Background The University Hospitals of Leicester (UHL) NHS trust is one of the largest NHS hospital trusts in the United Kingdom. It serves a population of approximately one million, of which one-fifth identify as non-Caucasian, predominantly of South Asian origin. Ethnic differences in the characteristics of patients with Systemic Sclerosis (SSc) have been identified, with important clinical consequences, but there is little data on South Asians. The ethnic composition of our trust presents a unique opportunity to investigate this gap in our knowledge and improve disease outcomes in this cohort of patients.
Objectives The aim of this study was to investigate differences in the clinical manifestations of SSc patients between Caucasian and South Asians within UHL NHS Trust. We also investigated the screening of complications in these patients with echocardiography and annual pulmonary function tests (PFTs).
Methods SSc patients were identified from the connective tissue disease database of the UHL Rheumatology Department. Demographic data, clinical manifestations, immunology profile, PFTs and echocardiography results were collated from a combination of medical records at UHL including, radiology, pathology and Respiratory Physiology records. Treatment records were drawn from the DAWN database.
Results A total of 70 SSc patients were identified, of which there were 10 (14%) South Asian, 58 (83%) Caucasian and 2 (3%) Black. We compared the following characteristics of the South Asian to the Caucasian population: Women 90.0 vs. 91.3% (p=0.89). Mean age 53.0 (95% CI 45.6-60.4, SD 12.0) vs. 62.2 (95% CI 58.9-65.6, SD 12.9) years (p<0.05). Mean age at diagnosis 45.2 (95% CI 36.2-54.2, SD 13.7) vs. 52.4 (95% CI 48.1-56.7, SD 16.0) years (p=0.21). Duration of disease 7.3 (95% CI 4.03-10.6, SD 5.1) vs. 8.9 (95% CI 6.5-11.5, SD 9.4) years (p=0.62). Limited disease 75.0 vs. 94.6% (p<0.05). Interstitial lung disease (ILD) 60.0 vs. 29.8% (p=0.64). Pulmonary Artery Hypertension 10.0 vs. 14.0% (p=0.74). Gastrointestinal complications 30.0 vs. 40.0% (p=0.50). Cardiac complications 0.0 vs. 10.3% (p=0.29). Raynaud's phenomenon 50.0 vs. 73.7% (p=0.13). Anti-Scl-70 antibody +ve 22.2 vs. 17.4% (p=0.73). Anti-centromere antibody +ve 50.0 vs. 31.0% (p=0.30). Current DMARD use 70.0 vs. 50.0% (p=0.24). Previous DMARD use 28.6 vs. 13.0% (p=0.29). Previous iloprost infusion 30.0 vs. 24.1% (p=0.70). Echocardiography 90.0 vs. 89.3% (p=0.94). Annual PFT 80.0 vs. 63.6% (p=0.24).
A minority (14%) of SSc patients in Leicestershire are South Asian, similar to the ethnic composition of Leicestershire.
The mean age of onset is significantly lower in the South Asian group compared to the Caucasian group.
The South Asian group had significantly more diffuse SSc disease compared to the Caucasian group.
The prevalence of ILD was twice as high in the South Asian group compared to the Caucasian group.
The usage of annual PFTs and echocardiography did not differ significantly between the South Asian and Caucasian groups.
Disclosure of Interest None declared