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Tolosa-Vilella C, Del Mar Rodero-Roldán M, Guillen-Del-Castillo A, Marín-Ballvé A, Boldova-Aguar R, Marí-Alfonso B, Feijoo-Massó C, Colunga-Argüelles D, Rubio-Rivas M, Trapiella-Martínez L, Iniesta-Arandia N, Callejas-Moraga E, García-Hernández FJ, Sáez-Comet L, González-Echávarri C, Ortego-Centeno N, Freire M, Vargas-Hitos JA, Ríos-Blanco JJ, Todolí-Parra JA, Rodríguez-Pintó I, Chamorro AJ, Pla-Salas X, Madroñero-Vuelta AB, Ruiz-Muñoz M, Fonollosa-Pla V, Simeón-Aznar CP. Nailfold videocapillaroscopy patterns in systemic sclerosis: implications for cutaneous subsets, disease features and prognostic value for survival. Clin Exp Rheumatol 2023; 41:1695-1703. [PMID: 37534953 DOI: 10.55563/clinexprheumatol/8lrofr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVES To assess the associations and prognostic value of scleroderma patterns by nailfold videocapillaroscopy (NVC) in patients with systemic sclerosis (SSc) and cutaneous subsets. METHODS At baseline, 1356 SSc patients from the RESCLE registry were compared according to the scleroderma pattern as Late pattern and non-Late pattern, which included Early and Active patterns. Patient characteristics, disease features, survival time and causes of death were analysed. RESULTS Late pattern was identified in 540 (39.8%), and non-Late pattern in 816 (60.2%) patients (88% women; 987 lcSSc/251 dcSSc). Late pattern was associated to dcSSc (OR=1.96; p<0.001), interstitial lung disease (ILD) (OR=1.29; p=0.031), and scleroderma renal crisis (OR=3.46; p<0.001). Once the cutaneous subset was disregarded in an alternative analysis, both digital ulcers (DU) (OR=1.29; p<0.037) and anti-topoisomerase I antibodies (OR=1.39; p< 0.036) emerged associated with the Late pattern. By cutaneous subsets, associations with Late pattern were: (1) in dcSSc, acro-osteolysis (OR=2.13; p=0.022), and systolic pulmonary artery pressure >40 mmHg by Doppler echocardiogram (OR=2.24; p<0.001); and (2) in lcSSc, ILD (OR=1.38; p=0.028). Survival was reduced in dcSSc with Late pattern compared to non-Late pattern (p=0.049). Risk factors for SSc mortality in multivariate regression Cox analysis were age at diagnosis (HR=1.03; p<0.001), dcSSc (HR=2.48; p<0.001), DU (HR=1.38; p=0.046), ILD (HR=2.81; p<0.001), and pulmonary arterial hypertension (HR=1.99; p<0.001). CONCLUSIONS SSc patients with Late pattern more frequently present dcSSc and develop more fibrotic and vascular manifestations. Advanced microangiopathy by NVC identifies dcSSc patients at risk of reduced survival due to SSc-related causes.
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Affiliation(s)
- Carles Tolosa-Vilella
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Parc Taulí, Hospital Universitari, Sabadell, Barcelona, and Universitat Autònoma de Barcelona, Spain
| | - Maria Del Mar Rodero-Roldán
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Alfredo Guillen-Del-Castillo
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, and Universitat Autònoma de Barcelona, Spain.
