Gender differences in organ involvement and survival in systemic sclerosis – experience of a EUSTAR center
Authors:   “Sf. Maria“ Clinical Hospital, Department of Internal Medicine and Rheumatology, Bucharest, Romania, Groseanu Laura ,   “Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania, Petre Andreea ,   “Sf. Maria“ Clinical Hospital, Department of Internal Medicine and Rheumatology, Bucharest, Romania, Balanescu Andra ,   “Sf. Maria“ Clinical Hospital, Department of Internal Medicine and Rheumatology, Bucharest, Romania,   “Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania, Bojinca Violeta ,   “Sf. Maria“ Clinical Hospital, Department of Internal Medicine and Rheumatology, Bucharest, Romania,   “Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania, Opris-Belinski Daniela ,   “Sf. Maria“ Clinical Hospital, Department of Internal Medicine and Rheumatology, Bucharest, Romania,   “Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania, Berghea Florian ,   “Sf. Maria“ Clinical Hospital, Department of Internal Medicine and Rheumatology, Bucharest, Romania,   “Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania, Saulescu Ioana ,   “Sf. Maria“ Clinical Hospital, Department of Internal Medicine and Rheumatology, Bucharest, Romania,   “Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania, Mazilu Diana ,   “Sf. Maria“ Clinical Hospital, Department of Internal Medicine and Rheumatology, Bucharest, Romania,   “Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania, Daia Iliescu Sanziana ,   “Sf. Maria“ Clinical Hospital, Department of Internal Medicine and Rheumatology, Bucharest, Romania,   “Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania, Borangiu Andreea ,   “Sf. Maria“ Clinical Hospital, Department of Internal Medicine and Rheumatology, Bucharest, Romania,   “Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania, Constantinescu Cosmin ,   “Sf. Maria“ Clinical Hospital, Department of Internal Medicine and Rheumatology, Bucharest, Romania,   “Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania, Cobilinschi Claudia ,   “Sf. Maria“ Clinical Hospital, Department of Internal Medicine and Rheumatology, Bucharest, Romania,   “Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania, Negru Maria Magdalena ,   “Sf. Maria“ Clinical Hospital, Department of Internal Medicine and Rheumatology, Bucharest, Romania,   “Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania, Abobului Mihai ,   “Sf. Maria“ Clinical Hospital, Department of Internal Medicine and Rheumatology, Bucharest, Romania,   “Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania, Ionescu Ruxandra ,   “Sf. Maria“ Clinical Hospital, Department of Internal Medicine and Rheumatology, Bucharest, Romania,   “Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania
Published: December 2021

Introduction. The low overall prevalence of systemic sclerosis (SSc) and the low proportion of male patients have resulted in a scarcity of studies assessing sex differences in SSc patients, and contradictory results have often been observed. Material and method. We performed a retrospective observational study using data extract from the EULAR scleroderma trials and research (EUSTAR) cohort 096 . We looked at sex influence on disease characteristics at baseline and then focused on patients with at least 2 years of follow-up to estimate the effects of sex on disease progression and survival. Results. 173 patients with SSc were available for the baseline analyses. In the longitudinal analysis after a mean follow-up of 3.5(±0.65) years, male sex was associated with a higher risk of scleroderma renal crisis (OR:9.45 (1.49 to 59.69); p = 0.004), digital contractures (OR:8.2 (3.1 to 21.9); p < 0.001), arrhythmias (OR: 3.37 (1.36 to 8.34); p = 0.006), pulmonary fibrosis (OR: 3.56, (1.51 to 8.41); p = 0.003), pulmonary hypertension (OR: 3.01 (1.19 to 7.59); p = 0.016), severe vascular involvement (OR:2.86, (1.22 to 6.73); p = 0.013) and low ventricular ejection fraction (OR: 2.84, (1.2 to 6.73); p = 0.014). Males had significantly reduced survival time after diagnosis (p = 0.004). The most frequent causes of death were scleroderma renal crisis in males and pulmonary hypertension in females. Conclusions. Although more common in women, SSc appears as strikingly more severe in men. Our results demonstrate a higher risk of severe organ involvement and poor prognosis in men. These results raise the point of including sex in the management and the decision-making process.