Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose :
The American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) suggested the 2013 ACR/EULAR classification criteria for systemic sclerosis (SSc), due to the lack of sensitivity for early and limited SSc of the 1980 ACR classification criteria.
The aim of this study was to determine how many patients with Raynaud phenomenon are reclassified as SSc by the 2013 ACR/EULAR classification criteria for SSc and to analyze the predictive variables of the new classification criteria in those patients.
Methods:
We applied the 2013 ACR/EULAR classification criteria for SSc to 60 patients who had been diagnosed as SSc according to the 1980 ACR classification criteria (SSc group) and 64 patients who presented Raynaud phenomenon with or without autoimmune disease, but did not fulfill the 1980 ACR classification criteria (Raynaud phenomenon group). We analyzed the discrepancy between the previous and the new classification criteria when subjects were categorized as those with SSc.
Results:
All patients who were diagnosed as SSc according to the previous classifications criteria fulfilled the new criteria. Furthermore, 17 of 64 patients (26.5%) in Raynaud phenomenon group were reclassified as SSc by the new criteria. Reclassified SSc patients in Raynaud phenomenon group significantly showed less frequency of scleroderma, sclerodactyly, finger pitting scar, interstitial lung disease and higher frequency of telangiectasia than those in SSc group (Table 1). Eleven of 17 patients who were reclassified as SSc (64.7%) had anti-centromere antibody. But none of 17 patients had anti-topoisomerase 1, meanwhile 29 of 60 patients who had been diagnosed as SSc (43.8%) had anti-topoisomerase 1 (Table 1). On multivariate linear regression analysis using variables with significance, puffy finger, sclerodactyly and telangiectasia were significant predictive values for the new classification as SSc in Raynaud phenomenon (RR=23.7, 29.5, 14.2; p value=<0.001, 0.015, 0.031).
Conclusion :
26.5% patients, who presented Raynaud phenomenon but did not fulfill the 1980 ACR classification criteria for SSc, were reclassified as SSc according to the 2013 ACR/EULAR classification criteria. Also, we suggest that physicians should pay attention to puffy finger, sclerodactyly and telangiectasia in patients with Raynaud phenomenon for the early diagnosis of SSc.
Table 1. Comparison of characteristics, clinical manifestations and autoantibodies between reclassified systemic sclerosis patients in Raynaud phenomenon group (New SSc) and patients in systemic sclerosis group (SSc).
|
Variables |
New SSc (n=17) |
SSc (n=60) |
P value |
|
RP duration (years) |
3.4±2.4 |
9.6±6.7 |
<0.001 |
|
Disease duration (years) |
1.25±1.25 |
6.4±5.8 |
<0.001 |
|
2013 ACR/EULAR score |
10.8±1.8 |
19.1±5.2 |
<0.001 |
|
Scleroderma (N(%)) |
0 (0) |
40 (66.7) |
<0.001 |
|
Puffy finger (N(%)) |
12 (70.5) |
27 (45.0) |
0.062 |
|
Sclerodactyly (N(%)) |
6 (35.3) |
55 (91.6) |
<0.001 |
|
Digital tip ulcer (N(%)) |
2 (11.8) |
20 (33.3) |
NS |
|
Fingertip pitting scar (N(%)) |
0 (0) |
19 (31.7) |
0.008 |
|
Telangiectasia (N(%)) |
5 (29.4) |
5 (8.3) |
0.022 |
|
Abnormal nailfold capillaries (N(%)) |
17 (100) |
56 (93.3) |
NS |
|
Pulmonary artery hypertension (N(%)) |
1 (5.9) |
3 (5.0) |
NS |
|
Interstitial lung disease (N(%)) |
2 (11.8) |
29 (48.3) |
0.007 |
|
ANA (centromere) (N(%)) |
9 (52.9) |
12 (20.0) |
0.007 |
|
Anti-centromere (N(%)) |
11 (64.7) |
13 (21.7) |
0.001 |
|
Anti-topoisomerase 1 (N(%)) |
0 (0) |
29 (48.3) |
<0.001 |
Values given as n (%) or mean ± standard deviation. p values < 0.05
NS, not significant
Disclosure:
J. S. Park,
None;
H. J. Park,
None;
Y. J. Ha,
None;
Y. B. Park,
None;
S. K. Lee,
None;
S. W. Lee,
None.
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