Age-related survival and clinical features in systemic sclerosis patients older or younger than 65 at diagnosis

• Published in: Rheumatology (Oxford, England) England), 2010-06, Vol.49 (6), p.1112-1117
• Main Authors: Pérez-Bocanegra, Carmen, Solans-Laqué, Roser, Simeón-Aznar, Carmen P., Campillo, Mercedes, Fonollosa-Pla, Vicente, Vilardell-Tarrés, Miquel
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Biological and medical sciences; Cause of Death; Disease Progression; Diseases of the osteoarticular system; Elderly; Female; Heart Diseases - complications; Heart Diseases - mortality; Heart Diseases - physiopathology; Humans; Lung Diseases - complications; Lung Diseases - mortality; Lung Diseases - physiopathology; Male; Medical sciences; Middle Aged; Mortality; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Scleroderma, Systemic - complications; Scleroderma, Systemic - mortality; Scleroderma, Systemic - physiopathology; Severity of Illness Index; Survival; Survival Rate; Systemic sclerosis; Visceral involvement
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/keq046

Objective. To analyse the differences in SSc clinical features and survival in patients aged ⩾65 years compared with young SSc patients. Methods. Of a total of 319 SSc patients, we identified 67 (21%) patients aged >65 years. Demographical data such as SSc subsets, the cutaneous complaint, internal organ involvement and the causes of morbidity and mortality were collected. Results of the elderly and young patients were compared. Results. There were 61 (91%) women and 6 (9%) men aged ⩾65 years. The limited SSc (lSSc) subset was more prevalent in elderly than in young patients (74.6 vs 54%, P = 0.002). Pulmonary disease (86.6% in elderly vs 73.8% in young patients, P = 0.034) and cardiac involvement (70.1% in elderly vs 49.6% in young patients, P = 0.004) were significantly more prevalent in elderly patients. In contrast, signs of oesophageal involvement (43.3% in elderly vs 57.5% in young patients, P = 0.040) were less frequent in aged patients. In addition, pulmonary and heart disease appeared significantly earlier after the diagnosis in patients aged ⩾65 years. Mortality was significantly higher in elderly than in young patients (35.8 vs 19%, P = 0.005), but when standardized mortality ratios (SMRs) were analysed, there was no significant mortality increase in the elderly. Conclusion. In elderly patients, the lSSc subset is more prevalent than the diffuse. Pulmonary and cardiac involvement are more prevalent in aged patients and appears sooner after the disease diagnosis. SSc is clearly related to increased mortality, although it is not significant in the elderly group.