Hispanic patients with systemic sclerosis have higher mortality rate, risk for lupus
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Key takeaways:
- Hispanic patients with SSc were also younger at baseline, with longer disease duration, compared with non-Hispanic white patients.
- Future research could focus on whether U1-RNP positivity is linked to human leukocyte antigen types.
Hispanic patients with systemic sclerosis are more likely to have concurrent systemic lupus erythematosus and U1-RNP positivity, and face greater mortality rates vs. non-Hispanic white patients, according to data.
“Reports suggest ethnical disparities among SSc patients, with potential influence on disease outcomes and survival rates,” Bochra Jandali, MD, of the McGovern Medical School at the University of Texas Health Science Center, and colleagues wrote in Arthritis Care & Research.
“The data regarding SSc characteristics and prognosis in Hispanic Americans are scarce,” they added. “... There are no reports of prospective cohort studies focusing on demographic and clinical characteristics of Hispanic American patients with SSc in comparison to other ethnic/racial groups.”
To assess disease manifestations among Hispanic American patients with SSc, compared with non-Hispanic Black and white patients, Jandali and colleagues performed a longitudinal analysis of data from the prospective, observational Genetics versus Environment in Scleroderma Outcome Study (GENISOS) cohort. The researchers included data from a total of 427 patients with SSc of fewer than 5 years duration. Among these patients, 124 (29%) were Hispanic, 220 (51.5%) were non-Hispanic white and 83 (19.5%) were non-Hispanic Black.
At baseline, 14% of Hispanic patients were U1-RNP positive, compared with 4.6% of non-Hispanic white patients (P = .003). Meanwhile, SLE was present in 4.1% of Hispanic patients and one non-Hispanic white patient (P = .023). Hispanic patients were also significantly younger overall, compared with non-Hispanic white patients, at enrollment — median age 46 vs. 51 years — and demonstrated longer disease duration — median duration 2.7 years vs. 2.1 years.
According to the researchers, Hispanic patients also had more restrictive lung disease and greater perceived disability vs. non-Hispanic white patients, with significantly lower levels of forced vital capacity (mean difference = –9.3%) and significantly higher scores on the modified Health Assessment Questionnaire (mean difference = 0.29). Over a median follow-up period of 3.8 years, Hispanic patients demonstrated greater risk for death than non-Hispanic white patients, regardless of age and gender (HR = 1.67; P = .015).
Meanwhile, Hispanic patients demonstrated more frequently limited cutaneous disease and anti-centromere antibodies, compared with non-Hispanic Black patients. Additionally, Hispanic patients had lower Rodnan Skin Scores than non-Hispanic Black patients (point estimate = –3.2; P = .029).
Future research should focus on whether the link to U1-RNP positivity among Hispanic patients could be associated with “certain more common [human leukocyte antigen] types” in patients with SSc, a question for which no data currently exists, the researchers wrote.
“Our results may support screening for [SLE] features in Hispanic patients with SSc,” Jandali and colleagues wrote. “We believe that understanding disease characteristics and its disparities based on ethnicity, sex, [and] geographic distribution is a critical and important step to provide the best care for SSc patients.”
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