Registry of the Spanish Network for Systemic Sclerosis: Survival, Prognostic Factors, and Causes of Death

Systemic sclerosis (SSc) is a rare, multisystem disease showing a large individual variability in disease progression and prognosis. In the present study, we assess survival, causes of death, and risk factors of mortality in a large series of Spanish SSc patients. Consecutive SSc patients fulfilling criteria of the classification by LeRoy were recruited in the survey. Kaplan-Meier and Cox proportional-hazards models were used to analyze survival and to identify predictors of mortality. Among 879 consecutive patients, 138 (15.7%) deaths were registered. Seventy-six out of 138 (55%) deceased patients were due to causes attributed to SSc, and pulmonary hypertension (PH) was the leading cause in 23 (16.6%) patients. Survival rates were 96%, 93%, 83%, and 73% at 5, 10, 20, and 30 years after the first symptom, respectively. Survival rates for diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc were 91%, 86%, 64%, and 39%; and 97%, 95%, 85%, and 81% at 5, 10, 20, and 30 years, respectively (log-rank: 67.63, P < 0.0001). The dcSSc subset, male sex, age at disease onset older than 65 years, digital ulcers, interstitial lung disease (ILD), PH, heart involvement, scleroderma renal crisis (SRC), presence of antitopoisomerase I and absence of anticentromere antibodies, and active capillaroscopic pattern showed reduced survival rate. In a multivariate analysis, older age at disease onset, dcSSc, ILD, PH, and SRC were independent risk factors for mortality. In the present study involving a large cohort of SSc patients, a high prevalence of disease-related causes of death was demonstrated. Older age at disease onset, dcSSc, ILD, PH, and SRC were identified as independent prognostic factors.

Systemic sclerosis sine scleroderma and limited cutaneous systemic sclerosis: similarities and differences

OBJECTIVES

To compare a cohort of patients with systemic sclerosis sine scleroderma (ssSSc) vs. patients with limited cutaneous systemic sclerosis (lcSSc).

METHODS

Forty-five patients with ssSSc and 186 patients with lcSSc were investigated. Demographic, clinical and immunologic features and survival were compared.

RESULTS

There were no significant differences between ssSSc and lcSSc in gender, age at onset and interval between onset and diagnosis. ssSSc patients fulfilled the ACR criteria for SSc less than lcSSc patients (13%/77%, p<0.0001). There were no significant differences in articular involvement, myopathy, tendon friction rubs and gastrointestinal, pulmonary, cardiac and renal involvements. There was a trend to higher prevalence of pulmonary arterial hypertension (PAH) in ssSSc patients (29%/19%) but not reach significant difference. The prevalence of antinuclear and anticentromere antibodies and slow capilaroscopic pattern was similar. Sicca syndrome (13%/30%; p=0.024), digital ulcers (16%/50%; p<0.0001), calcinosis (11%/26%; p=0.047) and acroosteolysis (0% /10%; p=0.028) were more frequently in lcSSc. Survival at 5, 10, and 15 yr was not different in ssSSc and lcSSc patients (100%/98%, 100%/98%, and 92%/89%, respectively).

CONCLUSIONS

ssSSc and lcSSc patients share demographic, clinical and immunologic features. Survival is also similar in both groups. Differences are mainly due to peripheral vascular manifestations. However, despite great similarities, we believe that ssSSc patients should be considered as a different subset in order to avoid misdiagnosis. ssSSc patients should be truly differentiated from early SSc using sensitive and specific studies looking for any asymptomatic organ involvement.

[An epidemiologic study of headache and its treatment in the general population of Catalonia]

INTRODUCTION

Headache is one of the most frequent symptoms that people suffer in their daily life. However, the available studies have been made in populations who ask for medical advice or in small geographical areas.

OBJECTIVES

The present survey was devoted to establish the prevalence of headache in the general population of Catalonia, as well as to establish its characteristics, the therapeutic behavior that was followed by those affected and the consequences for the sufferers.

PATIENTS AND METHODS

The survey included a sample of 1,964 people, who were representative of the population older than 18 years, and was obtained from the census. The data were obtained by means of a telephone interview. The prevalence of pain in the last six months was established. Among the sufferers of headaches, additional information was obtained concerning its characteristics, its relationship with socio demographic characteristics and the therapeutic behaviors used by patients. The degree of impairment and disability secondary to headache was also determined.

RESULTS

The prevalence was 42%, and it was the highest in women (52.8 vs 31.1%) young people (mean age of 43.4 16 years), unskilled manual workers, middle level managers and technicians and those with university studies. Headaches had a long duration (84.4%, more than 3 years); the episodes were frequent, of short duration and or severe intensity (61.2% were severe unbearable). Self medication was the therapeutic behavior most commonly used (52.3%, being acetylsalicylic acid the most employed), followed by visit to the physician (47.4%, being the prescription of paracetamol the preferred treatment) and some alternative medical treatments (16.1%). Headaches limited the daily activities of the sufferers (31.4%), forced to bed rest (23.4%) and even resulted in time off work (4.6%). All personal, social and work impairments had short duration in most individuals.

CONCLUSIONS

Headache has a high prevalence in the general population. Although the episodes had a brief duration and self medication was commonly used, pain is frequently severe, limits the daily activities and sufferers often visit the physicians to obtain relief. Headaches should not be considered as a minor health disorder.