PT  - JOURNAL ARTICLE
AU  - Benjamin Terrier
AU  - Frédérique Charbonneau
AU  - Emmanuel Touzé
AU  - Alice Berezne
AU  - Christian Pagnoux
AU  - Stéphane Silvera
AU  - Jean-François Meder
AU  - Loïc Guillevin
AU  - Catherine Oppenheim
AU  - Luc Mouthon
TI  - Cerebral Vasculopathy Is Associated with Severe Vascular Manifestations in Systemic Sclerosis
AID  - 10.3899/jrheum.081222
DP  - 2009 Jun 16
TA  - The Journal of Rheumatology
4099  - http://www.jrheum.org/content/early/2009/06/15/jrheum.081222.short
4100  - http://www.jrheum.org/content/early/2009/06/15/jrheum.081222.full
AB  - Objective To investigate brain involvement in patients with systemic sclerosis (SSc). Methods Sixty-three patients with SSc fulfilling the American College of Rheumatology and/or Leroy and Medsger criteria were retrospectively studied, including 30 (47.6%) with limited cutaneous and 27 (42.9%) with diffuse cutaneous SSc. Forty-one patients underwent computed tomography (CT) scan and magnetic resonance imaging (MRI) of the brain, 11 patients only CT scan, and the remaining 11 patients only MRI. Cerebral vasculopathy on MRI and CT scan was defined as absent or mild (score < 1), moderate (1 ≤ score < 2), or severe (score ≥ 2) on a 4-point scale (0 to 3). Results Cerebral vasculopathy was identified on CT scan in 22 patients (moderate in 12 and severe in 10) and on MRI in 38 patients (moderate in 28 and severe in 10). Patients with severe cerebral vasculopathy seen on MRI were more likely to have pulmonary arterial hypertension (PAH; p = 0.003) and showed a tendency to have scleroderma renal crisis (SRC; p = 0.25, test for trend p = 0.097). A similar association was found between severe cerebral vasculopathy seen on CT scan and PAH (p = 0.026) or SRC (p = 0.04). After adjusting for age and hypertension, severe cerebral vasculopathy was still associated with increased risk of severe vascular manifestations [odds ratio (OR) 32, 95% confidence interval (CI) 3.45–297, p = 0.002 for CT scan; OR 26, 95% CI 1.71–394, p = 0.019 for MRI]. Conclusion Severe cerebral vasculopathy is associated with severe vascular manifestations in SSc patients. SSc patients with severe vascular complications should undergo neuroradiological imaging assessment of brain involvement.