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Risk Factors for Future Scleroderma Renal Crisis at Systemic Sclerosis Diagnosis.

Sarah M Gordon1,2, Rodger S Stitt1,2, Robert Nee1,2

  • 1From the Nephrology Department, and the Rheumatology Department, Walter Reed National Military Medical Center; the Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.

The Journal of Rheumatology
|July 17, 2018
PubMed
Summary

Systemic sclerosis patients with proteinuria, anemia, hypertension, or elevated ESR at diagnosis face higher scleroderma renal crisis risk. Identifying three or more factors accurately predicts future SRC, enabling early intervention.

Keywords:
HYPERTENSIONPROTEINURIARISK FACTORSSCLERODERMA RENAL CRISISSYSTEMIC SCLEROSIS

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Area of Science:

  • Rheumatology
  • Nephrology
  • Immunology

Background:

  • Systemic sclerosis (SSc) is a complex autoimmune disease characterized by fibrosis and vasculopathy.
  • Scleroderma renal crisis (SRC) is a severe complication of SSc, necessitating improved risk prediction at diagnosis.
  • Existing risk factors for SRC include corticosteroid use, anti-RNA polymerase III antibodies (ARA), skin thickness, and tendon friction rubs.

Purpose of the Study:

  • To identify additional clinical and laboratory predictors of future SRC in patients with SSc at the time of diagnosis.
  • To improve the risk stratification profile for SRC development in SSc patients.

Main Methods:

  • A retrospective cohort study utilizing military electronic medical records from 2005 to 2016.
  • Comparison of demographics, clinical characteristics, and laboratory results between 31 SSc patients who developed SRC and 322 SSc controls without SRC.
  • Statistical analysis adjusted for potential confounding variables.

Main Results:

  • Proteinuria, anemia, hypertension, chronic kidney disease, elevated erythrocyte sedimentation rate (ESR), thrombocytopenia, hypothyroidism, Anti-Ro antibody seropositivity, and ARA were significantly associated with future SRC.
  • The presence of three or more of these risk factors at SSc diagnosis demonstrated high sensitivity (77%) and specificity (97%) for predicting future SRC.
  • No control patients had four or more identified risk factors.

Conclusions:

  • A panel of clinical and laboratory factors at SSc diagnosis can predict future SRC development.
  • Patients with identified risk factors may benefit from close monitoring of blood pressure, proteinuria, and estimated glomerular filtration rate (eGFR) for early SRC detection.
  • Future research should focus on prospective therapeutic studies in this high-risk SSc population.