| | - Adela Marín-Ballvé
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Rafael Boldova-Aguar
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Begoña Marí-Alfonso
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Parc Taulí, Hospital Universitari, Sabadell, Barcelona, and Universitat Autònoma de Barcelona, Spain
| | - Carlos Feijoo-Massó
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Parc Taulí, Hospital Universitari, Sabadell, Barcelona, and Universitat Autònoma de Barcelona, Spain
| | | | - Manuel Rubio-Rivas
- Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Luis Trapiella-Martínez
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario de Cabueñes, Gijón, Spain
| | - Nerea Iniesta-Arandia
- Department of Systemic Autoimmune Diseases, Institut Clinic de Medicina i Dermatología, Hospital Universitario Clínic, Barcelona, Spain
| | - Eduardo Callejas-Moraga
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Parc Taulí, Hospital Universitari, Sabadell, Barcelona, and Universitat Autònoma de Barcelona, Spain
| | | | - Luis Sáez-Comet
- Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Cristina González-Echávarri
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - Norberto Ortego-Centeno
- Department of Internal Medicine, Unit of Systemic Autoimmune Diseases, Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria Ibs Granada, Facultad de Medicina Granada, Spain
| | - Mayka Freire
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | | | - Juan J Ríos-Blanco
- Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Antonio-J Chamorro
- Department of Internal Medicine, Hospital Clínico Universitario de Salamanca, Universidad de Salamanca-IBSAL, Salamanca, Spain
| | - Xavier Pla-Salas
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Consorci Hospitalari de Vic, Vic, Barcelona, Spain
| | | | - Manuel Ruiz-Muñoz
- Department of Internal Medicine, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Vicent Fonollosa-Pla
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, and Universitat Autònoma de Barcelona, Spain
| | - Carmen Pilar Simeón-Aznar
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, and Universitat Autònoma de Barcelona, Spain
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Pestaña-Fernández M, Rubio-Rivas M, Tolosa-Vilella C, Guillén-Del-Castillo A, Colunga-Argüelles D, Argibay A, Marí-Alfonso B, Marín-Ballvé A, Pla-Salas X, Chamorro AJ, Castro-Salomó A, Madroñero-Vuelta AB, Sánchez-García ME, Sáez-Comet L, González-Echávarri C, Ortego-Centeno N, Vargas-Hitos JA, Todolí-Parra JA, Trapiella-Martínez L, Lledó GM, Freire M, Fonollosa-Pla V, Simeón-Aznar CP. The incidence rate of pulmonary arterial hypertension and scleroderma renal crisis in systemic sclerosis patients with digital ulcers on endothelin antagonist receptors (ERAs) and phosphodiesterase-5 inhibitors (PDE5i). Rheumatology (Oxford) 2021; 60:872-880. [PMID: 32844220 DOI: 10.1093/rheumatology/keaa401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/03/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Endothelin antagonist receptors (ERAs) and phosphodiesterase-5 inhibitors (PDE5i) are beneficial in pulmonary arterial hypertension (PAH) and digital ulcers (DU) and prevent from DU recurrences. Our study aimed to determine the difference in the incidence rate of PAH and scleroderma renal crisis (SRC) in patients with SSc and DU (SSc-DU) under ERAs/PDE5i or without treatment. METHODS We conducted a retrospective cohort study including SSc-DU patients from the Spanish Scleroderma Registry (RESCLE). The primary outcome was the incidence rate of PAH and SRC in patients under ERAs/PDE5i or not. RESULTS Some 544 patients out of 1817 (29.9%) in the RESCLE database had DU, 221 (40.6%) under ERAs/PDE5i and 323 (59.4%) not. The incidence rate (95% CI) difference between patients under treatment or not under did not reach statistical significance in PAH [-0.1 (-4.8, 4.69), P = 0.988] or in SRC [0.7 (-2.2, 3.7), P = 0.620]. However, the time from the first DU to the diagnosis of SRC was delayed in treated patients [mean (s.d.) 7.6 (5.8) years vs 2.9 (5.3); P = 0.021]. The dcSSc subset was more prevalent in the treatment group (36 vs 26%; P = 0.018), along with anti-topoisomerase I antibodies (34 vs 18%; P < 0.001) and tendon friction rubs (12 vs 6%; P = 0.038), whereas the lcSSc subset was more prevalent in the no-treatment group (57 vs 66%; P = 0.031) along with ACA (37 vs 46%; P = 0.031). CONCLUSION There was no difference in the incidence rate of PAH and SRC between groups. However, treatment with ERAs and/or PDE5i appeared to delay the occurrence of SRC.
