Tuesday, 23 Apr 2019

You are here

Early Predictive Factors for Scleroderma Renal Crisis

It has been historically said that risk factors for scleroderma renal crisis (SRC) includes include cold exposure, steroid use, dehydration, rapid progression of skin disease, tendon friction rubs, anti-RNA polymerase III antibodies and pregnancy.  A new study examines risk factor for SRC at the onset and diagnosis in systemic sclerosis patients. 

Researchers from Reed National Military Medical Center studied a systemic sclerosis (SSc) cohort seen between 2005 and 2016, specifically looking at 31 cases of newly diagnosed SSc cases who developed SRC after SSc diagnosis (compared to 322 without SRC).

The following findings at SSc diagnosis were predictive of future SRC:

  • proteinuria (p < 0.001; OR 183, 95% CI 19.1–1750),
  • anemia (p = 0.001; OR 9.9, 95% CI 2.7–36.2),
  • hypertension (p < 0.001; OR 13.1, 95% CI 4.7–36.6),
  • chronic kidney disease (p = 0.008; OR 20.7, 95% CI 2.2–190.7),
  • elevated erythrocyte sedimentation rate (p < 0.001; OR 14.3, 95% CI 4.8–43.0),
  • thrombocytopenia (p = 0.03; OR 7.0, 95% CI 1.2–42.7),
  • hypothyroidism (p = 0.01; OR 2.8, 95% CI 1.2–6.7),
  • anti-Ro antibody seropositivity (p = 0.003; OR 3.9, 95% CI 1.6–9.8), and
  • anti-RNA polymerase III antibodies (p = 0.02; OR 4.1, 95% CI 1.2–13.8).

Individually the predictive value for SRC was low, but finding any three or more of these present at diagnosis was sensitive (77%) and specific (97%) for future SRC. No SSc without SRC disease controls had ≥ 4 risk factors.

These profiles add to the current list and should be considered in new SSc patients as they may benefit from close observation of blood pressure, proteinuria, and other signs of renal crisis. 

The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

EULAR 2019 Update to Lupus Management

The goal of SLE treatment is remission or low disease activity and flare prevention. Hydroxychloroquine is recommended in all patients with lupus, at a dose not exceeding 5 mg/kg real body weight. Glucocorticoids (GC) should be minimised to less than 7.5 mg/day (prednisone equivalent). Appropriate initiation of immunomodulatory agents (methotrexate, azathioprine, mycophenolate) can be tailored to the clinical scenarios and may allow for tapering or discontinuation of GC.

Mortality Risk Factors in Systemic Sclerosis

A French cohort study of 625 systemic sclerosis (SStc) patients has found a significantly increased mortality risk that can be predicted by common clinical variables.

In addition to a multicenter prospective study, investigators performed a metanalysis on SSc standarized mortality ratios (SMR) and hazard ratios of prognosis factors.

Better Tests Ahead in Lupus

The advent of "big data" and "-omics" technologies offers hope that clinicians will soon have better diagnostics for systemic lupus erythematosus, rheumatologists here were told.

GCA Relapse Risk High with Steroids

Prior to the introduction of tocilizumab to manage giant cell arteritis (GCA), glucocorticoids (GC) have been the mainstay of therapy, but has been limited by relapses in disease. A recent metanalysis shows that relapses occur in nearly half of patients and are related to the duration of therapy rather than the initial dose of GC.

A literature review found 34 studies (2,505 patients) from 8 RCTs of GCA patients only treated with GC.

Presenting Features of Early SLE

What clinical features best identify early systemic lupus erythematosus (SLE) patients from mimics?  A multicenter, multinational study aimed to evaluate manifestations at disease onset and to compare early SLE manifestations to those of diseases mimicking SLE.