Older Patients With Systemic Sclerosis May Need More Frequent Follow-Ups

Findings of a new study show that older age at disease onset is an additional risk factor for disease progression in systemic sclerosis (SSc). In turn, the researchers suggest that practitioners perform more frequent follow-up examinations among these older patients so that organ complications can be detected earlier.

Previously, there had been controversy about the relationship between the age at disease onset, disease course, and clinical characteristics. To assess the connection, the researchers analyzed clinical data from the German Network for Systemic Scleroderma registry. 

The 3281 patients from the registry had limited cutaneous SSc, diffuse cutaneous SSc, or SSc-overlap syndromes. Based on their age at disease onset, the patients were divided into 3 groups (<40 years, 40-60 years, >60 years).

Among all the patients, 24.5% had developed their first non-Raynaud phenomenon symptoms before the age of 40 years, and 22.5% had developed such symptoms when they were older than age 60 years.

With the exceptions of gastrointestinal and musculoskeletal involvement, the patients aged older than 60 years at disease onset experienced a more rapidly progressing disease course. 

These older patients—a large proportion of whom were women—were significantly more likely to develop limited cutaneous SSc than the other 2 SSc subsets. Patients in the older cohort were also more likely to have pulmonary hypertension. However, these patients were less likely to have digital ulcerations.

Compared with patients who were younger at disease onset, older patients developed significantly earlier first skin changes and specific organ manifestations.

While corticosteroid use did not have an impact on the observed relationships, the researchers did find that significantly fewer patients aged older than 60 years received immunosuppressive treatment.

“Not only the specific SSc subset, but also the patients with an older age at disease onset represent subgroups at risk and should be examined more frequently regarding potential organ manifestations,” the researchers concluded. “Importantly, an older age at disease onset is an additional risk factor for disease progression in addition to well-known risk factors such as SSc subsets, specific antibodies, and specific organ manifestations.”

—Colleen Murphy

Reference:

Moinzadeh P, Kuhr K, Siegert E, et al. Older age onset of systemic sclerosis – accelerated disease progression in all disease subsets. Rheumatology. 2020;59(11):3380-3389. doi:10.1093/rheumatology/keaa127