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Affiliation(s)
- Melani Pestaña-Fernández
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Manuel Rubio-Rivas
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carles Tolosa-Vilella
- Department of Internal Medicine, Parc Taulí, Hospital Universitario, Sabadell, Barcelona, Spain
| | - Alfredo Guillén-Del-Castillo
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Dolores Colunga-Argüelles
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Ana Argibay
- Unit of Systemic Autoimmune Diseases and Thrombosis, Department of Internal Medicine, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Begoña Marí-Alfonso
- Department of Internal Medicine, Parc Taulí, Hospital Universitario, Sabadell, Barcelona, Spain
| | - Adela Marín-Ballvé
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
| | - Xavier Pla-Salas
- Unit of Systemic Autoimmune Diseases, Department of Internal Medicine, Consorci Hospitalari de Vic, Vic, Barcelona, Spain
| | - Antonio-J Chamorro
- Department of Internal Medicine, Hospital Clínico Universitario de Salamanca, Universidad de Salamanca-IBSAL, Salamanca, Spain
| | - Antoni Castro-Salomó
- Department of Internal Medicine. Hospital Universitario Sant Joan, Reus, Tarragona, Spain
| | | | | | - Luis Sáez-Comet
- Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Cristina González-Echávarri
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - Norberto Ortego-Centeno
- Inst. Invest. Biosanitaria Ibs Granada, Department of Internal Medicine, Unit of Systemic Autoimmune Diseases, Department of Medicine, Facultad de Medicina, Hospital Universitario San Cecilio, Granada, Spain
| | | | | | - Luis Trapiella-Martínez
- Unit of Systemic Autoimmune Diseases, Department of Internal Medicine, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - Gema María Lledó
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
| | - Mayka Freire
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Vicent Fonollosa-Pla
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Carmen Pilar Simeón-Aznar
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Pestaña-Fernández M, Rubio-Rivas M, Tolosa-Vilella C, Guillén-Del-Castillo A, Freire M, Vargas-Hitos JA, Todolí-Parra JA, Rodríguez-Carballeira M, Marín-Ballvé A, Espinosa G, Colunga-Argüelles D, Ortego-Centeno N, Trapiella-Martínez L, Carbonell-Muñoz C, Pla-Salas X, Perales-Fraile I, Corbella X, Fonollosa-Pla V, Simeón-Aznar CP. Longterm Efficacy and Safety of Monotherapy versus Combination Therapy in Systemic Sclerosis–associated Pulmonary Arterial Hypertension: A Retrospective RESCLE Registry Study. J Rheumatol 2019; 47:89-98. [DOI: 10.3899/jrheum.180595] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2019] [Indexed: 11/22/2022]
Abstract
Objective.Monotherapy is an option as first-line therapy for pulmonary arterial hypertension (PAH). However, combination therapy is a beneficial alternative. Our objective was to evaluate the efficacy of monotherapy versus combination therapy in patients with systemic sclerosis (SSc)–associated PAH.Methods.All patients with SSc-associated PAH from the Spanish Scleroderma Registry (RESCLE) were reviewed. Patients were split into 3 groups: monotherapy versus sequential combination versus upfront combination therapy. The primary endpoint was death from any cause at 1, 3, and 5 years from PAH diagnosis.Results.Seventy-six patients (4.2%) out of 1817 had SSc-related PAH. Thirty-four patients (45%) were receiving monotherapy [endothelin receptor antagonist (n = 22; 29%) or phosphodiesterase-5 inhibitors (n = 12; 16%)], 25 (33%) sequential combination, and 17 (22%) upfront combination therapy. A lower forced vital capacity/DLCO in the sequential combination group was reported (2.9 ± 1.1 vs 1.8 ± 0.4 vs 2.3 ± 0.8; p = 0.085) and also a higher mean pulmonary arterial pressure in combination groups (37.2 ± 8.7 mmHg vs 40.8 ± 8.8 vs 46 ± 15.9; p = 0.026) at baseline. Treatment regimen (p = 0.017) and functional class (p = 0.007) were found to be independent predictors of mortality. Sequential combination therapy was found to be an independent protective factor (HR 0.11, 95% CI 0.03–0.51; p = 0.004), while upfront combination therapy showed a trend (HR 0.68, 95% CI 0.23–1.97; p = 0.476). Survival from PAH diagnosis among monotherapy, sequential, and upfront combination groups was 78% versus 95.8% versus 94.1% at 1 year, 40.7% versus 81.5% versus 51.8% at 3 years, and 31.6% versus 56.5% versus 34.5% at 5 years (p = 0.007), respectively. Side effects were not significantly different among groups.Conclusion.Combination sequential therapy improved survival in our cohort.
