POS0827 CALCINOSIS IS NOT A PERIPHERAL PROBLEM IN SYSTEMIC SCLEROSIS, IT CAN BECOME A CENTRAL PROBLEM WITH SERIOUS CONSEQUENCES
Authors: A. Balbir-Gurman, D. Militianu, N. Puchkov, V. Shataylo, Y. Braun-Moscovici
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Subcutaneous or soft tissue calcinosis is an often feature of systemic sclerosis, mainly in subcutaneous tissues of hands and bony prominences (elbow, styloid, knee, etc.). Calcified mass may be found occasionally on imaging performed for various indications; in other cases, bulking calcinosis mass (tumoral calcinosis) occurs in a sensitive area such as spinal cord (paraspinal and intraspinal calcinosis) and may cause pain and neurologic difficulties of various severity. <h3>Objectives:</h3> We aimed to analyze clinical features of spinal calcinosis (SpC). <h3>Methods:</h3> Rambam Rheumatology Institute is an EUSTAR center (center 042) with 430 patients' cohort. We performed a retrospective analysis of SSc patients' (included in our EUSTAR cohort) files and imaging with information on cervical, thoracic and lumbar spine (CT or PET FDG or MRI) kept in the Rambam electronic archive was performed. All images were assessed by senior rheumatologist (ABG, YBM) and musculo-skeletal imaging specialist (DM, NP). We assessed correlation of paraspinal and/or intraspinal calcinosis with clinical parameters and outcome. Statistics included Student's T-test and Pearson's chi-squared test (p&lt;0.05, significant). <h3>Results:</h3> We retracted imaging files for 261 SSc patients' (male 18.8%, age 60.4 [SD11.6] and disease duration 12.3 [SD7.8] years), 29 (11.1%) patients had at least one paraspinal and 18 (6.9%) - intraspinal calcinosis. Distribution of SpC was: <b>cervical</b> 10/60 (16.7%) - paraspinal and 9/60 (15%) - intraspinal (location C2,3,4,5), <b>thoracic</b> - 20/243 (8.2%) paraspinal and 7/243 (2.9%) - intraspinal (location D6,7,11,12), and <b>lumbar</b> - 10/39 (25.6%) paraspinal and 8/39 (20.5%) intraspinal (location L1,2,3,4); 39 patients had imaging of the whole spine. There was not statistical difference in age, sex, disease duration, incidence of lung cancer, aortic stenosis and myositis between patients with and without SpC. Seventeen out of 29 (58.6%) of SpC patients died compared to 88/232 (37.9%) without SpC (p&lt;0.0306). Patients with SpC cared more ATA (19/29 [65.5%] versus 81/212 [38.2] and less ACA (3/19 [10.3] versus 66/212 [31.1]) antibodies. Hands calcinosis and acroosteolysis and soft tissue (except hands) calcinosis were more often in patients with spinal calcinosis: 12/19 (63.2%) versus 42/137 (30.7%, p&lt;0.009, 17/19 (89.5%) versus 56/138 (40.6%, p&lt;0.001, and 22/28 (78.6%) versus 38/196 (19.4%, p&lt;0.001, accordingly; 5 patients with SpC had severe acroosteolysis of large bones (2 - mandibula and 1 - clavicula, humeral head and hip head each). Eight (27.6%) patients with intraspinal SpC had severe neurologic symptoms: pain, gait difficulties and myelopathy, four patients underwent surgery (1 - cervical and 3 - lumbar spine; one patient dead shortly after surgery from urosepsis). <h3>Conclusion:</h3> In SSc patients, SpC is associated with severe bone and soft tissue damage (extraspinal and intraspinal calcinosis, acroosteolysis and large bone resorption), major neurologic morbidity and significant consequences such as need for neurosurgery and significant mortality. SpC lesions could be observed on routine imaging, awareness on SpC is important particularly in patients with neurologic symptoms. <h3>REFERENCES:</h3> [1] Motegi SI, Sekiguchi A, Yonemoto Y, et al. Demographic and clinical characteristics of spinal calcinosis in systemic sclerosis: Possible association with peripheral angiopathy. J Dermatol. 2019 Jan;46(1):33-36. [2] Zanatta E, Desportes M, Do HH, et al. Pseudotumoral calcinosis in systemic sclerosis: Data from systematic literature review and case series from two referral centres. Semin Arthritis Rheum. 2020 Dec;50(6):1339-1347. [3] Sambataro D, Sambataro G, Zaccara E, et al. Tumoral calcinosis of the spine in the course of systemic sclerosis: report of a new case and review of the literature. Clin Exp Rheumatol. 2015 Jul-Aug;33(4 Suppl 91):S175-8. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>