Inflammatory Stays Inflammatory: A Subgroup of Systemic Sclerosis Characterized By High Morbidity and Inflammatory Resistance to Cyclophosphamide

Aleksey Mitev¹, Daria Feldmann¹, Moritz Binder², Kim Möller³, Anna-Maria Kanne¹, Thomas Hügle⁴, Peter M. Villiger⁵, Reinhard Voll⁶, Stephanie Finzel¹ and Florian Kollert⁷, ¹Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, ²Department of Internal Medicine, Mayo Clinic, Rochester, MN, ³Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom, ⁴Rheumatology, University Hospital Lausanne (CHUV), Lausanne, Switzerland, ⁵Rheumatology and Clin Immunol, Bern, Switzerland, ⁶Clinic for Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany, ⁷Department of Rheumatology, Immunology, and Allergology, Inselspital, University Hospital Bern, Bern, Switzerland

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: C Reactive Protein, Cardiovascular disease, cyclophosphamide, inflammation and systemic sclerosis

Session Information

Date: Sunday, October 21, 2018

Session Title: Systemic Sclerosis and Related Disorders – Clinical Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Elevated levels of C-reactive protein (CRP) in systemic sclerosis (SSc) have been linked to early inflammatory stages of the disease. This study has been set to investigate CRP levels in a longitudinal cohort of SSc patients and to correlate these findings with comorbidities and disease characteristics.

Methods: In this retrospective study patients with SSc were recruited from the outpatient clinic of the Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg. Only patients with at least three consecutive visits over at least one year were included in this study. CRP serum levels were measured at every visit and categorized as positive if CRP concentrations were ≥ 5mg/l. Subjects with elevated CRP levels at more than 80% of visits were defined as inflammatory SSc. The longitudinal CRP profile was correlated to comorbidities and disease characteristics.

Results: A total of 1,815 consecutive visits of 131 SSc patients were analyzed. Over the observed time span (91 [136-56] months) 18.3% (n=24) of patients had continuously elevated CRP levels (inflammatory SSc), whereas in 29% (n=38) CRP levels were always in the normal range. There was no association between disease duration and CRP levels at first visit (p>0.5). Inflammatory SSc was associated (p<0.05) with anti-topoisomerase I-antibodies, diffuse cutaneous SSc (dcSSC), pulmonary fibrosis, rheumatoid arthritis, and cardiac arrhythmia (p<0.05). Moreover, patients with inflammatory SSc revealed higher modified Rodnan skin scores (mRSS), and lower FCV, TLC, and DLCO (p<0.001). Even treatment with cyclophosphamide (CYC) did not alter CRP levels (n=12, median dose 4.5 g (3-10), median CRP before CYC 18.0 mg/l, after CYC 17.7 mg/l, p=0.754).

Conclusion: Inflammatory SSc is characterized by a more severe disease phenotype and high morbidity. Even treatment with CYC does not alter CRP levels in these patients.

Disclosure: A. Mitev, None; D. Feldmann, None; M. Binder, None; K. Möller, None; A. M. Kanne, None; T. Hügle, None; P. M. Villiger, None; R. Voll, None; S. Finzel, None; F. Kollert, None.

To cite this abstract in AMA style:

Mitev A, Feldmann D, Binder M, Möller K, Kanne AM, Hügle T, Villiger PM, Voll R, Finzel S, Kollert F. Inflammatory Stays Inflammatory: A Subgroup of Systemic Sclerosis Characterized By High Morbidity and Inflammatory Resistance to Cyclophosphamide [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/inflammatory-stays-inflammatory-a-subgroup-of-systemic-sclerosis-characterized-by-high-morbidity-and-inflammatory-resistance-to-cyclophosphamide/. Accessed March 28, 2023.

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