Background/Purpose: Lung involvement, including interstitial lung disease (ILD), is the leading cause of death in patients with systemic sclerosis (SSc). High resolution CT (HRCT) is the gold standard for diagnosing SSc-ILD as chest x-rays (CXR) are poorly sensitive for documenting the presence and extent of disease. As such, a CXR suggestive of ILD should warrant the completion of HRCT chest for further characterization. We explored a national patient registry of SSc patients to determine the proportion of patients who receive an HRCT after a CXR suggestive of fibrosis.

Methods: Longitudinal clinical data from patients in the registry collected and contributed by SSc experts between 2004-2018 was reviewed. We included patients at least 18 years of age, with a diagnosis of SSc, and with at least one CXR indicating fibrosis. We excluded patients who had previously known ILD or an abnormal HRCT prior to their first abnormal CXR. Of these patients, we determined the proportion of patients who underwent an HRCT within a year of CXR findings. Using SPSS, descriptive statistics characterized the population and analyses (Pearson’s chi-square and T-tests) determined whether there were differences in patient characteristics between those who did and did not receive an HRCT.

Results: Of 1698 SSc patients, we identified 223 who had a positive CXR with no previous abnormal HRCT; Mean (SD) age was 56.6 (12.2) years, 83.9% were female, and 38.1% of patients had diffuse systemic sclerosis. Average FVC and DLCO were 90.4% (SD 18.2%) and 68.8% (SD 23.1%) of predicted, respectively. Only 21.5% (48/223) underwent an HRCT within 12 months following their abnormal CXR. There were no significant group differences in age, sex, smoking history, co-morbidities, subset of disease, autoantibody profile, symptoms, or skin score between those who did and did not undergo an HRCT. Of the patients who had a HRCT, 83.3% had ≥1 abnormality reported.

Conclusion: A large proportion of SSc patients in this study whose CXR suggested fibrosis did not have a HRCT ordered within 1 year of the CXR, suggesting a care gap. A major limitation of this study is that we are unable to account for under-reporting of HRCTs as it may not be available at the time of CSRG data submission; we will examine for this by completing a comprehensive chart review of a smaller cohort of CSRG patients. Other next steps include exploring if HRCT ordering practices evolved over time and how this impacted the proportion of patients who did not undergo HRCT.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/care-gap-in-patients-with-systemic-sclerosis-with-cxr-findings-suggestive-of-fibrosis/