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García-Hernández FJ, Castillo-Palma MJ, Tolosa-Vilella C, Guillén-Del Castillo A, Rubio-Rivas M, Freire M, Vargas-Hitos JA, Todolí-Parra JA, Rodríguez-Carballeira M, Espinosa-Garriga G, Colunga-Argüelles D, Ortego-Centeno N, Trapiella-Martínez L, Rodero-Roldán MM, Pla-Salas X, Perales-Fraile I, Pons-Martín Del Campo I, Chamorro AJ, Fernández-de la Puebla Giménez RA, Madroñero-Vuelta AB, Ruíz-Muñoz M, Fonollosa-Pla V, Simeón-Aznar CP. Pulmonary hypertension in Spanish patients with systemic sclerosis. Data from the RESCLE registry. Clin Rheumatol 2018; 38:1117-1124. [PMID: 30535994 DOI: 10.1007/s10067-018-4390-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 11/12/2018] [Accepted: 11/30/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Our objective was to evaluate the pulmonary hypertension (PH) data for Spanish patients with systemic sclerosis (SSc), define the PH types and determine the associated factors. METHOD Descriptive study of PH-related data from the multicentre RESCLE registry. Estimated systolic pulmonary artery pressure (esPAP), measured via echocardiogram was considered elevated if ≥ 35 mmHg. Left heart disease (LHD) and interstitial lung disease (ILD) were identified. When performed, data from right heart catheterisation (RHC) were collected. RESULTS esPAP was elevated in 350 of 808 patients (43.3%). One hundred and forty-four patients (17.8%) were considered to have PH (88 via RHC and the rest due to elevated esPAP along with evidence of significant LHD or ILD): PAH 3.7%, secondary to ILD 8.3%, secondary to LHD 2.8% and unclassified 3%. Prevalence of elevated esPAP was greater in diffuse SSc (dSSc) than in limited scleroderma (lSSc) (50.5 vs. 42.2%, p 0.046). In the group with elevated esPAP, a lower prevalence of anti-centromere antibodies (41.9% vs. 52.3%, p 0.006) and a greater prevalence of anti-topoisomerase-1 antibodies (ATA) (25.1% vs. 18.6%, p 0.04) were observed compared to the group with normal esPAP. Patients with elevated esPAP had a lower rate of digital ulcers (50.6% vs. 60.2%, p 0.007) and esophageal involvement (83.6% vs. 88.7%, p 0.07) and higher rate of renal crisis (4.6% vs. 1.8%, p 0.066). CONCLUSIONS Prevalence of PAH was lower than expected (3.7%). Probability of having elevated esPAP was higher among patients with dSSc and among those with ATA.
