Multiple Comorbidities Can Have Big Impact on SSc Outcomes
In a cohort of 2000 patients with systemic sclerosis (SSc), 20% were found to have multimorbidity, primarily driven by cardiovascular disease and other important cardiovascular risk factors. The presence of multimorbidity was linked to reduced survival rates and impaired physical function.
METHODOLOGY:
Researchers aimed to determine the frequency and prognostic impact of multimorbidity in 2000 patients with SSc (median age at SSc onset , 47.4 years; 85.4% women) from the Australian Scleroderma Cohort Study.
Charlson Comorbidity Index (CCI) scores were calculated at each visit for all participants, with multimorbidity defined as having a CCI score of ≥ 4.
Health Assessment Questionnaire Disability Index scores were collected every year during study visits, whereas data on demographics, disease, and medication use were collected at each visit.
The median duration of SSc at recruitment was 7.1 years, and the median follow-up duration was 4.2 years.
TAKEAWAY:
During the follow-up period, multimorbidity was observed in 20.1% of participants at a median of 12 years after the onset of SSc; the key comorbidities were hypertension (80.5%), dyslipidemia (67.2%), obstructive lung disease (50.4%), malignancy (48.9%), and ischemic heart disease (40.1%).
The presence of multimorbidity increased the risk for death by 57% (hazard ratio [HR], 1.57; P < .01), with chronic kidney disease showing the strongest association with mortality (HR, 2.41; P < .01), followed by left ventricular dysfunction (HR, 1.76; P < .01).
< .01), with chronic kidney disease showing the strongest association with mortality (HR, 2.41; < .01), followed by left ventricular dysfunction (HR, 1.76; < .01). Having multimorbidity was also associated with poorer physical function ( P < .01), with peripheral vascular disease having the largest impact on physical function, followed by left ventricular dysfunction.
IN PRACTICE:
'These data suggest a role for aggressive management of comorbid cardiac and renal disease to potentially improve outcomes in SSc,' the authors wrote.
SOURCE:
This study was led by Jessica L. Fairley, MBBS, The University of Melbourne and St Vincent's Hospital Melbourne, both in Melbourne, Australia. It was published online on April 21, 2025, in ACR Open Rheumatology .
LIMITATIONS:
The CCI was modified for application to the database as not all variables were available for analysis, including depression, cellulitis, liver disease, peptic ulcer disease, hemiplegia, HIV/AIDS, and dementia. This likely resulted in underestimating the frequency of multimorbidity in the cohort. Additionally, the Australian Scleroderma Cohort Study exhibits a degree of survivor bias, where more severely ill individuals may not survive to recruitment.
DISCLOSURES:
The Australian Scleroderma Cohort Study was supported by Janssen, Boehringer Ingelheim, Scleroderma Australia, and other sources. Some authors reported receiving grants, payments, honoraria, consulting fees, and travel support from, and having other ties with various pharmaceutical companies including the funding agencies.
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