# Diagnosis of Digital Ischemia During the COVID-19 Pandemic: A Study From a Developing Country

## TL;DR

This study explores the causes of digital ischemia in Bangladesh during the pandemic, finding that connective tissue diseases and vasculitis are common.

## Contribution

The study provides insights into the etiology of digital ischemia in a developing country context during the COVID-19 pandemic.

## Key findings

- Connective tissue disease-associated vasculitis was the most common cause of digital ischemia.
- Systemic sclerosis and peripheral arterial disease were significant causes of vasculopathy.
- Fever, arthralgia, and high CRP were significantly associated with vasculitis.

## Abstract

Objective: Digital ischemia (DI) is an uncommon condition. Information on the etiology of DI is limited. This study aimed to determine the diagnosis of DI in a tertiary care center in Bangladesh.

Methods: This cross-sectional study was conducted in the rheumatology department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from September 1, 2020, to August 31, 2021. A total of 25 consecutive patients with DI were enrolled. Each patient was assessed following the classification/diagnostic criteria for vasculitis and vasculopathy. The 2012 International Chapel Hill Consensus Conference on the Nomenclature of Vasculitides was used for case definition. The study subjects were divided into vasculitis and vasculopathy groups. Fisher’s exact and Student’s t-tests were used to compare the groups.

Results: The mean age was 35.88 years with a female predominance (72%). Among 25 patients, 15 (60%) were in the vasculitis group and 10 (40%) in the vasculopathy group. Takayasu arteritis was found in one subject (4%), and another 14 had vasculitis associated with connective tissue diseases: 11 (44%) lupus vasculitis, two (8%) rheumatoid vasculitis, and one (4%) associated with dermatomyositis. In the vasculopathy group, five cases (20%) had systemic sclerosis (SSc), four (16%) had peripheral arterial disease (PAD), and one (4%) had primary antiphospholipid syndrome (APS). Fever (p=0.01), arthralgia/arthritis (p=0.01), and high CRP (p=0.04) were significantly associated with vasculitis.

Conclusion: In the hospital setting, connective tissue disease-associated vasculitis and SSc-related vasculopathy were the common causes of DI.