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Affiliation(s)
| | - María J Castillo-Palma
- Department of Internal Medicine, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Carles Tolosa-Vilella
- Department of Internal Medicine, Corporación Sanitaria Universitaria Parc Taulí, Sabadell, Spain
| | - Alfredo Guillén-Del Castillo
- Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Manuel Rubio-Rivas
- Department of Internal Medicine, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Mayka Freire
- Systemic Autoimmune Diseases and Thrombosis Unit, Department of Internal Medicine, Complejo Hospitalario Universitario de Vigo, Pontevedra, Galicia, Spain
| | - José A Vargas-Hitos
- Department of Internal Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - José A Todolí-Parra
- Department of Internal Medicine, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Gerard Espinosa-Garriga
- Systemic Autoimmune Diseases Unit, Instituto Clínic de Medicina y Dermatología, Hospital Universitario Clínic, Barcelona, Spain
| | | | - Norberto Ortego-Centeno
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Campus de la Salud, Complejo Universitario de Granada, Granada, Spain
| | - Luis Trapiella-Martínez
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital de Cabueñes, Gijón, Spain
| | - María M Rodero-Roldán
- Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Xavier Pla-Salas
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Consorci Hospitalari de Vic, Barcelona, Spain
| | - Isabel Perales-Fraile
- Department of Internal Medicine, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | | | - Antonio J Chamorro
- Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | | | - Manuel Ruíz-Muñoz
- Department of Internal Medicine, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Vicent Fonollosa-Pla
- Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Carmen P Simeón-Aznar
- Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Rubio-Rivas M, Corbella X, Pestaña-Fernández M, Tolosa-Vilella C, Castillo AGD, Colunga-Argüelles D, Trapiella-Martínez L, Iniesta-Arandia N, Castillo-Palma MJ, Sáez-Comet L, Egurbide-Arberas MV, Ortego-Centeno N, Freire M, Vargas-Hitos JA, Ríos-Blanco JJ, Todolí-Parra JA, Rodríguez-Carballeira M, Marín-Ballvé A, Segovia-Alonso P, Pla-Salas X, Madroñero-Vuelta AB, Ruiz-Muñoz M, Fonollosa-Pla V, Simeón-Aznar CP. Correction to: First clinical symptom as a prognostic factor in systemic sclerosis: results of a retrospective nationwide cohort study. Clin Rheumatol 2018; 37:2303-2304. [DOI: 10.1007/s10067-018-4179-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sánchez-Cano D, Ortego-Centeno N, Callejas JL, Fonollosa Plá V, Ríos-Fernández R, Tolosa-Vilella C, Espinosa-Garriga G, Colunga-Argüelles D, Egurbide-Arberas MV, Rubio-Rivas M, Freire M, Ríos-Blanco JJ, Trapiella-Martínez L, Rodríguez-Carballeira M, Marín-Ballvé A, Pla-Salas X, Simeón-Aznar CP. Interstitial lung disease in systemic sclerosis: data from the spanish scleroderma study group. Rheumatol Int 2018; 38:363-374. [PMID: 29322341 DOI: 10.1007/s00296-017-3916-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 12/15/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate the clinical characteristics of patients with interstitial lung disease (ILD) in the setting of a large cohort of systemic sclerosis (SSc) patients, and to analyse the differences according to the SSc subtype (following the modification of classification criteria of the American College of Rheumatology for SSc proposed by LeRoy and Medsger), factors are associated with moderate-to-severe impairment of lung function, as well as mortality and causes of death. METHODS A descriptive study was performed, using the available data from the Spanish Scleroderma Study Group. RESULTS Twenty-one referral centers participated in the registry. By April 2014, 1374 patients with SSc had been enrolled, and 595 of whom (43%) had ILD: 316 (53%) with limited cutaneous SSc (lcSSc), 240 (40%) with diffuse cutaneous SSc (dcSSc), and 39 (7%) with SSc sine scleroderma (ssSSc). ILD in the lcSSc and the ssSSc subsets tended to develop later, and showed a less impaired forced vital capacity (FVC) and a ground glass pattern on high-resolution computed tomography (HRCT) less frequently, compared with the dcSSc subset. Factors related to an FVC < 70% of predicted in the multivariate analysis were: dcSSc, positivity to anti-topoisomerase I antibodies, a ground glass pattern on HCRT, an active nailfold capillaroscopy pattern, lower DLco, older age at symptoms onset, and longer time between symptoms onset and ILD diagnosis. Finally, SSc-associated mortality and ILD-related mortality were highest in dcSSc patients, whereas that related to pulmonary arterial hypertension was highest in those with lcSSc-associated ILD. CONCLUSIONS Our study indicates that ILD constitutes a remarkable complication of SSc with significant morbidity and mortality, which should be borne in mind in all three subgroups (lcSSc, dcSSc, and ssSSc).
