The major finding was a bimodal incidence pattern with an increased risk of lymphoma, mainly NHL, early during follow-up, but lung cancer and squamous skin cancer later on.
IntroductionWhile microvascular disease is well described in systemic sclerosis (SSc), it is still unclear whether the occurrence of ischemic macrovascular events and atherosclerosis is enhanced among patients with SSc.MethodsIn this study, 111 SSc patients (74% of prevalent cases in Stockholm County) and 105 age- and sex-comparable population controls were investigated. Previous ischemic arterial events were tabulated. As surrogate measures of atherosclerosis, plaque occurrence and intima-media thickness (IMT) were determined with carotid ultrasound and the ankle-brachial index (ABI) was calculated. Traditional cardiovascular risk factors were recorded and we also measured biomarkers indicating systemic inflammation and endothelial activation/dysfunction.ResultsMean age was 62 ± 12 years for patients and controls. Ischemic arterial events were more common, due to increased occurrence of ischemic heart disease (IHD) and ischemic peripheral vascular disease (IPVD), in the patient group (12% vs. 4%, P = 0.03 and 9% vs. 0%, P = 0.003 respectively). On a group level, there was no difference regarding the occurrence of ischemic cerebrovascular disease, the frequency of plaques, IMT or ABI between SSc patients and controls. Subgroup analyses revealed that patients with anticentromere antibodies (ACA+) had more plaques and more ischemic arterial events compared to other SSc patients (67% vs. 39% and 32% vs. 11%; P = 0.006 and P = 0.01, respectively) and compared to controls (67% vs. 41% and 32% vs. 7%, P = 0.02 and P = 0.0003, respectively). Biomarkers of inflammation/endothelial activation were generally increased among SSc patients.ConclusionsPatients with SSc are at enhanced risk for IHD and IPVD. The ACA+ SSc subgroup was particularly affected with both ischemic arterial events and premature atherosclerosis. The microvascular vulnerability of ACA+ patients is previously well documented. We demonstrate that ACA+ SSc patients have an enhanced risk of macrovascular injury as well. This group should be followed closely and modifiable cardiovascular risk factors should be treated at an early stage.
BackgroundNo previous studies have examined the effect of intensive exercise in systemic sclerosis patients with pulmonary impairment. The objective of this study was to examine the effect of an eight-week intensive aerobic exercise and muscle endurance training program for patients with systemic sclerosis with 50–100% of forced vital capacity.MethodsA single-subject experimental design with repeated systematic measures during a six week A-phase (non-interventional baseline period) and an eight week B-phase (exercise intervention period) was used. Three women and one man with median age 66 years and median disease duration of 3.5 years completed aerobic exercise corresponding to 15 on the Borg RPE scale (strenuous) and muscular endurance training three times/week. Physical capacity (six-minute walk test), aerobic capacity (submaximal treadmill test) and muscle endurance in shoulder and hip flexion (Functional Index 2) were assessed every other week throughout the 14-week study. Activity limitation (Health Assessment Questionnaire), quality of life (Short Form 36), Raynaud, Fatigue and Global Health during the recent week (Visual Analogue Scales) were assessed at weeks 0, 6, 14.ResultsThree participants improved significantly in muscular endurance, and two participants improved significantly or clinically relevant in aerobic capacity. All other variables remained unchanged, except for a trend towards reduced fatigue.ConclusionsThis eight week exercise program was largely successful with positive effects on aerobic capacity and muscle endurance.Trial registrationClinicaltrials.gov Identifier: NCT01813578
Both NTproBNP and hs-cTnI were associated with echocardiographic abnormalities, which were more prevalent in SSc patients than in controls. Our results thus suggest that hs-cTnI could be a potential cardiac biomarker in SSc. Low RV function and signs of pulmonary hypertension (PH) were uniquely found in the SSc group. SSc patients had more valve regurgitation than controls, an observation that warrants more clinical attention.
Although ECGs are inexpensive, commonly available screening tools, to detect arrhythmias, such as frequent ventricular extrasystoles (VES), Holter tracings should be performed. The frequencies of AV and/or IV conduction abnormalities and septal Q waves/low R waves have not changed since 1985. The unmet need of anti-fibrotic treatment in SSc is underscored by these findings.
Background: Patients with rheumatoid arthritis are at increased risk of death from cardiovascular disease (CVD). This risk is influenced by the inflammatory activity of the rheumatoid arthritis as well as by traditional risk factors for CVD. However, little is known about whether or to what extent hereditary factors for CVD contribute additional risk in patients with rheumatoid arthritis. Objective: To assess the clinical impact of a parental history of CVD in patients with rheumatoid arthritis. Methods: Population based cohort study of 10 805 Swedish patients with rheumatoid arthritis aged 16-67 years during follow up (1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000). Parents, and cardiovascular deaths among patients and parents, were identified through register linkages. Relative risk of death v the general population was assessed using standardised mortality ratios (SMR), which were compared by Poisson regression. Results: Rheumatoid patients with a parental history of fatal CVD had an SMR of death from CVD of 2.9 (95% confidence interval, 2.5 to 3.4). By contrast, rheumatoid patients without a parental history of fatal CVD had an SMR of 1.7 (1.2 to 2.3). A parental death from CVD was associated with a 70% increase in the risk of fatal CVD in rheumatoid arthritis (SMR ratio = 1.7 (1.2 to 2.4), and an increase in the 10 year mortality from CVD from 5% to 10% in men and from 2% to 4% in women aged 50 to 67 years. Conclusions: Parental history of death from CVD is an important (and easily assessable) risk factor for fatal CVD in rheumatoid arthritis.
Background Previous studies have demonstrated that physical activity has several benefits among the general population. In patients with systemic sclerosis (SSc) few studies concerning the frequency of physical activity are sparse and no studies have compared different aspects of physical activity between patients with SSc and the general population. Objectives The aim of the study was to examine different aspects of self-reported physical activity in patients with SSc and matched population controls. Methods 106 patients, fulfilling the ACR criteria for SSc, and 106 controls, individually matched for age, gender and living region were investigated clinically by a rheumatologist. All participants filled out a questionnaire about exercise capacity, physical activity and sedentary behaviour. A nurse collected the questionnaire and measured weight and height. Results In total, 178 women and 34 men were included. The mean age of the patients was 61.9 (SD 12.4) and for controls 62.01 (SD 12.4) years. The Body Mass Index was lower in patients, mean 24.4 (SD 3.7), than controls, 26.1 (3.9) (p=0.001). The patients reported lower capacity for walking, jogging and running compared to controls (p<0.001). There were no significant difference in physical exercise the previous year between the patients and the controls (p=0.1). Similar results concerning physical activity on “low to moderate” intensity 6-7 times/week were reported in patients (36%) and controls (31%) (ns). Concerning physical activity on “high” intensity 4-7 times/week the results also were similar in patients (17%) and controls (19%) (ns). Conclusions This is the first study reporting different aspects of physical activity in patients with SSc compared to matched controls. Although the patients reported lower exercise capacity than controls, this study indicated that there was no difference in physical exercise the previous year. Only approximately 1/5 of both patients and controls reached the general recommendations for physical activity, i.e. on high intensity. Future interventions should focus on supporting increased physical activity and exercise in patients with SSc. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5299
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