Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


Clinical Associations of Elevated Acute Phase Response, Proteinuria and Low Dlco in Early Scleroderma Patients: A Report From the EULAR Scleroderma Trials and ReSearch Group (EUSTAR) Database.

Carreira1,  Patricia E., Carmona2,  Loreto, Joven3,  Beatriz E., Denton4,  Christopher D., Allanore5,  Yannick, Walker6,  Ulrich A., Matucci-Cerinic7,  Marco

Instituto de Investigación Hospital 12 de Octubre (I+12), Madrid, Spain
Fundación Española de Reumatología, Madrid, Spain
HOSPITAL UNIVERSITARIO 12 DE OCTUBRE, MADRID, Spain
Royal Free Hospital, Medical School, London, England
Paris Descartes University, Rheumatology A department, Cochin Hospital, Paris, France
Dept. of Rheumatology at Basel University, Felix-Platter Spital, Basel, Switzerland
University of Florence, Florence, Italy
Justus-Liebig Universität Gieben, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
Florence

Background/Purpose:

Elevated ESR, low DLCO and proteinuria are known risk factors for early mortality in systemic sclerosis (SSc). Although these factors are routinely collected by SSc experts, this is not the case in other settings, as general rheumatology clinics. The EUSTAR database allow us to analyze the clinical associations of these mortality risk factors in a large number of early SSc patients, which might help to improve scleroderma care in daily practice. The objective of this study is to identify the clinical associations of elevated ESR, proteinuria and low DLCO in a large group of recently diagnosed SSc patients

Methods:

EUSTAR collects prospectively the Minimal Essential Data Set (MEDS), on all sequential SSc patients in participating centres. Patients with disease duration <3 years at the first EUSTAR entry were selected, and baseline data from the first visit were analyzed. Since ESR was not collected in MEDS, we used elevated acute response (ESR > 20 mmHg and/or CRP over normal ) as a surrogate. Binary logistic regression, Chi square ant t test were used to analyze differences between groups with or without elevated acute response, proteinuria and low DLCO. Generalized lineal model was used to identify symptoms present in patients with none, one, two or three of these prognostic factors

Results:

From 1180 patients (19% men), 482 had diffuse and 590 had limited disease. Mean age was 53±14 years. Mean disease duration was 18±6 months and time between Raynaud onset and first non Raynaud symptom was 3±7 months. By multivariate logistic regression, elevated acute response was associated with older age (OR 1.02; 95%CI 1.009–1.04; p=0.001), arthritis (OR 2.4; 95%CI 1.6–3.7; p<0.0001), male gender (OR 1.9; 95%CI 1.3–2.8; p=0.003), higher mRSS (OR 1.04; 95%CI 1.02–1.06; p<0.0001), Scl70 (OR 1.6; 95%CI 1.1–2.3; p=0.02), muscular atrophy (OR 1.9; 95%CI 1.1–3.3; p=0.02) and low FVC (OR 1.8; 95%CI 1.3–2.7; p=0.002). Proteinuria was associated with renal crisis (OR 8.1; 95%CI 2.7–24.5; p<0.0001), high blood pressure (OR 2.5; 95%CI 1.2–5.1; p=0.02), intestinal involvement (OR 2.3; 95%CI 1.1–4.8; p=0.02) and pulmonary hypertension (OR 2.5; 95%CI 1.2–5.1; p=0.02). Low DLCO was associated with lung fibrosis (OR 3.7; 95%CI 2.3–5.9; p<0.0001), low FVC (OR 4.5; 95%CI 2.6–7.5; p<0.0001) and pulmonary hypertension (OR 1.7; 95%CI 1–3.2; p=0.05). Generalized lineal model showed that the presence of lung fibrosis (p<0.0001), low FVC (p<0.0001), renal crisis (p<0.004), CK elevation (p=0.04), pulmonary hypertension (p=0.04) and arthritis (p=0.05) were more frequent in patients with increased number of poor prognostic factors

Conclusion:

In early SSc patients, elevated acute phase response is associated with severe skin and visceral involvement, proteinuria with renal crisis, and low DLCO with lung disease and pulmonary hypertension. Patients with increased number of these 3 poor prognostic factors present with diffuse disease, renal crisis and lung, articular and muscular involvement. Our results support the importance of a careful evaluation, including acute phase response, DLCO and urine protein, in every SSc patient.

To cite this abstract, please use the following information:
Carreira, Patricia E., Carmona, Loreto, Joven, Beatriz E., Denton, Christopher D., Allanore, Yannick, Walker, Ulrich A., et al; Clinical Associations of Elevated Acute Phase Response, Proteinuria and Low Dlco in Early Scleroderma Patients: A Report From the EULAR Scleroderma Trials and ReSearch Group (EUSTAR) Database. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :692
DOI:

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