Article
Is there a Difference in the clinical Presentation of juvenile Systemic Scleroderma Patients according the Age of onset: Results from the juvenile Scleroderma Inception Cohort www.juvenile-scleroderma.com
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Authors
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Ivan Foeldvari
- Schön Klinik Hamburg-Eilbek, Hamburger Zentrum für Kinder- und Jugendrheumatologie, Hamburg
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Jens Klotsche
- Deutsches Rheuma-Forschungszentrum (DRFZ), Programmbereich Epidemiologie, Berlin
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Ozgur Kasapcopur
- Department of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University,, Istanbul
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Amra Adrovic
- Department of Pediatric Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University,, Istanbul, Turkey
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Valda Stanevicha
- University Childrens Hospital, Riga, Latvia
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M. T. Terreri
- Universidade Federal de São Paulo, Pediatric Rheumatology, Sao Paulo, Brasil
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Ekaterina Alexeeva
- Russian Academy of Medical Sciences, Rheumatology Department, Scientific Center for Children’s Health, Moskau, Russland
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Maria Katsicas
- Hospital de Pediatria, Buenos Aires, Argentine
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Vanessa Smith
- Gent University Hospital, Rheumatology, Gent, Belgium
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Rolando Cimaz
- University of Florence, Florence, Italy
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Mikhail Kostik
- Saint-Petersburg State Pediatric Medical University, St. Petersburg, Russia
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Thomas Lehman
- Hospital for Special Surgery, New York, USA
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Jordi Anton
- University Children´s Hospital, Pediatric Rheumatology, Barcelona, Spain
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W. Alberto Sifuentes-Giraldo
- University Hospital Ramón y Cajal, Madrid, Spain
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Flavio Sztajnbok
- Hospital Universitario Pedro Ernesto, Rio de Janeiro, Brasilien
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Tadey Avcin
- University Childrens Hospital, Pediatric Rheumatology, Ljubljana, Slovenia
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Mahesh Janarthanan
- Pediatric Rheumatology, Chennai, India
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Maria Jose Santos
- Serviço de Reumatologia, Hospital Garcia de Orta, Almada, Portugal
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Monika Moll
- Universitätsklinikum Tübingen, Klinik für Kinder- und Jugendmedizin, Tübingen
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Dana Nemcova
- University Childrens Hospital, Pediatric Rheumatology, Prague, Czech
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Cristina Battagliotti
- hospital den Ninos Dr. Orlando Alassia, Santa Fe, Argentine
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Jürgen Brunner
- Medizinische Universität Innsbruck, Department für Kinder- und Jugendheilkunde, Innsbruck, Österreich
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Despina Eleftheriou
- Great Ormond Street Childrens Hospital, London, United Kingdom
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Liora Harel
- Pediatric Rheumatology, Nettnja, Israel
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Tilmann Kallinich
- Charité - Universitätsmedizin Berlin, Klinik für Pädiatrie mit Schwerpunkt Pneumologie und Immunologie, Sektion Rheumatologie, Berlin
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Kirsten Minden
- Deutsches Rheuma-Forschungszentrum (DRFZ) und Charité Universitätsmedizin Berlin, Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Berlin
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Susan Nielsen
- Juliane Marie Centret, Rigshospitalet, Pediatric Rheumatology, Copenhagen, Danmark
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Kathryn Torok
- University Childrens Hospital, Pittsburgh, United States of America
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Josef Uziel
- University Children´s Hospital, Pediatric Rheumatology, Karfa Saba, Israel
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Ann Stevens
- Seattle Children's, Seattle, USA
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Clarissa Pilkington
- Great Ormond Street Hospital, London, Vereinigtes Königreich
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Nicola Helmus
- Schön Klinik Hamburg-Eilbek, Hamburger Zentrum für Kinder- und Jugendrheumatologie, Hamburg
| Published: | September 4, 2017 |
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Outline
Text
Background: Juvenile systemic sclerosis (jSSc) is an orphan autoimmune disease. It was rarely looked at the differences between the clinical presentations of patients at different paediatric age groups. The juvenile scleroderma inception cohort (http://www.juvenile-scleroderma.com/) is a prospective standardized register for patients with jSSc.
Methods: Patients with jSSc were included worldwide to the juvenile scleroderma inception cohort. We compared the demographics and clinical characteristics of the patients at different age ranges. We created 3 cohorts with different age ranges at onset of disease. Patents aged less than 5 years (Group1), 5-10 years (Group2) and over 10 years (Group3) at the time of diagnosis of the first non-Raynaud involvement of jSSc.
Results: Up till now 88 patients were enrolled,14 patients (15%) in Group1, 22 (25%) in Group2 and 52 (59%) in Group3. Diffuse subtype occurred in 71% in Group1, in 82% in Group2 and in 65% in Group3. Most patients were Caucasian. Disease duration at time of inclusion into the cohort was 3.9 years in Group1, 4.9 years in Group2 and 2.2 years in Group3. ANA positivity was 57% in Group1, 77% in Group2 and 86% in Group3. Anti-scl 70 was around 30% in all groups. Anti-Centromere positivity was 7 to 10%. Mean modified skin score was 12.4 in Group1, 16.5 in Group2 and 15.9 in Group3. Raynaud Phenomenon occurred in 85 to 95% of the patients. History of active or inactive ulceration occurred in 57% in Group1, 62% in Group2 and 43% in Group3. Decreased FVC under 80% occurred in 43% in Group1, 32% in Group2 and 30% in Group3. Pulmonary hypertension occurred in 7% in Group1 and in 10% in Group3. No renal hypertension was observed. Urinary sedimentary changes occurred in 7% in Group1 and in 10% in Group3. Gastrointestinal involvement occurred in 21% in Group1, 45% in Group2 and 27% in Group3. Musculoskeletal involvement occurred in 58 to 64 %. Patient global disease activity (VAS 0-100) was 42.8 to 47.9. Patient global disease damage (VAS 0-100) was 39.6- to 45.0. Physician global disease activity (VAS 0-100) was 35.4-40.0. Physician global disease damage (VAS 0-100) was 37.1 in Group1, 41.3 in Group2 and 27.7 in Group3.
Conclusion: It seems to be that patients, with onset of the disease in younger age have more severe disease as patients with disease onset after the age of 10 years. We need more patients in our cohort to gain more sufficient data to prove our preliminary observation.
