Abstract
ObjectivesTo assess the association of gender with clinical expression, health-related quality of life (HRQoL), disability, and self-reported symptoms of depression and anxiety in patients with systemic sclerosis (SSc).MethodsSSc patients fulfilling the American College of Rheumatology and/or the Leroy and Medsger criteria were assessed for clinical symptoms, disability, HRQoL, self-reported symptoms of depression and anxiety by specific measurement scales.ResultsOverall, 381 SSc patients (62 males) were included. Mean age and disease duration at the time of evaluation were 55.9 (13.3) and 9.5 (7.8) years, respectively. One-hundred-and-forty-nine (40.4%) patients had diffuse cutaneous SSc (dcSSc). On bivariate analysis, differences were observed between males and females for clinical symptoms and self-reported symptoms of depression and anxiety, however without reaching statistical significance. Indeed, a trend was found for higher body mass index (BMI) (25.0 [4.1] vs 23.0 [4.5], p = 0.013), more frequent dcSSc, echocardiography systolic pulmonary artery pressure >35 mmHg and interstitial lung disease in males than females (54.8% vs 37.2%, p = 0.010; 24.2% vs 10.5%, p = 0.003; and 54.8% vs 41.2%, p = 0.048, respectively), whereas calcinosis and self-reported anxiety symptoms tended to be more frequent in females than males (36.0% vs 21.4%, p = 0.036, and 62.3% vs 43.5%, p = 0.006, respectively). On multivariate analysis, BMI, echocardiography PAP>35 mmHg, and anxiety were the variables most closely associated with gender.ConclusionsIn SSc patients, male gender tends to be associated with diffuse disease and female gender with calcinosis and self-reported symptoms of anxiety. Disease-associated disability and HRQoL were similar in both groups.
Highlights
Systemic sclerosis (SSc) is a connective-tissue disease characterized by excessive collagen deposition in the dermis and internal organs, and by vascular hyper-reactivity and obliterative microvascular phenomena [1]
A cohort of 91 SSc patients (10% males) from Spain revealed clinical and immunological differences between the genders; arthralgias were more often encountered in females, whereas myositis and nucleolar antinuclear antibodies were more frequent in males [15]
Parameters recorded were age; sex; age at disease onset; disease duration; body mass index (BMI); disease subset; mouth opening; skin involvement; telangiectasia; Raynaud’s phenomenon; pitting scars; digital ulcers; calcinosis; gastrointestinal tract, joint and/or muscle involvement; dyspnoea; ILD; echocardiography systolic pulmonary artery pressure [PAP].35 mmHg); and renal crisis
Summary
Systemic sclerosis (SSc) is a connective-tissue disease characterized by excessive collagen deposition in the dermis and internal organs, and by vascular hyper-reactivity and obliterative microvascular phenomena [1]. Consistent with other auto-immune diseases, SSc is predominant among females, with a ratio of females to males of 1:1 to 14:1 [13], along with gender differences in disease activity and incidence. Such differences have been explained by genetic and hormonal factors and lifestyle [14,15]. A cohort of 91 SSc patients (10% males) from Spain revealed clinical and immunological differences between the genders; arthralgias were more often encountered in females, whereas myositis and nucleolar antinuclear antibodies were more frequent in males [15]. Hudson et al found that the time to diagnosis was longer for women than men after the onset of Raynaud’s phenomenon, and suggested that there may be possible biologic differences in the progression of disease or in the health care trajectories of men and women with early SSc [20]
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