Romana Vieira, Georgina Terroso, Raquel Miriam Ferreira, Rafaela Nicolau, André Saraiva, Maria João Salvador, Ana Catarina Duarte, Ana Cordeiro, João Paulo Vilas-Boas, Inês Genrinho, Ana Bento da Silva, Laura Gago, Catarina Resende, Patricia Martins, Nathalie Madeira, Sara DinisMaura Couto, Inês Santos, Filipe Araújo, Ana Filipa Mourão, Miguel Gomes Guerra, Margarida Oliveira, Alexandra Daniel, Marília Rodrigues, Catarina Dantas Soares, Hugo Parente, Carolina Furtado, Tomás Fontes, Joana Abelha-Aleixo

Research output: Contribution to journalArticlepeer-review


Introduction/objectives: The study aims to define the clinical and subclinical calcinosis prevalence, the sensitivity of radiographed site and clinical method for its diagnosis, and the phenotype of Portuguese systemic sclerosis (SSc) patients with calcinosis. Method: A cross-sectional multicenter study was conducted with SSc patients fulfilling Leroy/Medsger 2001 or ACR/EULAR 2013 classification criteria, registered in the Calcinosis was assessed through clinical examination and radiographs of hands, elbows, knees, and feet. Independent parametric or non-parametric tests, multivariate logistic regression, and sensitivity calculation of radiographed site and clinical method for calcinosis detection were performed. Results: We included 226 patients. Clinical calcinosis was described in 63 (28.1%) and radiological calcinosis in 91 (40.3%) patients, of which 37 (40.7%) were subclinical. The most sensitive location to detect calcinosis was the hand (74.7%). Sensitivity of the clinical method was 58.2%. Calcinosis patients were more often female (p = 0.008) and older (p < 0.001) and had more frequently longer disease duration (p < 0.001), limited SSc (p = 0.017), telangiectasia (p = 0.039), digital ulcers (p = 0.001), esophageal (p < 0.001) and intestinal (p = 0.003) involvements, osteoporosis (p = 0.028), and late capillaroscopic pattern (p < 0.001). In multivariate analysis, digital ulcers (OR 2.63, 95% CI 1.02–6.78, p = 0.045) predicted overall calcinosis, esophageal involvement (OR 3.52, 95% CI 1.28–9.67, p = 0.015) and osteoporosis (OR 4.1, 95% CI 1.2–14.2, p = 0.027) predicted hand calcinosis, and late capillaroscopic pattern (OR 7.6, 95% CI 1.7–34.9, p = 0.009) predicted knee calcinosis. Anti-nuclear antibody positivity was associated with less knee calcinosis (OR 0.021, 95% CI 0.001–0477, p = 0.015). Conclusions: Subclinical calcinosis high prevalence suggests that calcinosis is underdiagnosed and radiographic screening might be relevant. Multifactorial pathogenesis may explain calcinosis predictors’ variability. Key Points • Prevalence of subclinical calcinosis in SSc patients is substantial. • Hand radiographs are more sensitive to detect calcinosis than other locations or clinical method. • Digital ulcers were associated with overall calcinosis, esophageal involvement and osteoporosis were associated with hand calcinosis, and late sclerodermic pattern in nailfold capillaroscopy was associated with knee calcinosis. • Anti-nuclear antibody positivity may be a protective factor for knee calcinosis.

Original languageEnglish
JournalClinical Rheumatology
Publication statusE-pub ahead of print - 8 May 2023


  • Calcinosis
  • Radiography
  • Subclinical
  • Systemic sclerosis


Dive into the research topics of 'Assessment of calcinosis in Portuguese patients with systemic sclerosis — a multicenter study'. Together they form a unique fingerprint.

Cite this