LAUSR

Early diagnosis of comorbid burden and treatment of rheumatological patients, especially panniculitis (Pn), is a complex problem, the solution of which lies in an interdisciplinary approach and the development of a general algorithm for managing patients.To study the structure and frequency of comorbid conditions in patients with Pn-lipodermatosclerosis (LDS).We examined 53 patients (3 men and 50 women aged 18 to 80) with verified LDS, who were observed at the V.A. Nasonova Research Institute of Rheumatology for ten years on average. The duration of the disease varied from 2 weeks to 20 years. Clinical, laboratory and instrumental examination of patients was carried out twice a year. Clinical examination was carried out to determine localization, prevalence, color and number of the affected areas of skin and subcutaneous fat (SCF), as well as pain intensity according to the Visual Analogue Scale (VAS). Laboratory and instrumental research included standard blood and urine tests, as well as computed tomography of the chest and Doppler ultrasound of the lower extremities. To assess the relationship between the presence of comorbid pathology and the course of LDS the patients were analyzed with the CIRS and Charlson indices.Most patients were overweigh women (60.3%) with average weight of 91.5±21.8 kg. Based on the duration of the disease we identified the main variants of the course of the disease: acute (up to 3 months), subacute (from 3 to 6 months), and chronic (more than 6 months). Skin lesions were associated with polyarthralgias (n=18) and/or myalgias (n=12), mainly in the area of the affected limb. In 16 patients an increase in the erythrocyte sedimentation rate was recorded on average up to 23.8 ±7.8 mm/h. The level of C-reactive protein (CRP) was more than 3 times higher than normal in 7 patients, 4 of them had an acute course of LDS. In the study group 17 patients did not have comorbid diseases, 64.7% of them were under 50 years old with an acute course of LDS (p=0.02). Concomitant pathology was detected in 68% of patients mainly with chronic LDS. In 67.9% of cases it was presented by chronic venous insufficiency (CVI), in 60.3% – by exogenous constitutional obesity, in 45.2% – by rheumatic diseases (75% of these patients had osteoarthritis, 17% – rheumatoid arthritis, 8% – antiphospholipid syndrome) and in 39.6% – arterial hypertension. Most patients had one concomitant disease, almost a fifth of patients had two concomitant diseases. The proportion of patients with three comorbid diseases was 11.1%, four comorbid diseases – 8.3% and five comorbid diseases – 5.5%. When assessing the Charlson index, 10-year survival rates over 90% (index values from 0 to 2 points) were registered in 66% of patients, from 53 to 77% (index values of 3-4) – in 26.4% and less than 21% (≥5 points) – in 7.5%. The comorbidity index correlated with the age of patients (r = 0.8; p<0.05). There was no correlation between the Charlson index and the duration of LDS (r=0.3; p=0.2). In patients older than 61 one or more comorbid conditions were recorded. The CIRS index for this group averaged 4.2 ± 0.3 points (range 0-10), in most patients (45.2%) the CIRS index did not exceed 5 points. An analysis of the relationship between the Charlson and the CIRS scales confirmed their significant correlation at the level of r=0.5, p=0.0000001.In patients with LDS a high incidence of comorbid pathology was detected. The treatment of this variant of panniculitis requires an interdisciplinary approach and interaction between doctors of different specialties.None declared