Risk and predictors of arterial hypertension in patients with systemic scleroderma
Background. Patients with inflammatory joint diseases, which include systemic scleroderma (SS), have increased cardiovascular disease risk compared with the general population. Arterial hypertension (AH) is a major modifiable risk factor contributing to increased cardiovascular disease risk in inflammatory joint diseases. The purpose of the study was to investigate the prognosis and predictors of AH development in patients with SS. Materials and methods. We have conducted a 5-year prospective observation of 73 patients, who were in the regional registry. The investigation of risk for AH development was performed using the Kaplan-Meier procedure. Calculations of predictors’ influence on the risk of AH were performed using Cox regression. Results. The 5-year risk of AH development in SS was 20.3 %. Estimated risk of AH on the first, third and fifth year of the disease is 18.2, 25.0 and 19.4 %, respectively. The resulting impact of the initial clinical and laboratory parameters on the risk of AH development (hazard ratio): age > 45 years — 2.04, diffuse scleroderma — 0.65, Raynaud phenomenon — 1,17, tightness of the skin of the hands — 1.74, arthritis — 0.99, pulmonary fibrosis — 1.84, anemia — 0.78, erythrocyte sedimentation rate (ESR) > 25 mm/h — 1.68, C-reactive protein (CRP) level > 5 mg/l — 1.52, rheumatoid factor (RF) > 14 IU/ml — 1,48, proteinuria — 1.09. Conclusions. The 5-year risk of AH in SS is 20.3 %. The strongest influence on the risk of AH development in SS showed: age > 43.7 years, the presence of the tightness of the skin of the hands, pulmonary fibrosis, ESR > 25 mm/h, CRP > 5 mg/l, RF > 14 IU/mL. AH in systemic scleroderma has a heterogeneous nature. In patients, who had AH at the onset of SS, in a five-year term, we can expect an increase in the occurrence of proteinuria and glomerular filtration rate decline.
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Agca R, Heslinga SC, Rollefstad S, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis 2016;0:1–12. doi:10.1136/annrheumdis-2016-209775
Simeon-Aznar CP, Fonollosa-Pla V, Carles Tolosa-Vilella, et al. Registry of the Spanish Network for Systemic Sclerosis. Survival, Prognostic Factors, and Causes of Death. Medicine (Baltimore). 2015 Oct;94(43):e1728. doi: 10.1097/MD.0000000000001728
Tyndall AJ, Bannert B, Vonk M. Causes and risk factors for death in systemic sclerosis: a study from the EULAR Scleroderma Trials and Research (EUSTAR) database. Ann Rheum Dis. 2010 Oct;69(10):1809-15. doi: 10.1136/ard.2009.114264. Epub 2010 Jun 15.
Arts EE, Popa C, den Broeder AA, et al. Performance of four current risk algorithms in predicting cardiovascular events in patients with early rheumatoid arthritis. Ann Rheum Dis 2015;74:668–74. doi: 10.1136/annrheumdis-2013-204024
Gómez-Vaquero C, Corrales A, Zacarias A, et al. SCORE and REGICOR function charts underestimate the cardiovascular risk in Spanish patients with rheumatoid arthritis. Arthritis Res Ther 2013;15:R91. DOI: 10.1186/ar4271
Chung CP, Giles JT, Petri M, et al. Prevalence of traditional modifiable cardiovascular risk factors in patients with rheumatoid arthritis comparison with control subjects from the multi-ethnic study of atherosclerosis. Semin Arthritis Rheum 2012;41:535–44. doi: 10.1016/j.semarthrit.2011.07.004.
Protogerou AD, Panagiotakos DB, Zampeli E, et al. Arterial hypertension assessed “out-of-office” in a contemporary cohort of rheumatoid arthritis patients free of cardiovascular disease is characterized by high prevalence, low awareness, poor control and increased vascular damage-associated “white coat” phenomenon. Arthritis Res Ther 2013;15(5):R142. doi: 10.1186/ar4324
Baghdadi LR, Woodman RJ, Shanahan EM, et al. The impact of traditional cardiovascular risk factors on cardiovascular outcomes in patients with rheumatoid arthritis: a systematic review and meta-analysis. PLoS ONE 2015;10:e0117952. doi: 10.1371/journal.pone.0117952
Hunzelmann N, Genth E, Krieg T, et al The registry of the German Network for Systemic Scleroderma: frequency of disease subsets and patterns of organ involvement. Rheumatology 2008;47:1185–1192. doi:10.1093/rheumatology/ken179
Walker UA, Tyndall A, Czirja´k L, et al. Clinical risk assessment of organ manifestations in systemic sclerosis: a report from the EULAR cleroderma Trials And Research group database . Ann Rheum Dis 2007;66:754–763. doi: 10.1136/ard.2006.062901.
