Scleroderma and related disorders : 223. Long Term Outcome in a Contemporary Systemic Sclerosis Cohort
Nihtyanova, Svetlana ; Ong, Voon ; Black, Carol ; Denton, Chris ; Lutalo, Pamela ; Shattles, Warren ; Jones, Hugh ; Nouri, Reem ; Hepburn, Alastair ; Chard, Michael ; Horwood, Natalie ; Lynn, Myo ; Duke, Oliver ; Kiely, Patrick ; Zouita, Louisa ; Davies, Ursula ; Hughes, Rod ; Lloyd, Mark ; Nikitorowicz Buniak, Joanna ; Shiwen, Xu ; Abraham, David ; Denton, Chris ; Black, Carol ; Stratton, Richard ; Hügle, Thomas ; Schuetz, Philipp ; Daikeler, Thomas ; Tyndall, Alan ; Matucci-Cerinic, Marco ; Walker, Ulrich A. ; van Laar, Jacob M. ; Pauling, John D. ; Flower, Victoria ; McHugh, Neil ; Liu, Shangxi ; Leask, Andrew ; Nikitorowicz Buniak, Joanna ; Aden, Nima ; Denton, Chris ; Abraham, David ; Stratton, Richard ; Khan, Korsa ; Hoyles, Rachel ; Shiwen, Xu ; Ong, Voon ; Abraham, David ; Denton, Chris ; Bhagat, Shweta ; Drummond, Tom ; Goh, Cyndi ; Busch, Robert ; Hall, Frances ; Meyer, Paul ; Moinzadeh, Pia ; Krieg, Thomas ; Hellmich, Martin ; Brinckmann, Juergen ; Neumann, Elena ; Mueller-Ladner, Ulf ; Kreuter, Alexander ; Dumitresco, Daniel ; Rosenkranz, Stefan ; Hunzelmann, Nicolas ; Binai, Nadine ; Huegle, Thomas ; van Laar, Jaap ; Shiwen, Xu ; Sonnylal, S. ; Tam, A. ; Jones, H. ; Stratton, Richard ; Leask, A. ; Norman, J. ; Denton, C. ; de Crombrugghe, B. ; Abraham, D. ; Chighizola, Cecilia B. ; Luigi Meroni, Pier ; Coghlan, Gerry ; Denton, Chris ; Ong, Voon ; Newton, Florence ; Shiwen, Xu ; Denton, Chris ; Abraham, David ; Stratton, Richard ; Derrett-Smith, Emma C. ; Dooley, Audrey ; Baliga, Reshma ; Hobbs, Adrian ; MacAllister, Raymond ; Abraham, David ; Denton, Chris ; Futema, Marta ; Pantelidis, Panagiotis ; Renzoni, Elizabeth ; Schreiber, Benjamin E. ; Ong, Voon ; Coghlan, Gerry J. ; Denton, Chris ; Wells, Athol U. ; Welsh, Ken ; Abraham, David ; Fonseca, Carmen ; Futema, Marta ; Ponticos, Markella ; Pantelidis, Panagiotis ; Wells, Athol ; Denton, Chris ; Abraham, David ; Fonseca, Carmen ; Denton, Chris ; Guillevin, Loic ; Krieg, Thomas ; Schwierin, Barbara ; Rosenberg, Daniel ; Silkey, Mariabeth ; Matucci-Cerinic, Marco ; Parapuram, Sunil ; Shi-wen, Xu ; Denton, Christopher ; Abraham, David ; Leask, Andrew ; Ahmed Abdi, Bahja ; Khan, Korsa ; Abraham, David ; Khan, Korsa ; Denton, Chris ; Xu, Shiwen ; Ong, Voon
In: Rheumatology, 2011, vol. 50, p. iii129-iii137
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- Background: We have previously compared outcome in two groups of systemic sclerosis (SSc) patients with disease onset a decade apart and we reported data on 5 year survival and cumulative incidence of organ disease in a contemporary SSc cohort. The present study examines longer term outcome in an additional cohort of SSc followed for 10 years. Methods: We have examined patients with disease onset between years 1995 and 1999 allowing for at least 10 years of follow-up in a group that has characteristics representative for the patients we see in contemporary clinical practice. Results: Of the 398 patients included in the study, 252 (63.3%) had limited cutaneous (lc) SSc and 146 (36.7%) had diffuse cutaneous (dc) SSc. The proportion of male patients was higher among the dcSSc group (17.1% v 9.9%, p = 0.037) while the mean age of onset was significantly higher among lcSSc patients (50 ± 13 v 46 ± 13 years ± SD, p = 0.003). During a 10 year follow-up from disease onset, 45% of the dcSSc and 21% of the lcSSc subjects developed clinically significant pulmonary fibrosis, p < 0.001. Among them approximately half reached the endpoint within the first 3 years (23% of dcSSc and 10% of lcSSc) and over three quarters within the first 5 years (34% and 16% respectively). There was a similar incidence of pulmonary hypertension (PH) in the two subsets with a steady rate of increase over time. At 10 years 13% of dcSSc and 15% of lcSSc subjects had developed PH (p=0.558), with the earliest cases observed within the first 2 years of disease. Comparison between subjects who developed PH in the first and second 5 years from disease onset demonstrated no difference in demographic or clinical characteristics, but 5-year survival from PH onset was better among those who developed this complication later in their disease (49% v 24%), with a strong trend towards statistical significance (p = 0.058). Incidence of SSc renal crisis (SRC) was significantly higher among the dcSSc patients (12% v 4% in lcSSc, p = 0.002). As previously observed, the rate of development of SRC was highest in the first 3 years of disease- 10% in dcSSc and 3% in lcSSc. All incidences of clinically important cardiac disease developed in the first 5 years from disease onset (7% in dcSSc v 1% in lcSSc, p < 0.001) and remained unchanged at 10 years. As expected, 10-year survival among lcSSc subjects was significantly higher (81%) compared to that of dcSSc patients (70%, p = 0.006). Interestingly, although over the first 5 years the death rate was much higher in the dcSSc cohort (16% v 6% in lcSSc), over the following years it became very similar for both subsets (14% and 13% between years 5 and 10, and 18% and 17% between years 10 and 15 for dcSSc and lcSSc respectively). Conclusions: Even though dcSSc patients have higher incidence for most organ complications compared to lcSSc subjects, the worse survival among them is mainly due to higher early mortality rate. Mortality rate after first 5 years of disease becomes comparable in the two disease subsets. Disclosure statement: The authors have declared no conflicts of interest