Article Text
PDF
Abstract
Background Systemic Sclerosis (SSc) has been widely studied from a purely global standpoint, but only a few trials have analysed patients with interstitial lung disease (SSc-ILD) as well.
Objectives 1. Describe the clinical features of a cohort of patients with SSc and SSc-ILD. 2. Determine whether there are disparities among different types of SSc-ILD and their progression in patients with either limited (lcSSc) or diffuse involvement (dcSSc). 3. Ascertain whether there are disparities among different types of SSc-ILD and their progression according to the SSc-specific autoantibody (AAb).
Methods Retrospective study of a cohort of patients with ILD-SSc controlled during an SSc consultation. The following variables were collected: sex, age, SSc and ILD progress in years, type of SSc and ILD, smoking, digital ulcers (DU), pulmonary hypertension, digestive disorders, cancer, SSc treatment, corticosteroid doses and lastly, lung function tests upon diagnosis, at treatment onset, and 24 months later. Additionally, a record was kept on the types of AAb present in every SSc. Qualitative and quantitative variables were compared in relation to the clinical and immunological sub-classification. Chi-square and Student's T Tests were performed. A p-value≤0.05 was considered significant.
Results out of 266 patients with SSc, data from 47 patients with ILD-SSc were gathered; 89.4% were female, with an age range of 66.09±15.1 years old, and 9.85±10.2 and 4.38±9.24 years of progression of their SSc and ILD respectively. 33 out of 47 sustained lcSSc, and both Scl-70/ATA (29.8%) and ACA (26.1%) were the most frequently found AAb. Non-specific interstitial pneumonia (NSIP) was the most common ILD radiological pattern (76.6%). Most patients with SSc underwent treatment (51.1%), 24% with mycophenolate mofetil (MMF); 36.2% of the patients had been concomitantly administrated corticosteroids with a mean prednisone dose of 15.73±10.3 mg/d.
Upon comparing patients with lcSSc and dcSSc, prevalence of DU was higher in those with dcSSc (p<0.01), MMF was less frequently used (p<0.02), rituximab was more usually employed (p<0.03), and they presented worse values of FEV1/FVC ratio after 24 months of treatment (p<0.03). No differences were observed as to either type of ILD or progression. However, when variables were analysed regarding AAb in SSc, patients with ACA presented both fewer DU (p<0.02) and NSIP pattern (p<0.02), and more frequent compromise of the small airway (p<0.01), they were younger and thus, they had had shorter progression of the disease. ILD diagnosis was made significantly earlier in those patients with RNA polymerase, and later in those with anti-U1RNP. No AAb was observed associated with neoplasia. Considering the types of ILD, patients with NSIP pattern were younger (p0.054) and presented worse spirometric values.
Conclusions In terms of ILD-SSc patient stratification, sub-classification by AAb appears to be more specific than the clinical sub-classification. ACA is related to less frequency of NSIP pattern. Unlike what has been described for SSc from a global point of view, in patients with ILD-SSc no association between AAb and neoplasia could be established.
Disclosure of Interest None declared