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Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

An Analysis of Agreement of Guidelines for Management in SSc from a Large Database (CSRG: Canadian Scleroderma Research Group).

Pope³,  Janet E., Harding⁴,  Sarah, Khimdas⁴,  Sarit, Bonner²,  Ash, Baron¹,  Murray

Jewish General Hospital, Montreal, QC, Canada
McMaster University
St Joseph Health Care London, London, ON, Canada
University of Western Ontario

Objective:

We determined congruence with recently published guidelines from EULAR/EUSTAR, for SSc investigations and treatment practices within the Canadian Scleroderma Research Group (CSRG)

Methods:

Investigations and medication use for SSc complications were obtained from SSc patients in the CSRG to determine adherence to guidelines.

Results:

The CSRG database of 938 SSc patients demonstrated that annual echocardiograms for PAH screening were done in 86.5%; for PAH treatment one quarter were receiving warfarin which has no recommendations, all diagnosed with PAH Class III/IV were on PAH specific treatment (9% of total CSRG patients had PAH). For Raynaud's: 47% were on calcium channel blockers and some sites used PDE5 inhibitors more than others. Iloprost is not approved in Canada, so its use for severe RP and digital ulcers was low. In the guidelines it is recommended that all SSc patients with GERD be recommended for PPIs. In the CSRG database, PPIs were used in 86%, and one quarter with GI symptoms were on prokinetic drugs. In those with SRC ever: 77% were on current ACE inhibitors, one third were on dialysis and 10% had received kidney transplants. It is recommended that ACE inhibitors not be discontinued post SRC. 19% of MRSS >10 were on methotrexate whereas only 3% were using D-penicillamine which was not recommended in the guidelines. In severe ILD, there was significant variability in use of cyclophosphamide. There was also variation between centers with >50 patients for treatment for inflammatory arthritis (with hydroxychloroquine and D-penicillamine). The rate of ordering some investigations such as HRCT was different at some centers, but obtaining echocardiograms annual did not differ and was at a rate of >90%.

Treatment and investigation practice frequency and variation among centers with n>50

Conclusions:

Although the guidelines were not published until after our standard of care was established, the SSc experts were mostly practicing in accordance with EULAR/EUSTAR recommendations. Methotrexate use for skin was only 19% for current use, but we did not study ever use so it may have been higher if studied in that way. CSRG practices were generally comparable to recently published guidelines; however, use of iloprost for digital ulcers and severe RP differed from guidelines as this drug is not approved in Canada. The CSRG adherence is a best case' scenario as these are centers with an interest in SSc and queries for non-adherence to recommended tests occur in the database. The adherence to EULAR/EUSTAR SSc guidelines in general rheumatology practice is likely far less than in SSc centers.

To cite this abstract, please use the following information:
Pope, Janet E., Harding, Sarah, Khimdas, Sarit, Bonner, Ash, Baron, Murray; An Analysis of Agreement of Guidelines for Management in SSc from a Large Database (CSRG: Canadian Scleroderma Research Group). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1202
DOI: 10.1002/art.28968

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