POS0872 CLINICAL FEATURES AND OUTCOME OF 1054 PATIENTS WITH SYSTEMIC SCLEROSIS: AN ANALYSIS OF THE PORTUGUESE REUMA.PT REGISTRY FOR SCLERODERMA (REUMA.PT/SSC)
Authors: R. Freitas, P. Martins, E. Dourado, M. J. Salvador, T. Santiago, I. Cordeiro, B. M. Fernandes, F. Guimarães, S. Garcia, B. Samões, N. Gonçalves, M. H. Fernandes Lourenco, A. S. Pinto, M. Rocha, M. Couto, E. Costa, F. Araújo, C. Resende, F. Godinho, A. Cordeiro, M. J. Santos
Journal: Annals of the Rheumatic Diseases (2021)

Background: Systemic sclerosis (SSc) may present distinctive manifestations and survival in different ethnic and geographic groups. Objectives: To describe the clinical features, treatments, and survival of adult SSc patients registered in Reuma.pt/SSc. Methods: Demographic features, SSc subsets, fulfilment of classification criteria, clinical and immunologic characteristics, comorbidities, medication and deaths were reviewed. Survival was calculated for patients included in the registry within the first 2 years of diagnosis. Results: In total, 1054 patients were included, 87.5% female, mean age at diagnosis 52.7 ± 14.8 years. The most common subset was limited cutaneous (lc)SSc (56.3%), followed by diffuse cutaneous (dc)SSc (17.5%), preclinical SSc (13%), overlap syndrome (9.8%) and SSc sine scleroderma (3.3%). Raynaud’s phenomenon (93.4%) and skin thickening (76.9%) were the most observed manifestations. Gastrointestinal (62.8% vs 47.8%), pulmonary (59.5% vs 23%) and cardiac (12.8% vs 6.9%) involvement were significantly more prevalent in dcSSc compared to lcSSc (Table 1). 52.5% of patients were ACA positive and 21% anti-topoisomerase positive, with significant differences between lcSSc and dcSSc. One third of patients was treated with immunomodulators, 53.6% with vasodilators, 23% received glucocorticoids and 2.3% biologics. During the median follow-up 12.4 years, 83 deaths (7.9%) were verified. The overall 1, 2 and 5 years survival was 98.0%, 96.8% and 92.6% respectively, without significant differences between lcSSc and dcSSc (Figure 1). Conclusion: Reuma.pt/SSc register is useful in routine patient monitoring and contributes to improve knowledge about this rare and complex disease. Clinical features of Portuguese SSc patients are similar to what has been described in other populations although the overall 5-year survival in recently diagnosed patients appears to be higher than previously reported. Table 1. Cumulative clinical and immunologic characteristics of Portuguese SSc patients Clinical and immunologic features Total N=1054 Limited cutaneous SSc N= 576 (56.3%) Diffuse cutaneous SSc N=180 (17.5%) P value Skin involvement – N(%) N=987 688 (90.6) 525 (90.7) 180 (100) &lt;0.01 Skin thickening * – N (%) N= 962 680 (76.9) 512 (88.9) 180 (100) &lt;0.01 Digital ulcers – N (%) N=970 325(33.5) 186 (34.7) 4 (51.5) &lt;0.01 Raynaud’s Phenomenon – N (%) N=1010 943 (93.4) 539 (95.7) 157 (92.4) 0.06 Musculoskeletal involvement – N(%) N=972 346 (45.6) 247 (42.7) 99 (55) &lt;0.01 Cardiac involvement –N(%) – N=924 71 (7.7) 36 (6.9) 19 (12.8) 0.02 Renal involvement –N(%) – N= 917 17 (1.9) 8!1.5) 6 (4.1) 0.07 Gastrointestinal involvement - N(%) N=933 508 (48.2) 277 (47.8) 113 (62.8) &lt;0.01 Pulmonary involvement – N(%) N=915 261 (28.5) 119 (23) 88 (59.5) &lt;0.01 PAH – N(%) N= 871 14 (1.6) 10 (2) 1 (0.7) 0.23 Intersticial lung disease – N(%) N=765 218 (28.5) 100 (22.7) 75 (57.7) &lt;0.01 Antinuclear antibodies - N(%) N=1040 934 (89.8) 522 (90.2) 154 (88.5) 0.57 Anti-centromere – N(%) N= 1027 540 (52.6) 383 (67.1) 16 (9.5) &lt;0.01 Anti-Scl70 – N(%) N=1020 214 (21) 12 (3.3) 104 (60.1) &lt;0.01 Anti-RNA polymerase III – N(%) N=710 25 (3.5) 12 (3.3) 7 (5.6) 0.38 Comorbidities Hypertension – N(%) N=431 117 (27.1) 76 (29.7) 67 (20.7) 0.1 Hyperlipidemia – N(%) N=431 71 (13.4) 72 (12.2) 24 (15.9) 0.08 Neoplasia – N(%) N=1054 29 (2.8) 12 (2.1) 7 (3.9) 0.14 PDE-5 (phosdiasterase-5); PPIs (proton pump inhibitors); PAH-Pulmonary arterial hypertension confirmed by right heart catheterization. Immunomodulators includes Metothrexate, Leflunomide, Hydroxycloroquine; Azathioprine, Mycophenolate Mofetil and Cyclophosphamide; * Does not include sclerodactyly. Figure 1. Panel A - Survival in years from diagnosis of patients with SSc included in Reuma.pt in the first 2 years of disease (N=472). Panel B - survival according to SSc subset (lcSSc and dcSSC). Disclosure of Interests: None declared