Ariane Barbacki1, Murray Baron1, Mianbo Wang1, Yuqing Zhang2, Wendy Stevens3, Joanne Sahhar4, Susanna Proudman5, Mandana Nikpour6, Ada Man7. 1. Lady Davis institute for Medical Research, Montreal, Quebec, Canada. 2. Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. 3. St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia. 4. Monash Health, Clayton, Victoria, Australia. 5. Royal Adelaide Hospital, North Terrace, Adelaide, South Australia. 6. University of Melbourne at St-Vincent Hospital, Melbourne, Fitzroy, Victoria, Australia. 7. Rheumatology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Abstract
OBJECTIVE: Systemic sclerosis (SSc) is an autoimmune disease characterized by progressive organ damage, which can be measured using the Scleroderma Clinical Trials Consortium Damage Index (SCTC-DI). We aimed to identify whether distinct trajectories of damage accrual exist and determine which variables are associated with different trajectory groups. METHODS: Incident cases of SSc (<2 years) were identified in the Australian Scleroderma Interest Group and Canadian Scleroderma Research Group prospective registries. Group-based trajectory modeling was used to identify SCTC-DI trajectories over the cohort's first 5 annual visits. Baseline variables associated with trajectory membership in a univariate analysis were examined in multivariable models. RESULTS: 410 patients were included. Three trajectory groups were identified: low (54.6%), medium (36.2%) and high (10.3%) damage. Patients with faster damage accrual had higher baseline SCTC-DI. Older age (OR 1.57, 95% CI 1.18 - 2.10), male sex (OR 2.55, 95% CI 1.10 - 5.88), diffuse disease (OR 6.7, 95% CI 2.57 - 17.48), tendon friction rubs (OR 5.4, 95% CI 1.86 - 15.66), and elevated CRP (OR 1.98, 95% CI 1.49 - 2.63) increased the odds of being in the high damage group versus the reference (low damage), whereas Caucasian ethnicity (OR 0.31, 95% CI 0.12 - 0.75) and anti-centromere antibodies (OR 0.24, 95% CI 0.07 - 0.77) decreased them. CONCLUSIONS: We identified three trajectories of damage accrual in a combined incident SSc cohort. Several characteristics increased the odds of belonging to worse trajectories. These findings may be helpful in recognizing patients in whom early aggressive treatment is necessary. This article is protected by copyright. All rights reserved.
OBJECTIVE: Systemic sclerosis (SSc) is an autoimmune disease characterized by progressive organ damage, which can be measured using the Scleroderma Clinical Trials Consortium Damage Index (SCTC-DI). We aimed to identify whether distinct trajectories of damage accrual exist and determine which variables are associated with different trajectory groups. METHODS: Incident cases of SSc (<2 years) were identified in the Australian Scleroderma Interest Group and Canadian Scleroderma Research Group prospective registries. Group-based trajectory modeling was used to identify SCTC-DI trajectories over the cohort's first 5 annual visits. Baseline variables associated with trajectory membership in a univariate analysis were examined in multivariable models. RESULTS: 410 patients were included. Three trajectory groups were identified: low (54.6%), medium (36.2%) and high (10.3%) damage. Patients with faster damage accrual had higher baseline SCTC-DI. Older age (OR 1.57, 95% CI 1.18 - 2.10), male sex (OR 2.55, 95% CI 1.10 - 5.88), diffuse disease (OR 6.7, 95% CI 2.57 - 17.48), tendon friction rubs (OR 5.4, 95% CI 1.86 - 15.66), and elevated CRP (OR 1.98, 95% CI 1.49 - 2.63) increased the odds of being in the high damage group versus the reference (low damage), whereas Caucasian ethnicity (OR 0.31, 95% CI 0.12 - 0.75) and anti-centromere antibodies (OR 0.24, 95% CI 0.07 - 0.77) decreased them. CONCLUSIONS: We identified three trajectories of damage accrual in a combined incident SSc cohort. Several characteristics increased the odds of belonging to worse trajectories. These findings may be helpful in recognizing patients in whom early aggressive treatment is necessary. This article is protected by copyright. All rights reserved.