FRI0480 Clinic and Mortality Differences Between Sclerodermic Men and Women of the Rescle Cohort

Abstract

BackgroundStudies evaluating the difference between men and women diagnosed of scleroderma (SSc) are scarce (1-5) because of the shortage of male patients.ObjectivesAssessing the existence of differences in clinical presentation and mortality causes among men and women in a large cohort of Spanish patients diagnosed with SSc.MethodsA registry of patients with SSc has been performed by the Spanish network for systemic sclerosis (RESCLE) since 2008, in which 90 clinical, immunological and capillaroscopic variables were collected prospectively. Data were collected until May 2014 for this study.Results1506 patients (1341 women), were included. Overall ratio female/male was 8/1. By subtypes lcSSc and preSSc were more frequent in females [84 (51%) vs 808 (60%), p0.023; 6 (3.6%) vs100 (7.5%), p0.076, respectively] and dcSSc in males [62 (38%) vs 293 (22%), p<0.001]. Diagnostic delay was longer in women (2.92 yrs vs 1.30yrs, p<0.001) and smoking was more prevalent in men. Myositis, tendon rubs, interstitial lung disease (ILD), cardiac conduction disturbances and renal crisis were more frequent in males, while isolated pulmonary arterial hypertension (PAH) and sicca syndrome in women. Positivity for ANA, ACA and antiRo was more frequent in women and antiScl-70 and antiRNA pol III in men. There were no sex differences in capillaroscopic patterns. In the multivariate study remained significant in the male predominance in smoking (OR 2.33, CI 1.49 to 4.14, p=0.002) and ILD (OR 1.70, CI 1.11 to 2 60, p=0.015) and in women sicca syndrome (OR 3, 1.63 to 5.52) and ANA positivity (OR 2.67, 1.29 to 5.51).Follow-up time (years) since the onset of symptoms was in males 8.69 yrs vs women 11.79, p=0.001. Altogether, 261 patients died (17%). Although there was no difference in the age at death, this was more common in men (31% men vs 15% women), and time from the onset of symptoms to death was longer in women [14.06 yrs (5.95 to 24.29) vs 8.33 (3.87 to 12.66), p<0.001]. Death was related to SSc in 112 (46%) (22 males vs 90 in women, p ns) while 129 (54%) (31 males vs. 103 for females, p ns) were due to other causes. ILD was the most common cause of death in men (27,5%) and PH in women (28,6%). PAH was more frequently a cause of death in women 39 (19,9%) than in men 0 (0,0%), p<0,001. The cumulative survival at 20 years from onset was 90.9% in women versus 76.3% in men, p<0.001.Conclusions1. In the RESCLE cohort, smoking and ILD were more frequent in males, and sicca syndrome and ANA positivity in women. 2. ILD was the most common cause of death in men and PAH in women. 3. PAH was more frequently a cause of death in women than in men. 4. Men had less survival since the onset of symptoms.ReferencesSimeόn CP et al, Br J Rheumatol 1996.Gaultier JB et al, Rev Med Interne 2008.Panopoulos ST et al, J Rheumatol 2013.Hussein H et al, J Rheumatol 2014.Elhai M et al, Ann Rheum Dis 2014.Disclosure of InterestNone declared

Occupation as a gendered-role and outcome in systemic sclerosis

“…While our data confirmed existing evidence of sex differences in SSc (e.g. male patients had higher rates of diffuse disease 2,6,23 and ILD, 24–26 and higher risk of mortality), 27 occupation, a gender-related variable, was not associated with disease subset, ILD, PH, pain, response to treatment or mortality in multivariate analyses.…”

Gender differences in systemic sclerosis: relationship to clinical features, serologic status and outcomes

“…Our comparisons were comprehensive, analyzing demographic information, disease subtype, environmental exposures, organ system involvement and severity, serum autoantibody profile, survival and causes of death. A recent abstract including over 1500 SSc patients concluded that dc-SSc, cigarette smoking, ILD and reduced survival were significantly more frequent among males (18). While there were many similarities when comparing the Pittsburgh female with male SSc patients, several key differences emerged, as illustrated in Table V. An environmental factor, i.e., cigarette smoking, is implicated in the pathogenesis of rheumatoid arthritis (19).…”