Scleroderma renal crisis uncommon in Asians with systemic sclerosis
Scleroderma renal crisis (SRC) appears to be a rare complication in Thai patients with systemic sclerosis (SSc), but is associated with high mortality, according to a study. Digital gangrene, current prednisolone dose ≥15 mg/day, serum albumin <3 mg/dL and cardiac involvement are independently associated with SRC.
Researchers retrospectively examined the medical records of 608 SSc patients seen at the Division of Rheumatology, Chiang Mai University. Each SRC patient was matched by disease duration (±1 year) with four SSc patients without SRC.
A total of 19 patients developed SRC (63.2 percent with hypertensive renal crisis; 36.8 percent with normotensive renal crisis), yielding an SRC prevalence of 3.13 percent. The mean age was 56.2 years, and median disease duration was 5 months. Majority (89.5 percent) had diffuse cutaneous SSc. There were 15 patients (78.9 percent) who required dialysis and 10 (52.6 percent) who died.
Multivariate conditional logistic regression analysis found SRC to be independently associated with digital gangrene (adjusted odd ratio [AOR], 31.41; 95 percent CI, 1.16 to 852.23; p=0.041), current prednisolone dose ≥15 mg/day (AOR, 31.22; 1.59 to 613.85; p=0.024), serum albumin <3 mg/dL (AOR, 7.97; 1.49 to 42.56; p=0.015) and cardiac involvement (AOR, 6.62; 1.08 to 40.63; p=0.041).
SRC was a major cause of death in patients with SSc, with prevalence rates of 12 to 18 percent in Western countries, until the late 1970s. Since then, the development of angiotensin-converting enzyme inhibitors (ACEI) has greatly helped in improving outcomes in SRC, as well as reducing the frequency of SRC. However, while ACEI has shown efficacy in managing SRC, the morbidities and mortalities from SRC remain high. [Ann Rheum Dis 2007;66:940–4; Semin Arthritis Rheum 2015;44:687–94; Ann Rheum Dis 2010;69:1809–15]