Masi AT, Rodnan GP, Medsger et al. Preliminary criteria for the classification of systemic sclerosis (scleroderma). Arthritis Rheum 1980;23:581-590.
Van den Hoogen, Khanna D, Fransen J et al. 2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative. Ann Rheum Dis. 2013 Nov;72(11):1747-55. doi: 10.1136/annrheumdis-2013-204424.
MOH of Ukraine from 12.10.2006 №676 “Clinical protocol for provision of medical care to patients with systemic sclerosis (SSc)” (2006) On approving the protocols of care, specialty "Rheumatology".
MOH of Ukraine from 24.05.2012 №384 «Hypertension. Updated and adapted evidence-based clinical guidelines"(2012).
MOH of Ukraine from 02.12.2004 p. №593 "Clinical protocol for provision of medical care to patients with nephrotic syndrome" (2004) On approving the protocols of care, specialty "Nephrology".
Hilde Tent, Femke Waanders, Jan A. Krikken et al. Performance of MDRD study and CKD-EPI equations for long-term follow-up of nondiabetic patients with chronic kidney disease. Nephrol Dial Transplant; 2011;0:1–7. doi: 10.1093/ndtj/gfr235.
Simeón-Aznar CP, Fonollosa-Plá V, Tolosa-Vilella C et al. Registry of the Spanish Network for Systemic Sclerosis: Clinical Pattern According to Cutaneous Subsets and Immunological Status. Semin Arthritis Rheum. 2012 Jun;41(6):789-800. doi: 10.1016/j.semarthrit.2011.10.004. Epub 2011 Dec 12.
Kuryata OV, Lysunets TK, Karavanska IL, Semenov VV. Risk of development and peculiarities of nefropathy in patients with systemic sclerosis. Ukrainian Journal of Rheumatology. 2015 3(61):17-23.
Yatsyshyn RI. Clinical and pathogenetic features of systemic sclerosis and its treatment: the dissertation thesis for the degree of Doctor of Medicine / Yatsyshyn Roman Ivanovich; Ivano-Frankivsk State Medical Academy. - Ivano-Frankivsk, 2003.
Shanmugam VK, Steen VD. Renal Manifestations in Scleroderma: Evidence for Subclinical Renal Disease as a Marker of Vasculopathy. Int J Rheumatol. 2010;2010. pii: 538589. doi: 10.1155/2010/538589. Epub 2010 Aug 17.
Sirenko O., Kuryata O., Semenov V., Lusynets T. Clinical features and nephropathy risk in patients with systemic sclerosis (based on 5-year follow-up). Journal of Scleroderma and Related Disorders. 2016 Vol.1(1); 132. doi: 10.5301/jsrd5000203.
Bryan C, Knight C, Black CM, Silman AJ. Prediction of five-year survival following presentation with scleroderma. Arthritis Rheum. 1999 Dec;42(12):2660-5. DOI:10.1002/1529-0131(199912)42:12<2660::AID-ANR23>3.0.CO;2-N.
Elhai M, Meune C, Avouac J, Kahan A, Allanore Y. Trends in mortality in patients with systemic sclerosis over 40 years: a systematic review and meta-analysis of cohort studies. Rheumatology (Oxford). 2012 Jun;51(6):1017-26. doi: 10.1093/rheumatology/ker269. Epub 2011 Sep 7.
Strickland G, Pauling J, Cavill C, Shaddick G, McHugh N. Mortality in systemic sclerosis-a single centre study from the UK. Clin Rheumatol. 2013 Oct;32(10):1533-9. doi: 10/.1007/s10067-013-2289-0. Epub 2013 Jun 29.
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