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Affiliation(s)
- D Sánchez-Cano
- Systemic Autoimmune Diseases Unit, Hospital Universitario San Cecilio, 18016, Granada, Spain
| | - N Ortego-Centeno
- Systemic Autoimmune Diseases Unit, Hospital Universitario San Cecilio, 18016, Granada, Spain.
| | - J L Callejas
- Systemic Autoimmune Diseases Unit, Hospital Universitario San Cecilio, 18016, Granada, Spain
| | - V Fonollosa Plá
- Internal Medicine Department, Hospital VallD'Hebron, 08035, Barcelona, Spain
| | - R Ríos-Fernández
- Systemic Autoimmune Diseases Unit, Hospital Universitario San Cecilio, 18016, Granada, Spain
| | - C Tolosa-Vilella
- Internal Medicine Department, Corporación Sanitaria Universitaria ParcTaulí, 08208, Sabadell, Barcelona, Spain
| | - G Espinosa-Garriga
- Department of Autoimmune Diseases, Institut Clinic de Medicina I Dermatologia, Hospital Clinic, 08036, Barcelona, Spain
| | - D Colunga-Argüelles
- Internal Medicine Department, Hospital Universitario Central de Asturias, 33011, Oviedo, Asturias, Spain
| | - M V Egurbide-Arberas
- Internal Medicine Department, Hospital de Cruces, 48903, Barakaldo, Vizcaya, Spain
| | - M Rubio-Rivas
- Internal Medicine Department, Hospital Universitario de Bellvitge, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Freire
- Internal Medicine Department, Complejo Hospitalario Universitario de Vigo, 36312, Vigo, Pontevedra, Spain
| | - J J Ríos-Blanco
- Internal Medicine Department, Hospital La Paz, 28046, Madrid, Spain
| | - L Trapiella-Martínez
- Internal Medicine Department, Hospital de Cabueñes, 33394, Gijón, Asturias, Spain
| | | | - A Marín-Ballvé
- Internal Medicine Department, Hospital Clínico Universitario Lozano Blesa, 50009, Zaragoza, Spain
| | - X Pla-Salas
- Internal Medicine Department, Consorci Hospitalari de Vic, 08500, Barcelona, Spain
| | - C P Simeón-Aznar
- Internal Medicine Department, Hospital VallD'Hebron, 08035, Barcelona, Spain.,Internal Medicine Department, Corporación Sanitaria Universitaria ParcTaulí, 08208, Sabadell, Barcelona, Spain
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Rubio-Rivas M, Corbella X, Pestaña-Fernández M, Tolosa-Vilella C, Guillen-Del Castillo A, Colunga-Argüelles D, Trapiella-Martínez L, Iniesta-Arandia N, Castillo-Palma MJ, Sáez-Comet L, Egurbide-Arberas MV, Ortego-Centeno N, Freire M, Vargas-Hitos JA, Ríos-Blanco JJ, Todolí-Parra JA, Rodríguez-Carballeira M, Marín-Ballvé A, Segovia-Alonso P, Pla-Salas X, Madroñero-Vuelta AB, Ruiz-Muñoz M, Fonollosa-Pla V, Simeón-Aznar CP, Callejas Moraga E, Calvo E, Carbonell C, Castillo MJ, Chamorro AJ, Colunga D, Corbella X, Egurbide MV, Espinosa G, Fonollosa V, Freire M, García Hernández FJ, González León R, Guillén Del Castillo A, Iniesta N, Lorenzo R, Madroñero AB, Marí B, Marín A, Ortego-Centeno N, Pérez Conesa M, Pestaña M, Pla X, Ríos Blanco JJ, Rodríguez Carballeira M, Rubio Rivas M, Ruiz Muñoz M, Sáez Comet L, Segovia P, Simeón CP, Soto A, Tarí E, Todolí JA, Tolosa C, Trapiella L, Vargas Hitos JA, Verdejo G. First clinical symptom as a prognostic factor in systemic sclerosis: results of a retrospective nationwide cohort study. Clin Rheumatol 2017; 37:999-1009. [PMID: 29214548 DOI: 10.1007/s10067-017-3936-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 11/07/2017] [Accepted: 11/27/2017] [Indexed: 12/21/2022]
Abstract
