[2009] [OP-0081] GENDER DIFFERENCES IN EARLY SYSTEMIC SCLEROSIS PATIENTS: A REPORT FROM THE EULAR SCLERODERMA TRIALS AND RESEARCH GROUP (EUSTAR) DATABASE
P.E. Carreira1, L. Carmona2, B.E. Joven1, Y. Allanore3, U. Walker4, M. Matucci-Cerinic5, European EUSTAR co-authors6 1Reumatología, Hospital 12 de Octubre; 2Unidad de Investigación, Fundación Española de Reumatología, Madrid, Spain; 3Rheumatology A, Cochin Hospital, Paris, France; 4Rheumatologische Universitatsklinik, Felix Platter Spital, Basel, Switzerland; 5Rheumatology, University of Florence, Florence, Italy; 6Rheumatology, EUSTAR Centres, Different European Cities, Spain
Background: Male gender is considered a factor of poor prognosis in systemic sclerosis (SSc). When SSc patients are selected regardless disease duration, as it happens in the majority of studies, the differences between genders may not be so clear. This could be due to a higher mortality of men at early stages of the disease. Being SSc a low prevalent disease affecting mainly women, it is difficult to collect enough number of SSc male patients at this early point. The EUSTAR database gives us the opportunity to study a large number of early SSc patients, trying to identify those subgroups of patients at highest risk for visceral involvement.
Objectives: to analyze demographic and clinical characteristics of patients with early SSc, and to compare disease presentation in male and female groups.
Methods: EUSTAR collects prospectively the Minimal Essential Data Set (MEDS) on all sequential patients fulfilling the American College of Rheumatology diagnostic criteria for SSc in participating centres. Patients with disease duration of less than 3 years at the first EUSTAR entry were selected, and only baseline data from the first visit were analyzed. Bivariate logistic regression, Chi square ant t test were used to analyze differences between groups. Multivariate logistic regression was used to determine independent associations of variables with patients groups
Results: From 1180 patients (19% men), 482 had diffuse and 590 had limited disease. Mean age at entry was 53±14 years, and 51±16 years at first non Raynaud symptom. Mean disease duration was 18±6 months and time between the onset of Raynaud and first non Raynaud symptom was 3±7 months, without differences between genders. Male patients had more diffuse skin involvement, had higher TSS, and presented more friction rubs, Scl70, elevated acute phase reactants, elevated CK, lung fibrosis and cardiac blocks, less arthritis, ACA and Raynaud (p<0.0001 for all) and lower DLCO (p=0.004) than women. In the diffuse subgroup, men had more Scl70 (p=0.03), acute phase reactants (p=0.01) and CK elevation (p=0.005) than women. In the limited group, males had higher TSS (p=0.003) more active disease (p=0.01), joint contractures (p=0.02), acute phase reactants (p=0.003), CK elevation (p=0.001), cardiac blocks (p=0.001), lung fibrosis (p=0.02), lung restriction (p=0.009) and lower DLCO (p=0.005) than females. By multivariate logistic regression, absence of ACA (OR=0.4; 95%CI 0.2-0.4; p=0.007), presence of elevated acute phase reactants (OR=2.3; 95%CI 1.2-4.3; p=0.009) and cardiac block (OR=2,5; 95%CI 1.02-6.1; p=0.04) persisted as independent variables associated with male gender. When only the 521 patients (21% males) with less than 12 months of disease duration were analyzed, the results were similar, although in the multivariate analysis, only cardiac block persisted as an independent variable associated with male gender (OR=5.7; 95%CI 1.7-18.5; p=0.004)
Conclusion: Features of diffuse disease, especially muscular, cardiac and lung involvement are present early in SSc male patients, even in those with limited skin disease. Together with a higher proportion of males than previously described (nearly 20%) in this large group of early SSc patients, these data indicate that males developing SSc may manifest more severe early visceral involvement and therefore should be carefully studied and promptly treated.
Disclosure of Interest: None declared
Ann Rheum Dis 2009;68(Suppl3):96
Abstract Session: Systemic sclerosis from bench to bedside
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