Systemic Sclerosis: More Severe in Men?

November 10, 2014

Systemic sclerosis is more common in women, but men seem to face a worse prognosis.

Elhai M, Avouac J, Walker UA, et al., A gender gap in primary and secondary heart dysfunctions in systemic sclerosis: a EUSTAR prospective study. Ann Rheum Dis (2014) 0:1–7. doi:10.1136/annrheumdis-2014-206386
 


Systemic sclerosis (SSc) is six times more common among women than among men, but men may have a worse prognosis, a large study reveals.  Men appear to have more severe disease and are more likely to have comorbid lung and heart dysfunction,

The study also finds that men are more likely to start out with active disease, diffuse cutaneous SSc with digital ulcers, and a risk of elevated creatine kinase.

The findings may point the way to sex-specific tailored treatments, with a focus on comorbidities, the researchers state.

They analyzed data from the large-scale European League Against Rheumatism Scleroderma Trials and Research (EUSTAR) cohort. 

They report that male sex is an independent risk factor for new onset pulmonary hypertension and cardiac dysfunction in SSc. Also, men have an almost two-fold greater risk of dying from SSc-related complications.

In contrast, the results show that at baseline women have more limited SSc, more frequent anticentromere antibody positivity, and more gastrointestinal involvement.

But the lack of sex-related differences in age of onset suggests that female hormones do not play a large role in SSc development.

The authors say their study is the first to demonstrate an independent association between male gender and pulmonary hypertension.