The objective of the study is to determine the importance of the mode of onset as prognostic factor in systemic sclerosis (SSc). Data were collected from the Spanish Scleroderma Registry (RESCLE), a nationwide retrospective multicenter database created in 2006. As first symptom, we included Raynaud's phenomenon (RP), cutaneous sclerosis, arthralgia/arthritis, puffy hands, interstitial lung disease (ILD), pulmonary arterial hypertension (PAH), and digestive hypomotility. A total of 1625 patients were recruited. One thousand three hundred forty-two patients (83%) presented with RP as first symptom and 283 patients (17%) did not. Survival from first symptom in those patients with RP mode of onset was higher at any time than those with onset as non-Raynaud's phenomenon: 97 vs. 90% at 5 years, 93 vs. 82% at 10 years, 83 vs. 62% at 20 years, and 71 vs. 50% at 30 years (p < 0.001). In multivariate analysis, factors related to mortality were older age at onset, male gender, dcSSc subset, ILD, PAH, scleroderma renal crisis (SRC), heart involvement, and the mode of onset with non-Raynaud's phenomenon, especially in the form of puffy hands or pulmonary involvement. The mode of onset should be considered an independent prognostic factor in systemic sclerosis and, in particular, patients who initially present with non-Raynaud's phenomenon may be considered of poor prognosis.
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Affiliation(s)
- Manuel Rubio-Rivas
- Department of Internal Medicine, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Xavier Corbella
- Department of Internal Medicine, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Melany Pestaña-Fernández
- Department of Internal Medicine, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carles Tolosa-Vilella
- Department of Internal Medicine, Corporación Sanitaria Universitaria Parc Taulí, Sabadell, Barcelona, Spain
| | | | - Dolores Colunga-Argüelles
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | - Nerea Iniesta-Arandia
- Department of Autoimmune Diseases, Institut Clinic de Medicina i Dermatología, Hospital Clínic, Barcelona, Spain
| | - María Jesús Castillo-Palma
- Collagenosis and Pulmonary Hypertension Unit, Department of Internal Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Luis Sáez-Comet
- Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - Mayka Freire
- Thrombosis and Vasculitis Unit, Department of Internal Medicine, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | | | | | - Adela Marín-Ballvé
- Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Pablo Segovia-Alonso
- Department of Internal Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Xavier Pla-Salas
- Department of Internal Medicine, Consorci Hospitalari de Vic, Barcelona, Spain
| | | | - Manuel Ruiz-Muñoz
- Department of Internal Medicine, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Vicent Fonollosa-Pla
- Autoimmune Unit, Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Carmen Pilar Simeón-Aznar
- Autoimmune Unit, Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Trapiella-Martínez L, Díaz-López JB, Caminal-Montero L, Tolosa-Vilella C, Guillén-Del Castillo A, Colunga-Argüelles D, Rubio-Rivas M, Iniesta-Arandia N, Castillo-Palma MJ, Sáez-Comet L, Egurbide-Arberas MV, Ortego-Centeno N, Freire M, Vargas-Hitos JA, Ríos-Blanco JJ, Todolí-Parra JA, Rodríguez-Carballeira M, Marín-Ballvé A, Chamorro-Fernández AJ, Pla-Salas X, Madroñero-Vuelta AB, Ruiz-Muñóz M, Fonollosa-Pla V, Simeón-Aznar CP. Very early and early systemic sclerosis in the Spanish scleroderma Registry (RESCLE) cohort. Autoimmun Rev 2017; 16:796-802. [DOI: 10.1016/j.autrev.2017.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 05/12/2017] [Indexed: 12/29/2022]
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